The use of immunotherapies for recurrent miscarriage: An overview of systematic reviews and meta-analysis

• Published in: Journal of reproductive immunology Vol. 158; p. 103986
• Main Authors: Cavalcante, Marcelo Borges, Alcântara da Silva, Pedro Henrique, Sampaio, Olga Goiana Martins, Câmara, Fernanda Eunice Araújo, de Melo Bezerra Cavalcante, Candice Torres, Barini, Ricardo
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.08.2023
• Subjects: Corticosteroid; Habitual abortion; Immunotherapy; Intravenous immunoglobulin; Lipid emulsion; Lymphocyte immunotherapy; Intravenous immunoglobulin; Corticosteroid; Habitual abortion; Lipid emulsion; Immunotherapy; Lymphocyte immunotherapy
• ISSN: 0165-0378; 1872-7603
• DOI: 10.1016/j.jri.2023.103986

Immunotherapies have been a treatment proposed for recurrent miscarriages (RMs). The use of immunotherapies remains not recommended in the management of couples with RM. This overview of systematic reviews and meta-analysis (SRs-MAs) aims to identify and evaluate the quality of SRs-MAs that studied the effectiveness of immunotherapies in the treatment of RM patients. SRs-MAs were searched in PubMed/Medline, Embase, and Web of Science. SRs-MAs were analyzed using AMSTAR-2, PRISMA 2020, Risk of Bias in Systematic (ROBIS), and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tools to evaluate the methodological quality, reporting quality, risk of bias, and evidence quality of included SRs-MAs, respectively. This review included 20 SRs-MAs that evaluated the following immunotherapies: intravenous immunoglobulin (13 publications), lymphocyte immunotherapy (6 publications), corticosteroids (3 publications), and lipid emulsion (1 publication). SRs-MAs were rated as high methodological, moderate, and critically low quality in 14 (70 %), 1 (5 %), and 5 (25 %) SRs-MAs and high reporting, moderate, and low quality in 13 (65 %), 4 (20 %), and 3 (5 %) SRs-MAs, respectively. The overall risk of bias revealed a low risk of bias for three-quarters of the SRs-MAs. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) analysis resulted in 23 outcomes, of which 4, 3, 5, and 11 results were of high, moderate, low, and very low quality, respectively. An improvement has been observed over the past few years in the quality of systematic reviews (SR)-MAs that have investigated the efficacy of intravenous immunoglobulin, lymphocyte immunotherapy, lipid emulsion therapy, and corticosteroids as a therapy for RM. •Assessing the quality of SRs-MAs is important to attest to the level of evidence.•Seventy percent of RM SR-MAs was rated as high methodological quality.•Sixty-five percent of RM SRs-MAs was rated as high reporting quality.•Seventy-five percent of RM SR-MAs had a low risk of bias.•GRADE rated the outcomes of RM immunotherapies as high quality in 18 % of cases.