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A comparison of effectiveness among frequent treatments of recurrent spontaneous abortion: A Bayesian network meta‐analysis
Author(s) -
Lv Sha,
Yu Jing,
Xu Xiaoxiao
Publication year - 2018
Publication title -
american journal of reproductive immunology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.071
H-Index - 97
eISSN - 1600-0897
pISSN - 1046-7408
DOI - 10.1111/aji.12856
Subject(s) - medicine , live birth , placebo , abortion , low molecular weight heparin , antiphospholipid syndrome , pregnancy , subgroup analysis , thrombophilia , funnel plot , randomized controlled trial , publication bias , obstetrics , heparin , meta analysis , thrombosis , genetics , alternative medicine , pathology , biology
Objective A comprehensive network meta‐analysis was designed to clarify contradictions and offer valuable clinical guidance in the treatment of recurrent spontaneous abortion ( RSA ). Method The included clinical trials were selected from the relevant medical journal databases and screened. Treatments were ranked by the surface under the cumulative ranking curve. Heat plots were constructed to analyze the inconsistency between direct data and network results, and adjusted funnel plots were constructed to assess publication bias. Results Forty‐nine randomized controlled trials involving a total of 8496 RSA patients were selected. With placebo as control, corticosteroid plus low dose aspirin ( LDA ) plus unfractionated heparin ( UFH ), granulocyte colony‐stimulating factor (G‐ CSF ) alone, and LDA plus low molecular weight heparin ( LMWH ) all demonstrated effectiveness in increasing successful live birth rates and reducing the incidences of miscarriage. However, no treatment was demonstrably superior to placebo in terms of pregnancy success. For all 3 endpoints (live birth, abortion and success pregnancy), the adjusted funnel plots were symmetric to zero and indicated no publication bias. In terms of live birth and abortion rates, no treatment outperformed placebo in patients with antiphospholipid syndrome. Conclusion In consideration of live birth and abortion rates, corticosteroid plus LDA plus UFH appeared to be the optimum treatment strategy; G‐ CSF was second, followed by LDA with LMWH , LDA plus LMWH plus intravenous immunoglobulin, corticosteroid with LDA and others. Subgroup analysis demonstrated no benefit of antithrombotic therapy in patients with antiphospholipid syndrome.