1
急速進行性腎炎症候群 RPGN
メタ解析の結果:フォレストプロット一覧
1001010.1IVCYの方が死亡率が低い POCYの方が死亡率が低い
0.01
Risk Ratio
199719982009
073
23270
76 7
103 96
60
13
03
4
7
IVCYEvents Total Events Total Weight
POCY
42.8%
57.2% 0.57[0.18,1.77]Not estimable
0.41[0.11,1.53]
0.49[0.21,1.17]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or Subgroup
Haubitz M 1998Guillevin L 1997
de Groot 2009
Test for overall effect; Z=1.60(P=0.11)Heterogeneity: Tau2= 0.00; Chi2=0.13, df=1(P=0.71); I2=0%
100.0%Total (95%CI)Total events
CQ1死亡(6カ月)
死亡(最終観察時)
1001010.1IVCYの方が死亡率が低い POCYの方が死亡率が低い
0.01
Risk Ratio
199719982009
2573
23272276 9
125 121
103
22
05
9
14
IVCYEvents Total Events Total Weight
POCY
30.3%3.9%
65.8% 0.77[0.38,1.56]0.16[0.01,2.96]0.53[0.19,1.52]
0.65[0.36,1.15]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or Subgroup
Haubitz M 1998Guillevin L 1997
de Groot 2009
Test for overall effect; Z=1.49(P=0.14)Heterogeneity: Tau2= 0.00; Chi2=1.33, df=2(P=0.52); I2=0%
100.0%Total (95%CI)Total events
腎死(6カ月)
1001010.1IVCYの方がESRDが少ない POCYの方がESRDが少ない
0.01
Risk Ratio
199719982009
073
23270
76 0
103 96
00
0
04
3
7
IVCYEvents Total Events Total Weight
POCY
50.1%
49.9% 5.00[0.33,110.43]Not estimable
8.65[0.47,157.87]
7.21[0.92,56.36]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or Subgroup
Haubitz M 1998Guillevin L 1997
de Groot 2009
Test for overall effect; Z=1.88(P=0.06)Heterogeneity: Tau2= 0.00; Chi2=0.03, df=1(P=0.86); I2=0%
100.0%Total (95%CI)Total events
腎死(最終観察時)
1001010.1IVCYの方がESRDが少ない POCYの方がESRDが少ない
0.01
Risk Ratio
199719982009
2573
23272276 1
125 121
14
6
85
3
16
IVCYEvents Total Events Total Weight
POCY
16.7%67.7%15.6% 2.56[0.28,22.92]
2.27[0.79,6.52]4.80[0.57,40.13]
2.62[1.10,6.25]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or Subgroup
Haubitz M 1998Guillevin L 1997
de Groot 2009
Test for overall effect; Z=2.18(P=0.03)Heterogeneity: Tau2= 0.00; Chi2=0.40, df=2(P=0.82); I2=0%
100.0%Total (95%CI)Total events
図 メタ解析の結果:フォレストプロット
2
エビデンスに基づく急速進行性腎炎症候群(RPGN)診療ガイドライン 2020 � � 急速進行性腎炎症候群 RPGN
図 メタ解析の結果:フォレストプロット(つづき 1)
重篤合併症(最終観察時)
1001010.1IVCYの方がSAEが少ない POCYの方がSAEが少ない
0.01
Risk Ratio
199719982009
073
23270
76 31
103 96
60
37
019
3
22
IVCYEvents Total Events Total Weight
POCY
87.8%
12.2% 0.43[0.12,1.52]Not estimable
0.59[0.37,0.94]
0.57[0.36,0.88]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or Subgroup
Haubitz M 1998Guillevin L 1997
de Groot 2009
Test for overall effect; Z=2.52(P=0.01)Heterogeneity: Tau2= 0.00; Chi2=0.22, df=1(P=0.64); I2=0%
100.0%Total (95%CI)Total events
1001010.1IVCYの方が重症感染症が少ない POCYの方が重症感染症が少ない
0.01
Risk Ratio
199719982009
2573
23272276 10
125 121
610
26
37
3
13
IVCYEvents Total Events Total Weight
POCY
45.9%29.1%24.1% 0.43[0.12,1.52]
0.37[0.11,1.08]0.57[0.27,1.57]
0.49[0.27,0.92]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or Subgroup
Haubitz M 1998Guillevin L 1997
de Groot 2009
Test for overall effect; Z=2.22(P=0.03)Heterogeneity: Tau2= 0.00; Chi2=0.89, df=2(P=0.64); I2=0%
100.0%Total (95%CI)Total events
重篤感染症(最終観察時)
寛解(最終観察時)
1001010.1IVCYの方が寛解率が低い POCYの方が寛解率が低い
0.01
Risk Ratio
199719982009
2573
23272276 54
125 121
1321
