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Bernuy-Guevara C, Chehade H, Muller YD, Vionnet J, Cachat F, Guzzo G, Ochoa-Sangrador C, Álvarez FJ, Teta D, Martín-García D, Adler M, de Paz FJ, Lizaraso-Soto F, Pascual M, Herrera-Gómez F. The Inhibition of Complement System in Formal and Emerging Indications: Results from Parallel One-Stage Pairwise and Network Meta-Analyses of Clinical Trials and Real-Life Data Studies. Biomedicines 2020; 8:biomedicines8090355. [PMID: 32948059 PMCID: PMC7554929 DOI: 10.3390/biomedicines8090355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/12/2020] [Accepted: 09/13/2020] [Indexed: 12/15/2022] Open
Abstract
This manuscript presents quantitative findings on the actual effectiveness of terminal complement component 5 (C5) inhibitors and complement component 1 (C1) esterase inhibitors through their formal and common “off-label” (compassionate) indications. The results emanated from pairwise and network meta-analyses to present evidence until September 2019. Clinical trials (CT) and real-life non-randomized studies of the effects of interventions (NRSI) are consistent on the benefits of C5 inhibitors and of the absence of effects of C1 esterase inhibitors (n = 7484): Mathematically, eculizumab (surface under the cumulative ranking area (SUCRA) >0.6) and ravulizumab (SUCRA ≥ 0.7) were similar in terms of their protective effect on hemolysis in paroxysmal nocturnal hemoglobinuria (PNH), thrombotic microangiopathy (TMA) in atypical hemolytic uremic syndrome (aHUS), and acute kidney injury (AKI) in aHUS, in comparison to pre-/off-treatment state and/or placebo (SUCRA < 0.01), and eculizumab was efficacious on thrombotic events in PNH (odds ratio (OR)/95% confidence interval (95% CI) in CT and real-life NRSI, 0.07/0.03 to 0.19, 0.24/0.17 to 0.33) and chronic kidney disease (CKD) occurrence/progression in PNH (0.31/0.10 to 0.97, 0.66/0.44 to 0.98). In addition, meta-analysis on clinical trials shows that eculizumab mitigates a refractory generalized myasthenia gravis (rgMG) crisis (0.29/0.13 to 0.61) and prevents new acute antibody-mediated rejection (AMR) episodes in kidney transplant recipients (0.25/0.13 to 0.49). The update of findings from this meta-analysis will be useful to promote a better use of complement inhibitors, and to achieve personalization of treatments with this class of drugs.
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Affiliation(s)
- Coralina Bernuy-Guevara
- Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain; (C.B.-G.); (F.J.Á.); (F.J.d.P.); (F.L.-S.)
| | - Hassib Chehade
- Pediatric Nephrology Unit, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (H.C.); (F.C.)
| | - Yannick D. Muller
- Transplantation Center, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (Y.D.M.); (J.V.); (G.G.); (M.P.)
| | - Julien Vionnet
- Transplantation Center, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (Y.D.M.); (J.V.); (G.G.); (M.P.)
- King’s College London, London WC2R 2LS, UK
| | - François Cachat
- Pediatric Nephrology Unit, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (H.C.); (F.C.)
| | - Gabriella Guzzo
- Transplantation Center, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (Y.D.M.); (J.V.); (G.G.); (M.P.)
| | | | - F. Javier Álvarez
- Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain; (C.B.-G.); (F.J.Á.); (F.J.d.P.); (F.L.-S.)
- Ethics Committee of Drug Research–east Valladolid area, University Clinical Hospital of Valladolid, 47005 Valladolid, Spain
| | - Daniel Teta
- Department of Nephrology, Hôpital du Valais, 1950 Sion, Switzerland;
| | - Débora Martín-García
- Clinical Nephrology Unit, University Clinical Hospital of Valladolid, 47003 Valladolid, Spain;
| | - Marcel Adler
- Center for Medical Oncology & Hematology, Hospital Thun, 3600 Thun, Switzerland;
| | - Félix J. de Paz
- Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain; (C.B.-G.); (F.J.Á.); (F.J.d.P.); (F.L.-S.)
| | - Frank Lizaraso-Soto
- Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain; (C.B.-G.); (F.J.Á.); (F.J.d.P.); (F.L.-S.)
- Centro de Investigación en Salud Pública, Instituto de Investigación de la Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15024, Peru
| | - Manuel Pascual
- Transplantation Center, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (Y.D.M.); (J.V.); (G.G.); (M.P.)
| | - Francisco Herrera-Gómez
- Pharmacological Big Data Laboratory, University of Valladolid, 47005 Valladolid, Spain; (C.B.-G.); (F.J.Á.); (F.J.d.P.); (F.L.-S.)
- Transplantation Center, Lausanne University Hospital and University of Lausanne, 1100 Lausanne, Switzerland; (Y.D.M.); (J.V.); (G.G.); (M.P.)
- Centro de Investigación en Salud Pública, Instituto de Investigación de la Facultad de Medicina Humana, Universidad de San Martín de Porres, Lima 15024, Peru
- Department of Nephrology, Hospital Virgen de la Concha, 49022 Zamora, Spain
- Castile and León’s Research Consolidated Unit n° 299, 47011 Valladolid, Spain
- Correspondence: ; Tel.: +34-983-423077
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