RESUMO
Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. It affects multiple organ systems and is associated with significant morbidity and mortality. The treatment for SLE primarily aims at controlling and remitting the disease. Baricitinib is a kinase inhibitor that selectively inhibits JAK1 and JAK2 enzymes. Recently this drug is being investigated as a potential therapeutic option for SLE. Objective: To analyze the efficacy of baricitinib in treating SLE. Methods: Search of databases identified relevant studies that reported the efficacy of baricitinib. Data of patient characteristics, intervention details, and outcomes was extracted. The data from the studies were pooled using a random-effects model. The odds ratio with their respective 95 % confidence intervals (CI) were calculated to analyze the results. A p value of <0.05 was considered statistically significant. Results: 3 RCTs were included in the analysis. 1849 patients were extracted from the included studies, most of the participants were females with a mean age of 43 years. The studies showed a significant effect of Baricitinib 4 mg in achieving SRI-4 [OR = 1.42 (95 % CI: 1.01, 2.00); p = 0.04]. There was no significant association of Baricitinib 2 mg in achieving SRI-4. Both dosages of the drug did not have any significant association in achieving LLDAS as compared to placebo. Serious adverse side effects were significantly associated with Bar 4 mg as compared to Bar 2 mg. Conclusion: Our meta-analysis suggests that baricitinib might be a potential treatment option for SLE. Further large-scale clinical trials are needed to confirm our findings. Potential side effects should also be considered while the administration of this drug.
RESUMO
BACKGROUND: Several studies were conducted over the years to find a significant association between non-surgical therapies such as Antithyroid Drug (ATD) Therapy and Radio-iodo therapy (RIT) with Graves' disease (GD) remission and relapse. However, these investigations did not have a specific focus on the age category of children and adolescents. Hence, this Research is performed to assess the association of non-surgical therapy (ATD and RIT) with Graves' disease (GD) remission and relapse in the children and adolescent population. DESIGN: A systematic review and meta-analysis of observational studies and clinical trials were carried out. METHODS: A systematic search of PubMed, EMBASE, and SCOPUS from their inception till April 2022 was performed for studies stating an association between ATD therapy and GD remission and relapse in participants 1-17 years old. The random-effects model was used in the meta-analysis to provide a pooled proportion of both primary outcomes. The quality and each study were assessed using the Newcastle Ottawa Scale (NOS). RESULT: From 6195 studies searched from the databases, only 16 relevant articles remained after a detailed evaluation. These studies, having a total of 2557 patients aged 5-17 years, were involved in the analysis with a pooled estimate showing a significant association of ATD therapy with GD remission (Estimate: 0.400, 95% Confidence interval: 0.265-0.535; I^2 = 98.16%) and with GD relapse (Estimate: 0.359, 95% Confidence interval: 0.257-0.461; I^2 = 98.26%). Subgroup analyses were conducted to assess the remission rate of different therapies suggesting that antithyroid drugs play a significant role in the remission of the patients. All included studies were classified as moderate quality. CONCLUSION: Following meta-analysis suggested that the ATD used in the analysis is effective in remitting GD in the children and adolescents population. Nevertheless, long-term RIT therapy and thyroidectomy leads to hypothyroidism. Still, large-sample, and high-quality studies targeting ATDs' use in children and adolescents with long-term surveillance of prognosis are needed.