88
2161
18
100
IVCYEvents Total Events Total Weight
POCY
50.5%41.6%7.8% 1.18[0.75,1.84]
1.14[0.94,1.38]1.09[0.91,1.29]
1.11[0.98,1.26]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or Subgroup
Haubitz M 1998Guillevin L 1997
de Groot 2009
Test for overall effect; Z=1.69(P=0.09)Heterogeneity: Tau2= 0.00; Chi2=0.19, df=2(P=0.91); I2=0%
100.0%Total (95%CI)Total events
再燃(9カ月)
1001010.1IVCYの方が再燃率が低い POCYの方が再燃率が低い
0.01
Risk Ratio
199719982009
2573
002276 3
98 98
04
7
67
0
13
IVCYEvents Total Events Total Weight
POCY
42.4%57.6%
Not estimable1.70[0.55,5.27]2.24[0.60,8.34]
1.91[0.81,4.51]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or Subgroup
Haubitz M 1998Guillevin L 1997
de Groot 2009
Test for overall effect; Z=1.49(P=0.14)Heterogeneity: Tau2= 0.00; Chi2=0.10, df=1(P=0.75); I2=0%
100.0%Total (95%CI)Total events
再燃(最終観察時)
1001010.1IVCYの方が再燃率が低い POCYの方が再燃率が低い
0.01
Risk Ratio
199719982009
2573
23272276 6
125 121
36
15
813
16
37
IVCYEvents Total Events Total Weight
POCY
36.1%
26.3%37.6% 1.52[0.62,3.69]
4.54[1.51,13.66]
2.08[0.64,5.18]
2.27[1.24,4.17]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or Subgroup
Haubitz M 1998Guillevin L 1997
de Groot 2009
Test for overall effect; Z=2.64(P=0.008)Heterogeneity: Tau2= 0.05; Chi2=2.41, df=2(P=0.30); I2=17%
100.0%Total (95%CI)Total events
1001010.1RTXの方が死亡率が低い CYの方が死亡率が低い
0.01
Risk Ratio
20101133
33 11
1
1
6
6
RTXEvents Total Events Total Weight
CY
100.0% 2.00[0.27,14.84]
2.00[0.27,14.84]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or SubgroupJones 2010
Test for overall effect; Z=0.68(P=0.50)Heterogeneity: Not applicable
100.0%Total (95%CI)Total events
CQ2死亡(12カ月)
3
エビデンスに基づく急速進行性腎炎症候群(RPGN)診療ガイドライン 2020 � � 急速進行性腎炎症候群 RPGN
●
メタ解析の結果:フォレストプロット一覧
重篤感染症の発生(12カ月)
1001010.1RTXの方が重篤感染症発症率が低い CYの方が重篤感染症発症率が低い
0.01
Risk Ratio
20101133
611
2
2
6
33
RTXEvents Total Events Total Weight
CY
100.0% 1.00[0.24,4.25]
1.00[0.24,4.25]
YearM-H, Random, 95% CIStudy or SubgroupJones 2010
Test for overall effect; Z=0.00(P=1.00)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
死亡(18カ月)
1001010.1RTXの死亡率が低い CYの死亡率が低い
0.01
Risk Ratio
20152015
1133512
8
51
62
1
3
26
84
RTXEvents Total Events Total Weight
CY
47.9% 2.00[0.27,14.84]1.00[0.15,6.83]
1.39[0.35,5.58]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or SubgroupJones 2015Geetha 2015
Test for overall effect; Z=0.47(P=0.64)
52.1%
100.0%Total (95%CI)Total eventsHeterogeneity: Tau2= 0.00; Chi2=0.24, df=1(P=0.62); I2=0%
腎死(12カ月)
1001010.1RTXの方が腎死率が低い IVCYの方が腎死率が低い
0.01
Risk Ratio
20151133
111
0
0
1
33
RTXEvents Total Events Total Weight
CY
100.0% 1.06[0.05,24.27]
1.06[0.05,24.27]
YearM-H, Random, 95% CIStudy or SubgroupJones 2015
Test for overall effect; Z=0.04(P=0.97)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
腎死(18カ月)
1001010.1RTXの方が腎死率が低い IVCYの方が腎死率が低い
0.01
Risk Ratio
20151133 0
2 2
2
RTXEvents Total Events Total Weight
CY
50.8% 1.76[0.09,34.20]20155151 20 49.2% 0.20[0.01,4.07]
YearM-H, Random, 95% CIStudy or SubgroupJones 2015Geetha 2015
Heterogeneity: Tau2= 0.06; Chi2=1.03, df=1(P=0.31); I2=2%Test for overall effect; Z=0.46(P=0.64)
