Comparative efficacy and safety of treatments for secondary Raynaud's phenomenon: a systematic review and network meta-analysis of randomised trials

摘要: Summary Background Several pharmacological treatments are available for secondary Raynaud's phenomenon, but there is uncertainty regarding the best options. We aimed to assess and compare benefits harms of phenomenon. Method did a systematic review network meta-analysis randomised controlled trials (RCTs) treatments. searched reviews published in MEDLINE Cochrane Database Systematic Reviews up Jan 31, 2017, RCTs from inception Sept 24, 2019 MEDLINE, Embase, ClinicalTrials.gov . included double-blind (parallel or crossover) that compared two more placebo patients with Individual patient data were obtained one unpublished RCT. Three researchers independently screened texts extracted data. Efficacy outcomes severity (on ten-point scale), daily frequency, mean duration phenomenon attacks. also examined tolerability acceptability. Pairwise meta-analyses Bayesian random-effects used synthesise This study registered PROSPERO (CRD42017057518). Findings 58 analysis, comprising 3867 (3540 [91·5%] phenomenon) 15 classes drugs. Phosphodiesterase 5 (PDE5) inhibitors effective than frequency (mean difference −0·36 [95% credibility interval −0·69 −0·04]), (–0·34 [−0·66 −0·03]), (–3·42 [−6·62 −0·29]) attacks (low moderate level evidence). Calcium channel blockers (CCBs) superior (–0·35 [−0·67 −0·02]) (–0·84 [−1·25 −0·45]) For attacks, selective serotonin-reuptake (–1·54 [−2·68 −0·41]; very low evidence) oral prostacyclin receptor agonists (–0·48 [−0·80 −0·16]; placebo. No other drug significantly regard efficacy outcomes. Compared placebo, was lower PDE5 (incidence rate ratio serious adverse events early exit due 3·30 CrI 1·49 7·55]) CCBs (3·13 [1·33 7·04]). all outcomes, global heterogeneity between-study variance ranged (I2=0% τ2=0·0 attack duration) (I2=41% τ2=0·2 tolerability). The overall risk bias judged be 22 (38%), high ten (17%), unclear 26 (45%) RCTs. Interpretation most options, albeit evidence. Current evidence does not support use any Funding None.