特利加压素治疗肝硬化食管胃静脉曲张出血的 快速卫生技术评估.

OBJECTIVE: To conduct rapid health technology assessment ( HTA) on the efficacy, safety and economical efficiency of terlipressin in the treatment of cirrhotic esophagogastric variceal bleeding (EVB), so as to provide evidence-based evidence for clinical drug selection. METHODS: HTA reports, systematic review / Metaanalysis and pharmacoeconomic research on terlipressin in the treatment of cirrhotic EVB were enrolled by retrieving CNKI, Wanfang Data, PubMed and the Cochrane Library ( the retrieval period was from the establishment of the database to Dec. 2021 ), and HTA website ( the search time was up to Jan. 7th, 2022 ). Two researchers independently screened the literature and extracted data information. After quality evaluation of the included literature, descriptive analysis and classification evaluation of the extracted results were carried out. RESULTS: A total of one HTA report, seven systematic review / Meta analysis and four pharmacoeconomic researches were included. In terms of effectiveness, compared with placebo, terpressin significantly improved the early bleeding control rate (OR = 0. 47, 95%CI = 0. 32-0. 70,P = 0. 000 14) and reduced mortality (RR = 0. 66,95% CI = 0. 49-0. 88,P = 0. 004 2), with statistically significant differences. Compared with other vasopressin, somatostatin and octreotide, terlipressin had no obvious advantage. In terms of safety, the incidence of adverse drug reactions of terlipressin was significantly lower than vasopressin, with statistically significant differences (OR = 0. 15,95%CI = 0. 03-0. 78,P = 0. 02). There was no significant difference between terlipressin and octreotide in the incidence of adverse drug reactions, incidence of death caused by adverse events and incidence of drug withdrawal caused by adverse events (P > 0. 05). Compared with somatostatin, terlipressin had higher incidence of adverse drug reactions, and the difference was statistically significant (OR = 2. 44,95%CI = 1. 03-5. 80,P = 0. 04), yet there was no statistically significant difference in the incidence of death caused by adverse events and incidence of drug withdrawal caused by adverse events (P> 0. 05). Results of three economics studies from China, the United Kingdom and Belgium showed that terlipressin has some cost advantages over somatostatin and octreotide, yet the reference value of the results of foreign studies was small. CONCLUSIONS: Terlipressin has significant efficacy and safety in the treatment of cirrhotic EVB, it is necessary to carry out further economic evaluation in China. [ABSTRACT FROM AUTHOR]