6284 0.60[0.07,5.13]100.0%Total (95%CI)Total events
Risk RatioM-H, Random, 95% CI
腎死(24カ月)
1001010.1RTXの方が腎死率が低い IVCYの方が腎死率が低い
0.01
Risk Ratio
20151133
211
0
0
2
33
RTXEvents Total Events Total Weight
CY
100.0% 1.76[0.09,34.20]
1.76[0.09,34.20]
YearM-H, Random, 95% CIStudy or SubgroupJones 2015
Test for overall effect; Z=0.38(P=0.71)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
死亡(24カ月)
1001010.1RTXが死亡率が低い CYが死亡率が低い
0.01
Risk Ratio
20151133
611
3
3
6
33
RTXEvents Total Events Total Weight
CY
100.0% 0.67[0.20,2.23]
0.67[0.20,2.23]
YearM-H, Random, 95% CIRisk Ratio
M-H, Random, 95% CIStudy or SubgroupJones 2015
Test for overall effect; Z=0.66(P=0.51)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
図 メタ解析の結果:フォレストプロット(つづき 2)
4
エビデンスに基づく急速進行性腎炎症候群(RPGN)診療ガイドライン 2020 � � 急速進行性腎炎症候群 RPGN
図 メタ解析の結果:フォレストプロット(つづき 3)
重篤感染症の発生(24カ月)
1001010.1RTXの方が重篤感染症発症率が低い CYの方が重篤感染症発症率が低い
0.01
Risk Ratio
20151133
1111
2
2
11
33
RTXEvents Total Events Total Weight
CY
100.0% 1.83[0.48,7.02]
1.83[0.48,7.02]
YearM-H, Random, 95% CIStudy or SubgroupJones 2015
Test for overall effect; Z=0.88(P=0.38)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
重篤合併症の発生(12カ月)
1001010.1RTXの方が重篤合併症発症率が低い CYの方が重篤合併症発症率が低い
0.01
Risk Ratio
20101133
1411
4
4
14
33
RTXEvents Total Events Total Weight
CY
100.0% 1.17[0.49,2.80]
1.17[0.49,2.80]
YearM-H, Random, 95% CIStudy or SubgroupJones 2010
Test for overall effect; Z=0.34(P=0.73)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
重篤合併症の発生(18カ月)
1001010.1RTXの方が重篤合併症発症率が低い CYの方が重篤合併症発症率が低い
0.01
Risk Ratio
20155151
2151
24
24
21
51
RTXEvents Total Events Total Weight
CY
100.0% 0.88[0.56,1.36]
0.88[0.56,1.36]
YearM-H, Random, 95% CIStudy or SubgroupGeetha 2015
Test for overall effect; Z=0.60(P=0.55)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
重篤合併症の発生(24カ月)
1001010.1RTXの方が重篤合併症発症率が低い CYの方が重篤合併症発症率が低い
0.01
Risk Ratio
20151133
1611
4
4
16
33
RTXEvents Total Events Total Weight
CY
100.0% 1.33[0.57,3.14]
1.33[0.57,3.14]
YearM-H, Random, 95% CIStudy or SubgroupJones 2015
Test for overall effect; Z=0.66(P=0.51)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
寛解〔BVAS=0,PSL中止(6カ月)〕
1001010.1RTXの方が累積寛解率が低い CYの方が累積寛解率が低い
0.01
Risk Ratio
20155151
3151
32
32
31
51
RTXEvents Total Events Total Weight
CY
100.0% 0.97[0.71,1.31]
0.97[0.71,1.31]
YearM-H, Random, 95% CIStudy or SubgroupGeetha 2015
Test for overall effect; Z=0.20(P=0.84)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
寛解〔BVAS=0,PSL中止(12カ月)〕
1001010.1RTXの方が累積寛解率が低い CYの方が累積寛解率が低い
0.01
Risk Ratio
20101133
3011
10
10
30
33
RTXEvents Total Events Total Weight
CY
100.0% 1.00[0.81,1.24]
1.00[0.81,1.24]
YearM-H, Random, 95% CIStudy or SubgroupJones 2010
Test for overall effect; Z=0.00(P=1.00)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
寛解〔BVAS=0,6カ月持続(12カ月)〕
1001010.1RTXの方が累積寛解率が低い CYの方が累積寛解率が低い
0.01
Risk Ratio
20101133
2511
9
9
25
33
RTXEvents Total Events Total Weight
CY
100.0% 0.93[0.66,1.30]
0.93[0.66,1.30]
YearM-H, Random, 95% CIStudy or SubgroupJones 2010
Test for overall effect; Z=0.45(P=0.66)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
