【作者】 唐惠林； 门鹏； 翟所迪；

【Author】 Tang Huilin;Men Peng;Zhai Suodi;Department of Pharmacy,Peking University Third Hospital;

【机构】 北京大学第三医院药剂科；

【摘要】 目的:快速评估司维拉姆治疗透析患者高磷血症的有效性、安全性和经济性。方法:计算机检索Pubmed、Embase、The Cochrane Library和专业卫生技术评估数据库收集司维拉姆治疗透析患者高磷血症的卫生技术评估报告、系统评价/meta分析和经济学评价。按照纳入排除标准筛选文献、提取资料和评价质量,对研究结果进行全面分析后得出结论。结果:共纳入22项研究,其中5项卫生技术评估报告、7项系统评价/meta分析和10项经济学评价。结果显示司维拉姆可有效控制血磷水平,但不增加血钙水平和高钙血症的风险。此外,Meta分析显示司维拉姆可延缓血管钙化,并可能降低死亡率。司维拉姆可增加血清全段甲状旁腺激素,同时还可降低总胆固醇、低密度脂蛋白胆固醇、碳酸氢盐及C反应蛋白水平。国内外的经济学研究显示,与碳酸钙相比,司维拉姆用于透析患者具有成本效果优势。国内的经济学研究显示,与碳酸镧相比,司维拉姆更具有成本效果优势,并可作为含钙磷结合剂的替代治疗。结论:基于目前可获得的证据支持司维拉姆用于透析患者高磷血症的治疗。更多还原

【Abstract】 Objective: To rapidly assess the efficacy, safety and economics of sevelamer in treating dialysis patients with hyperphosphatemia. Methods: Electronic databases including Pubmed, Embase, the Cochrane Library, and relevant health technology assessment databases were systematically searched to collected the health technology assessment report, systematic review/meta-analysis, and economic analysis that evaluate the sevelamer in treating dialysis patients with hyperphosphatemia. We selected studies according to inclusion and exclusion criteria, extracted data, assess the quality, and then made the conclusions after comprehensive analysis for the evidences. Results: 22 studies were selected, including 5 health technology assessment reports, 7 systematic reviews/meta-analyses, and 10 economic analyses. The results showed that sevelamer was efficient in controlling serum phosphorus levels, without increasing the serum calcium levels and risk of hypercalcemia. Furthermore, sevelamer may slow the progression of vascular calcification and reduce the mortality. Sevelamer also increases serum intact parathyroid hormone levels, and decreases total cholesterol, LDL-cholesterol, serum bicarbonate, and C-reactive protein. The results from economic analyses from both China and abroad showed that sevelamer was a cost-effective option in treating dialysis patients with hyperphosphatemia, compared with calcium-based phosphate binders. In China, sevelamer is likely to be a cost-saving option compared to lanthanum, and provides more efficacious alternatives than calcium-based phosphate binders. Conclusions: Current available evidences support use of sevelamer for treating dialysis patients with hyperphosphatemia.更多还原