Hepatic Sinusoidal Obstruction Syndrome/Veno-Occlusive Disease (SOS/VOD) Primary Prophylaxis in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Network Meta-Analysis of Randomized Controlled Trials
Sousa-Pimenta M, Martins Â, Estevinho LM, Pinho Vaz C, Leite L, Mariz J (2024) · Journal of Clinical Medicine · n=0
Характеристика исследования
- Дизайн
- first network meta-analysis comparing primary prophylactic strategies against SOS/VOD in HSCT recipients (pairwise and consistent network structure)
- Размер выборки (n)
- —
- Вмешательство
- Ursodeoxycholic acid (UDCA), defibrotide, fresh frozen plasma, heparin, and other prophylactic agents against SOS/VOD
- Компаратор
- Placebo or no prophylaxis (and pairwise between active agents)
- Первичная конечная точка
- Incidence of SOS/VOD with primary prophylaxis vs no prophylaxis or alternative
- Основной результат
- UDCA OR 0.38 (95% CI 0.14-1.06, SUCRA 0.720) - lower SOS/VOD incidence in all HSCT recipients; defibrotide OR 0.64 (95% CI 0.23-1.67, SUCRA 0.486); in allotransplantation subgroup defibrotide OR 0.51 (SUCRA 0.650) similar to UDCA
- Длительность наблюдения
- 100 days post-HSCT
- PMID
- 39598060
Ключевые выводы
- First network meta-analysis of SOS/VOD prophylaxis strategies
- UDCA emerges as most consistently effective prophylactic agent
- Defibrotide competitive in allotransplant subgroup (SUCRA 0.650)
- Pairwise comparisons supplemented with consistent network structure
- Demonstrates utility of network meta-analysis for orphan complications
Ограничения
- Limited number of RCTs to include
- Heterogeneous patient populations across trials
- Variable SOS/VOD diagnostic criteria
- Network inconsistency possible
- Not applicable to whole-leech hirudotherapy
Клиническое значение
Sousa-Pimenta 2024 introduces network meta-analytic synthesis to the SOS/VOD prophylaxis evidence base. For ASH, this work demonstrates how methodologically advanced syntheses can rank competing pharmacologic strategies, distinct from the K040187 device-leech US clinical practice where comparative effectiveness research uses simpler study designs.
Связанные исследования
Defibrotide for prophylaxis of sinusoidal obstruction syndrome/veno-occlusive disease (SOS/VOD) in pediatric high-risk patients: consensus guidelines from the European Society for Blood and Marrow Transplantation (EBMT)
Corbacioglu S, Bajwa R, Antmen AB, Balduzzi A, Boelens JJ, Bonifazi F, Cesaro S, Ciceri F, Colecchia A, Dignan F, Kleinschmidt K, Mahadeo KM, Pagliuca A, Sedlacek P, Shaw PJ, Stein J, Szmit Z, Tambaro F, Ince E, Verna M, Yesilipek A, Zecca M, Richardson PG, Mohty M, Kalwak K (2026)
Burden of illness of non-hematopoietic stem cell transplant-related hepatic sinusoidal obstruction syndrome: A systematic review
Fan L, Stewart F, Ruiz K, Devani D, Fusco N, Gill M, Amber V, Su W, Gangi A, Hanvesakul R (2024)
Impact of Oral Eicosapentaenoic Acid on Veno-Occlusive Disease/Sinusoidal Obstruction Syndrome Onset Prevention: Single-Center Retrospective Analysis
Miyazaki Y, Narumi H, Azuma T, Tanimoto K, Masuda Y, Kato J, Konishi T, Nabe S, Maruta M, Ochi T, Yamanouchi J, Takenaka K (2025)