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만성골수성백혈병 치료제의 효과: 메타분석

The Effect of Treatment for Chronic Myeloid Leukemia: Meta- Analysis

유기연
한국병원약사회 (The Korean Society of Health-System Pharmacists)|2013.08|병원약사회지 (Journal of Korean Society of Health-System Pharmacists)|제30권 제4호|pp. 304-319|DOI 10.32429/jkshp.2013.30.4.002

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키워드

ImatinibChronic myeloid leukemiaDasatinibTyrosine kinase inhibitorsNilotinib

초록

Chronic myeloid leukemia (CML) is one of the myeloproliferative disorders which is associated with the Philadelphia chromosome t(9;22)(q34;q11) resulting in a BCR-ABL gene. This abnormal gene produces a specific product BCR-ABL tyrosine kinase. Therefore, tyrosine kinase inhibitors (TKIs) could be used for long term controls of CML progression for most patients, and these have good tolerance and low adverse drug reaction rates. The present study was performed to evaluate the efficacy and safety of imatinib, dasatinib, and nilotinib as a first, second, third line therapy for CML. This meta-analysis was taken on August 31st 2012, the Medline and Embase searches were used to access the appropriate studies. Twenty-six studies, which suggested the cytogenetic, hematologic and molecular responses, were selected for this analysis. Dasatinib (0.839, 95% CI: 0.790-0.878) and nilotinib (0.797, 95% CI: 0.749-0.838) were analyzed as to having superior cytogenetic responses for patients of newly diagnosed CML-CP (chronic phase) when compared to imatinib (0.676, 95% CI: 0.749-0.838). The ADR, however were less shown in the imatinib group as compared to the second generation TKIs. For imatinib resistant or intolerant patients, the dasatinib 100 mg qd (CCgR 95% CI: 0.474-0.597, CHR 95% CI: 0.877-0.953, MMolR 95% CI: 0.253-0.376) were analyzed with the most suitable therapy option as compared to dasatinib 70 mg (CCgR 95% CI: 0.372-0.429, CHR 95% CI: 0.489-0.561, MMolR 95% CI: 0.274-0.410) or nilotinib 400 mg bid (CCgR 95% CI: 0.324-0.382, CHR 95% CI: 0.587-0.673, MMolR 95% CI: 0.220-0.289). In the third line therapy for CML, there are no significant differences between dasatinib 70 mg bid and nilotinib 400 mg bid groups.

Abstract

Chronic myeloid leukemia (CML) is one of the myeloproliferative disorders which is associated with the Philadelphia chromosome t(9;22)(q34;q11) resulting in a BCR-ABL gene. This abnormal gene produces a specific product BCR-ABL tyrosine kinase. Therefore, tyrosine kinase inhibitors (TKIs) could be used for long term controls of CML progression for most patients, and these have good tolerance and low adverse drug reaction rates. The present study was performed to evaluate the efficacy and safety of imatinib, dasatinib, and nilotinib as a first, second, third line therapy for CML. This meta-analysis was taken on August 31st 2012, the Medline and Embase searches were used to access the appropriate studies. Twenty-six studies, which suggested the cytogenetic, hematologic and molecular responses, were selected for this analysis. Dasatinib (0.839, 95% CI: 0.790-0.878) and nilotinib (0.797, 95% CI: 0.749-0.838) were analyzed as to having superior cytogenetic responses for patients of newly diagnosed CML-CP (chronic phase) when compared to imatinib (0.676, 95% CI: 0.749-0.838). The ADR, however were less shown in the imatinib group as compared to the second generation TKIs. For imatinib resistant or intolerant patients, the dasatinib 100 mg qd (CCgR 95% CI: 0.474-0.597, CHR 95% CI: 0.877-0.953, MMolR 95% CI: 0.253-0.376) were analyzed with the most suitable therapy option as compared to dasatinib 70 mg (CCgR 95% CI: 0.372-0.429, CHR 95% CI: 0.489-0.561, MMolR 95% CI: 0.274-0.410) or nilotinib 400 mg bid (CCgR 95% CI: 0.324-0.382, CHR 95% CI: 0.587-0.673, MMolR 95% CI: 0.220-0.289). In the third line therapy for CML, there are no significant differences between dasatinib 70 mg bid and nilotinib 400 mg bid groups.

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