5
エビデンスに基づく急速進行性腎炎症候群(RPGN)診療ガイドライン 2020 � � 急速進行性腎炎症候群 RPGN
●
メタ解析の結果:フォレストプロット一覧
図 メタ解析の結果:フォレストプロット(つづき 4)
1001010.1RTXの方が累積寛解率少ない CYの方が累積寛解率少ない
0.01
Risk Ratio
20155151
3851
39
39
38
51
RTXEvents Total Events Total Weight
CY
100.0% 0.97[0.78,1.22]
0.97[0.78,1.22]
YearM-H, Random, 95% CIStudy or SubgroupGeetha 2015
Test for overall effect; Z=0.23(P=0.82)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
寛解〔BVAS=0,6カ月持続(18カ月)〕
寛解維持〔BVAS=0,PSL中止(12カ月)〕
1001010.1RTXの方が寛解維持率が低い CYの方が寛解維持率が低い
0.01
Risk Ratio
20155151
2351
24
24
23
51
RTXEvents Total Events Total Weight
CY
100.0% 0.96[0.63,1.46]
0.96[0.63,1.46]
YearM-H, Random, 95% CIStudy or SubgroupGeetha 2015
Test for overall effect; Z=0.20(P=0.84)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
寛解維持〔BVAS=0,PSL中止(18カ月)〕
1001010.1RTXの方が寛解維持率が低い CYの方が寛解維持率が低い
0.01
Risk Ratio
20155151
2151
22
22
21
51
RTXEvents Total Events Total Weight
CY
100.0% 0.95[0.61,1.50]
0.95[0.61,1.50]
YearM-H, Random, 95% CIStudy or SubgroupGeetha 2015
Test for overall effect; Z=0.20(P=0.84)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
寛解維持〔BVAS=0,PSL中止(24カ月)〕
1001010.1RTXの方が寛解維持率が低い CYの方が寛解維持率が低い
0.01
Risk Ratio
20151133
2011
7
7
20
33
RTXEvents Total Events Total Weight
CY
100.0% 0.95[0.56,1.61]
0.95[0.56,1.61]
YearM-H, Random, 95% CIStudy or SubgroupJones 2015
Test for overall effect; Z=0.18(P=0.86)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
再燃(12カ月)
1001010.1RTXの方が再燃率が低い CYの方が再燃率が低い
0.01
Risk Ratio
20101027
410
1
1
4
27
RTXEvents Total Events Total Weight
CY
100.0% 1.48[0.19,11.71]
1.48[0.19,11.71]
YearM-H, Random, 95% CIStudy or SubgroupJones 2010
Test for overall effect; Z=0.37(P=0.71)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
再燃(18カ月)
1001010.1RTXの方が再燃率が低い CYの方が再燃率が低い
0.01
Risk Ratio
20151027
1949
2
12
5
65
RTXEvents Total Events Total Weight
CY
17.5% 0.93[0.21,4.03]
1.33[0.72,2.46]
YearM-H, Random, 95% CIStudy or Subgroup
Jones 201520153938 1014 82.5% 1.44[0.73,2.83]Geetha 2015
Test for overall effect; Z=0.91(P=0.36)
100.0%Total (95%CI)Total eventsHeterogeneity: Tau2= 0.00; Chi2=0.28, df=1(P=0.59); I2=0%
Risk RatioM-H, Random, 95% CI
6
エビデンスに基づく急速進行性腎炎症候群(RPGN)診療ガイドライン 2020 � � 急速進行性腎炎症候群 RPGN
図 メタ解析の結果:フォレストプロット(つづき 5)
再燃(24カ月)
1001010.1RTXの方が再燃率が低い CYの方が再燃率が低い
0.01
Risk Ratio
20151027
710
2
2
7
27
RTXEvents Total Events Total Weight
CY
100.0% 1.30[0.32,5.23]
1.30[0.32,5.23]
YearM-H, Random, 95% CIStudy or SubgroupJones 2015
Test for overall effect; Z=0.36(P=0.72)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
CQ3-1死亡(3カ月)
1001010.1PEの方が死亡率が低い IVMEPの方が死亡率が低い
0.01
Risk Ratio
20136770
1167
11
11
11
70
PEEvents Total Events Total Weight
IVMEP
100.0% 0.96[0.45,2.06]
0.96[0.45,2.06]
YearM-H, Random, 95% CIStudy or SubgroupJones 2007 Walsh2013
Test for overall effect; Z=0.11(P=0.91)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
死亡(12カ月)
1001010.1PEの方が死亡率が低い IVMEPの方が死亡率が低い
0.01
Risk Ratio
20136770
1967
16
16
19
70
PEEvents Total Events Total Weight
IVMEP
100.0% 1.14[0.64,2.02]
1.14[0.64,2.02]
YearM-H, Random, 95% CIStudy or SubgroupJones 2007 Walsh2013
