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首页> 外文期刊>The Journal of Allergy and Clinical Immunology >Safety risks for patients with aspirin-exacerbated respiratory disease after acute exposure to selective nonsteroidal anti-inflammatory drugs and COX-2 inhibitors: Meta-analysis of controlled clinical trials
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Safety risks for patients with aspirin-exacerbated respiratory disease after acute exposure to selective nonsteroidal anti-inflammatory drugs and COX-2 inhibitors: Meta-analysis of controlled clinical trials

机译：急性暴露于选择性非甾体抗炎药和COX-2抑制剂后阿司匹林加重呼吸道疾病患者的安全风险：对照临床试验的荟萃分析

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Background Nonsteroidal anti-inflammatory drugs (NSAIDs) cause bronchospasm in susceptible patients with asthma, often termed aspirin-exacerbated respiratory disease (AERD), with the risk being greatest after acute exposure. Selective NSAIDs that preferentially inhibit COX-2 might be safer. Objective We sought to systematically evaluate changes in symptoms and pulmonary function after acute selective NSAID or COX-2 inhibitor exposure in patients with the AERD phenotype. Methods A systematic review of databases was performed to identify all blinded, placebo-controlled clinical trials evaluating acute selective NSAID or COX-2 inhibitor exposure in patients with AERD. Effect estimates for changes in respiratory function and symptoms were pooled by using fixed-effects meta-analysis, with heterogeneity investigated. Results No significant difference in respiratory symptoms (risk difference, -0.01; 95% CI, -0.03 to 0.01; P =.57), decrease in FEV1 of 20% or greater (RD, 0.00; 95% CI, -0.02 to 0.02; P =.77), or nasal symptoms (RD, -0.01; 95% CI, -0.04 to 0.02; P =.42) occurred with COX-2 inhibitors (eg, celecoxib). Selective NSAID exposure caused respiratory symptoms in approximately 1 in 13 patients with AERD (RD, 0.08; 95% CI, 0.02 to 0.14; P =.01). No significant differences were found according to leukotriene antagonist exposure or whether NSAIDs were randomly allocated. Conclusion According to clinical trial evidence in patients with stable mild-to-moderate asthma with AERD, acute exposure to COX-2 inhibitors is safe, and selective NSAIDs exhibit a small risk. Thus COX-2 inhibitors could be used in patients with AERD or in patients with general asthma unwilling to risk nonselective NSAID exposure when oral challenge tests are unavailable.
机译：背景非甾体类抗炎药（NSAIDs）在易感性哮喘患者（通常称为阿司匹林加重性呼吸道疾病（AERD））中引起支气管痉挛，在急性暴露后风险最大。优先抑制COX-2的选择性NSAID可能更安全。目的我们试图系统评价AERD表型患者急性选择性NSAID或COX-2抑制剂暴露后症状和肺功能的变化。方法对数据库进行系统评价，以鉴定所有盲法，安慰剂对照的临床试验，以评估AERD患者的急性选择性NSAID或COX-2抑制剂暴露。通过使用固定效果荟萃分析汇总呼吸功能和症状变化的效果估计值，并研究异质性。结果呼吸道症状无显着差异（风险差异-0.01; 95％CI，-0.03至0.01; P = .57），FEV1降低20％或更高（RD，0.00; 95％CI，-0.02至0.02 ; P = .77）或鼻症状（RD，-0.01; 95％CI，-0.04至0.02; P = .42）出现于COX-2抑制剂（例如塞来昔布）。选择性NSAID暴露导致13例AERD患者中约有1例出现呼吸道症状（RD，0.08; 95％CI，0.02至0.14; P = 0.01）。根据白三烯拮抗剂暴露量或是否随机分配NSAID，未发现显着差异。结论根据临床试验证据，在患有AERD的轻度至中度哮喘稳定患者中，急性暴露于COX-2抑制剂是安全的，选择性NSAIDs的风险较小。因此，在无法进行口服攻击试验时，COX-2抑制剂可用于AERD患者或不愿冒非选择性NSAID暴露风险的普通哮喘患者。

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