Test for overall effect; Z=0.44(P=0.66)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
死亡(5年)
1001010.1PEの方が死亡率が低い IVMEPの方が死亡率が低い
0.01
Risk Ratio
20136869
3468
33
33
34
69
PEEvents Total Events Total Weight
IVMEP
100.0% 1.02[0.72,1.43]
1.02[0.72,1.43]
YearM-H, Random, 95% CIStudy or SubgroupJones 2007 Walsh2013
Test for overall effect; Z=0.09(P=0.93)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
末期腎不全(3カ月)
1001010.1PEの方が末期腎不全が少ない ステロイドパルスの方が末期腎不全が少ない
0.01
Risk Ratio
6770
1167
23
23
11
70
PEEvents Total Events Total Weight
ステロイドパルス
100.0% 0.46[0.24,0.86]
0.46[0.24,0.86]
YearM-H, Random, 95% CIStudy or SubgroupJones 2007(Walsh2013)
Test for overall effect; Z=2.41(P=0.02)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
末期腎不全(12カ月)
1001010.1PEの方が末期腎不全が少ない ステロイドパルスの方が末期腎不全が少ない
0.01
Risk Ratio
6770
1067
22
22
10
70
PEEvents Total Events Total Weight
ステロイドパルス
100.0% 0.44[0.22,0.55]
0.44[0.22,0.55]
YearM-H, Random, 95% CIStudy or SubgroupJones 2007(Walsh2013)
Test for overall effect; Z=2.44(P=0.01)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
図 メタ解析の結果:フォレストプロット
7
エビデンスに基づく急速進行性腎炎症候群(RPGN)診療ガイドライン 2020 � � 急速進行性腎炎症候群 RPGN
●
メタ解析の結果:フォレストプロット一覧
図 メタ解析の結果:フォレストプロット(つづき)
末期腎不全(5年)
1001010.1PEの方が末期腎不全少ない ステロイドパルスの方が末期腎不全少ない
0.01
Risk Ratio
6869
2368
33
33
23
69
PEEvents Total Events Total Weight
ステロイドパルス
100.0% 0.69[0.45,1.04]
0.69[0.45,1.04]
YearM-H, Random, 95% CIStudy or SubgroupJones 2007(Walsh2013)
Test for overall effect; Z=1.78(P=0.06)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
腎の回復(3カ月)
1001010.1ステロイドパルスの方が腎の回復多い PEの方が腎の回復多い0.01
Risk Ratio
6770
4867
33
33
48
70
PEEvents Total Events Total Weight
ステロイドパルス
100.0% 1.39[1.04,1.86]
1.39[1.04,1.86]
YearM-H, Random, 95% CIStudy or SubgroupJayne 2007(Walsh2013)
00 00 Not estimableJayne 2007(Walsh2013)
Test for overall effect; Z=2.23(P=0.03)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
腎の回復(12カ月)
1001010.1ステロイドパルスの方が腎の回復が多い PEの方が腎の回復多い
0.01
Risk Ratio
00
4167
0
29
0
70
PEEvents Total Events Total Weight
ステロイドパルス
100.0% 1.35[0.97,1.90]
1.35[0.97,1.90]
YearM-H, Random, 95% CIStudy or SubgroupJayne 2007(Walsh2013)
6770 2941Not estimable
Jayne 2007(Walsh2013)
Test for overall effect; Z=1.75(P=0.08)
100.0%Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
重篤合併症(12カ月)
1001010.1PEの方が少ない ステロイドパルスの方が少ない
0.01
Risk Ratio
6770
3567
32
32
35
70
PEEvents Total Events Total Weight
ステロイドパルス
1.05[0.74,1.45]
1.05[0.74,1.45]YearM-H, Random, 95% CIStudy or Subgroup
Jayne 2007(Walsh2013)
Test for overall effect; Z=0.26(P=0.79)
100.0%
100.0%
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
重篤感染症(12カ月)
1001010.1PEの方が重篤感染症の発症が低い IVMEPの方が重篤感染症の発症が低い
0.01
Risk Ratio
6770
2067
17
17
20
70
PEEvents Total Events Total Weight
IVMEP
1.13[0.65,1.96]
1.13[0.65,1.96]2013YearM-H, Random, 95% CIStudy or Subgroup
Jayne 2007 Walsh2013
Test for overall effect; Z=0.42(P=0.67)
100.0%
100.0%
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
再燃(5年)
1001010.1PEの方が再燃少ない ステロイドパルスの方が再燃少ない
0.01
Odds Ratio
6869
1068
16
16
10
69
PEEvents Total Events Total Weight
ステロイドパルス
0.55[0.23,1.32]
0.55[0.23,1.32]YearM-H, Random, 95% CIStudy or Subgroup
Jayne 2007(Walsh2013)
Test for overall effect; Z=1.34(P=0.18)
100.0%
100.0%
Total (95%CI)Total eventsHeterogeneity: Not applicable
Odds RatioM-H, Random, 95% CI
8
エビデンスに基づく急速進行性腎炎症候群(RPGN)診療ガイドライン 2020 � � 急速進行性腎炎症候群 RPGN
死亡(1カ月)
1001010.1PEを行った方が死亡率が少ない non PE群の方が死亡率が少ない
0.01
Risk Ratio
1821
0
1600
03437
0160
PEEvents Total Events Total Weight
non PE
Not estimable
Not estimable
Not estimable20112002YearM-H, Random, 95% CIStudy or Subgroup
Ingeborg 2002
Test for overall effect; Not applicable
Total (95%CI)
Szpirt 2011
Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CI
死亡(3カ月)
1001010.1PEの方が死亡率が少ない non PE群の方が死亡率が少ない
0.01
Risk Ratio
1821
0
1601
13437
0160
PEEvents Total Events Total
non PE
Not estimable
0.29[0.01,6.66]
0.29[0.01,6.66]20112002YearM-H, Random, 95% CIStudy or Subgroup
Ingeborg 2002
Test for overall effect; Z=0.78(P=0.44)
Total (95%CI)
Szpirt 2011
Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
死亡(6カ月)
1001010.1PEの方が死亡率が低い non PE群の方が死亡率が低い
0.01
Risk Ratio
1821
0
1
11821
0
PEEvents Total Events Total
non PE
0.29[0.01,6.66]
0.29[0.01,6.66]2002YearM-H, Random, 95% CIStudy or Subgroup
Ingeborg 2002
Test for overall effect; Z=0.78(P=0.44)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
死亡(1年)
1001010.1PEの方が死亡率が低い non PE群の方が死亡率が低い
0.01
Risk Ratio
2325
5
08
9
1
4146
5
PEEvents Total Events Total
non PE
0.54[0.22,1.36]
0.57[0.22,1.51]19912002
YearM-H, Random, 95% CIStudy or SubgroupPusey 1991Ingeborg 2002
Test for overall effect; Z=1.30(P=0.19)
Total (95%CI)Total events
Risk RatioM-H, Random, 95% CIWeight
91.4%
100.0%
1821 0.29[0.01,6.66]8.6%
Heterogeneity: Tau2= 0.00; Chi2=0.17, df=1(P=0.68); I2=0%
死亡(10年)
1001010.1Favours[experimental] Favours[control]
0.01
Risk Ratio
1821
2
2
21821
2
PEEvents Total Events Total
non PE
0.86[0.13,5.48]
0.86[0.13,5.48]2002YearM-H, Random, 95% CIStudy or Subgroup
Ingeborg 2002
Test for overall effect; Z=0.16(P=0.87)
Total (95%CI)Total events
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
Heterogeneity: Not applicable
CQ3-2腎死(1カ月)
1001010.1PEの方が腎死率が低い non PE群の方が腎死率が低い
0.01
Risk Ratio
1214
12
4
16
161625
1631
0
71
8
PEEvents Total Events Total
non PE
0.50[0.15,1.65]
1.71[0.68,4.30]198819911992
YearM-H, Random, 95% CIStudy or SubgroupGlockner 1988Pusey 1991Edward Cole 1992Szpirt 2011
Test for overall effect; Z=0.57(P=0.57)
Total (95%CI)Total events
Risk RatioM-H, Random, 95% CIWeight
40.1%231
60.92[0.06,13.87]13.3%
33.9%16 0.09[0.01,1.52]20115 12.6%
67 0.72[0.23,2.25]100.0%
Heterogeneity: Tau2= 0.62; Chi2=5.98, df=3(P=0.11); I2=50%
図 メタ解析の結果:フォレストプロット(つづき)
9
エビデンスに基づく急速進行性腎炎症候群(RPGN)診療ガイドライン 2020 � � 急速進行性腎炎症候群 RPGN
●
メタ解析の結果:フォレストプロット一覧
図 メタ解析の結果:フォレストプロット(つづき)
腎死(2カ月)
1001010.1PEの方が腎死が少ない non PE群の方が腎死が少ない
0.01
Risk Ratio
1214
6
3
31214
6
PEEvents Total Events Total
non PE
1.71[0.54,5.42]
1.71[0.54,5.42]1988YearM-H, Random, 95% CIStudy or Subgroup
Glockner 1988
Test for overall effect; Z=0.92(P=0.36)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
腎死(3カ月)
1001010.1PEの方が腎死が少ない non PE群の方が腎死が少ない
0.01
Risk Ratio
1616
3
6
103232
3
PEEvents Total Events Total
non PE
0.40[0.13,1.22]
0.50[0.15,1.66]1992YearM-H, Random, 95% CIStudy or Subgroup
Test for overall effect; Z=1.62(P=0.11)
Total (95%CI)Total events
Risk RatioM-H, Random, 95% CIWeight
84.5%1616 40 0.11[0.01,1.91]201115.5%
100.0%
Edward Cole 1992Szpirt 2011
Heterogeneity: Tau2= 0.01; Chi2=1.01, df=1(P=0.31); I2=1%
腎死(6カ月)
1001010.1PEの方が腎死が少ない non PE群の方が腎死が少ない
0.01
Risk Ratio
1214
7
3
82830
6
PEEvents Total Events Total
non PE
0.69[0.08,5.92]
1.71[0.54,5.42]1988YearM-H, Random, 95% CIStudy or Subgroup
Test for overall effect; Z=0.34(P=0.73)
Total (95%CI)Total events
Risk RatioM-H, Random, 95% CIWeight
57.4%1616 51 0.20[0.03,1.53]199242.6%
100.0%
Edward Cole 1992Glockner 1988
Heterogeneity: Tau2= 1.76; Chi2=3.48, df=1(P=0.06); I2=71%
腎死(1年)
1001010.1PEの方が腎死率が低い non PE群の方が腎死率が低い
0.01
Risk Ratio
1214
12
4
166771
8
PEEvents Total Events Total
non PE
0.72[0.23,2.25]
1.71[0.68,4.30]1988YearM-H, Random, 95% CIStudy or Subgroup
Test for overall effect; Z=0.57(P=0.57)
Total (95%CI)Total events
Risk RatioM-H, Random, 95% CIWeight
40.1%2325 11 0.92[0.06,13.87]199113.3%1616 63 0.50[0.15,1.66]199233.9%1616 50 0.09[0.01,1.52]201112.6%
100.0%
Edward Cole 1992Szpirt 2011
Pusey 1991Glocjner 1988
Heterogeneity: Tau2= 0.62; Chi2=5.98, df=3(P=0.11); I2=50%
1001010.1PEの方が腎死が少ない non PE群の方が腎死が少ない
0.01
Risk Ratio
1616
2
7
71616
2
PEEvents Total Events Total
non PE
0.29[0.07,1.17]
0.29[0.07,1.17]2011YearM-H, Random, 95% CIStudy or Subgroup
Szpirt 2011
Test for overall effect; Z=1.74(P=0.08)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
腎死(5年)
腎死(10年)
1001010.1PEの方が腎死が少ない non PE群の方が腎死が少ない
0.01
Risk Ratio
1821
9
6
61821
9
PEEvents Total Events Total
non PE
1.29[0.57,2.92]
1.29[0.57,2.92]2002YearM-H, Random, 95% CIStudy or Subgroup
Ingeborg 2002
Test for overall effect; Z=0.60(P=0.55)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
10
エビデンスに基づく急速進行性腎炎症候群(RPGN)診療ガイドライン 2020 � � 急速進行性腎炎症候群 RPGN
腎機能の悪化(1カ月)
1001010.1PE群の方が腎機能の悪化が少ない non PE群の方が腎機能の悪化が少ない
0.01
Risk Ratio
1616
0
6
61616
0
PEEvents Total Events Total
non PE
0.08[0.60,1.26]
0.08[0.60,1.26]2011YearM-H, Random, 95% CIStudy or Subgroup
Szpirt 2011
Test for overall effect; Z=1.80(P=0.07)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
腎機能の悪化(3カ月)
1001010.1PE群の方が腎機能の悪化が少ない non PE群の方が腎機能の悪化が少ない
0.01
Risk Ratio
1616
1
7
71616
1
PEEvents Total Events Total
non PE
0.14[0.02,1.03]
0.14[0.02,1.03]2011YearM-H, Random, 95% CIStudy or Subgroup
Szpirt 2011
Test for overall effect; Z=1.93(P=0.05)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
腎機能の悪化(5年)
1001010.1PE群の方が腎機能の悪化が少ない non PE群の方が腎機能の悪化が少ない
0.01
Risk Ratio
1616
5
11
111616
5
PEEvents Total Events Total
non PE
0.45[0.20,1.01]
0.45[0.20,1.01]2011YearM-H, Random, 95% CIStudy or Subgroup
Szpirt 2011
Test for overall effect; Z=1.94(P=0.05)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
重篤感染症(全期間)
1001010.1PE群の方が重篤感染症が少ない non PE群の方が重篤感染症が少ない
0.01
Risk Ratio
1616
4
2
21616
4
PEEvents Total Events Total
non PE
2.00[0.42,9.42]
2.00[0.42,9.42]1992YearM-H, Random, 95% CIStudy or Subgroup
Edward Cole 1992
Test for overall effect; Z=0.88(P=0.38)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
重篤合併症(全期間)
1001010.1PEの方が重篤合併症が少ない non PE群の方が重篤合併症が少ない
0.01
Risk Ratio
1214
3
2
21214
3
PEEvents Total Events Total
non PE
1.29[0.26,6.46]
1.29[0.26,6.46]1988YearM-H, Random, 95% CIStudy or Subgroup
Glockner 1988
Test for overall effect; Z=0.31(P=0.76)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
図 メタ解析の結果:フォレストプロット(つづき)
1001010.1RTXの方が死亡率が低い AZAの方が死亡率が低い
0.01
Risk Ratio
5857
0
2
25857
0
RTXEvents Total Events Total
AZA
0.20[0.01,4.15]
0.20[0.01,4.15]M-H, Random, 95% CIStudy or Subgroup
Guillevin L 2014, Terrier B 2018
Test for overall effect; Z=1.04(P=0.30)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
CQ4死亡(28カ月)
図 メタ解析の結果:フォレストプロット
11
エビデンスに基づく急速進行性腎炎症候群(RPGN)診療ガイドライン 2020 � � 急速進行性腎炎症候群 RPGN
●
メタ解析の結果:フォレストプロット一覧
図 メタ解析の結果:フォレストプロット(つづき)
再発〔Major(28カ月)〕
1001010.1RTXの方が再発率が低い AZAの方が再発率が低い
0.01
Risk Ratio
5857
3
17
175857
3
RTXEvents Total Events Total
AZA
0.18[0.06,0.58]
0.18[0.06,0.58]M-H, Random, 95% CIStudy or Subgroup
Guillevin L 2014, Terrier B 2018
Test for overall effect; Z=2.87(P=0.004)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
再発〔Major(60カ月)〕
1001010.1RTXの方が再発率が低い AZAの方が再発率が低い
0.01
Risk Ratio
5857
16
28
285857
16
RTXEvents Total Events Total
AZA
0.58[0.35,0.95]
0.58[0.35,0.95]M-H, Random, 95% CIStudy or Subgroup
Guillevin L 2014, Terrier B 2018
Test for overall effect; Z=2.15(P=0.03)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
再発〔Major or Minor(28カ月)〕
1001010.1RTXの方が再発率が低い AZAの方が再発率が低い
0.01
Risk Ratio
5857
9
26
265857
9
RTXEvents Total Events Total
AZA
0.35[0.18,0.68]
0.35[0.18,0.68]M-H, Random, 95% CIStudy or Subgroup
Guillevin L 2014, Terrier B 2018
Test for overall effect; Z=3.08(P=0.002)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
再発〔Major or Minor(60カ月)〕
1001010.1RTXの方が再発率が低い AZAの方が再発率が低い
0.01
Risk Ratio
5857
27
39
395857
27
RTXEvents Total Events Total
AZA
0.70[0.51,0.98]
0.70[0.51,0.98]M-H, Random, 95% CIStudy or Subgroup
Guillevin L 2014, Terrier B 2018
Test for overall effect; Z=2.10(P=0.04)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
重篤合併症(28カ月)
1001010.1RTXの方がSAEsが少ない AZAの方がSAEsが少ない
0.01
Risk Ratio
5857
25
25
255857
25
RTXEvents Total Events Total
AZA
1.02[0.67,1.54]
1.02[0.67,1.54]M-H, Random, 95% CIStudy or Subgroup
Guillevin L 2014, Terrier B 2018
Test for overall effect; Z=0.08(P=0.93)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
重篤合併症(60カ月)
1001010.1RTXの方がSAEsが少ない AZAの方がSAEsが少ない
0.01
Risk Ratio
5857
39
31
315857
39
RTXEvents Total Events Total
AZA
1.28[0.95,1.72]
1.28[0.95,1.72]M-H, Random, 95% CIStudy or Subgroup
Guillevin L 2014, Terrier B 2018
Test for overall effect; Z=1.62(P=0.10)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%
死亡(60カ月)
1001010.1RTXの方が死亡率が低い AZAの方が死亡率が低い
0.01
Risk Ratio
5857
0
4
45857
0
RTXEvents Total Events Total
AZA
0.11[0.01,2.05]
0.11[0.01,2.05]M-H, Random, 95% CIStudy or Subgroup
Guillevin L 2014, Terrier B 2018
Test for overall effect; Z=1.47(P=0.14)
Total (95%CI)Total eventsHeterogeneity: Not applicable
Risk RatioM-H, Random, 95% CIWeight
100.0%
100.0%