酪氨酸激酶抑制剂（TKI）已成为治疗慢性期（CP）慢性粒细胞白血病（CML）的首选药物。本研究旨在利用网络荟萃分析（NMA）比较不同TKI作为CML一线治疗的安全性和有效性，为TKI临床精准使用提供依据。 Embase、中国知网 (CNKI)、万方、中国科技期刊数据库 (VIP)、SinoMed 和 ClinicalTrials.gov 纳入了比较不同 TKI 作为 CML 一线治疗的随机对照试验。检索时间线从开始到2023年7月21日。使用系统评价和荟萃分析的首选报告项目（PRISMA）和频率论NMA方法，比较了不同TKI的有效性和安全性，包括主要分子反应率（ MMR）、完全细胞遗传学缓解（CCyR）、所有级别不良事件、3级或以上血液学不良事件和肝毒性。共纳入25项RCT，涉及6,823名CML患者和6种TKI。从疗效来看，达沙替尼、尼洛替尼、雷多替尼等二代TKI相比伊马替尼在改善患者MMR和CCyR方面表现出一定优势。此外，800 mg 伊马替尼比 400 mg 伊马替尼提供更好的 MMR 和 CCyR。就安全性而言，不同 TKI 之间所有级别不良事件的发生率没有显着差异。所有 TKI 均可引起严重的 3-4 级血液学不良事件，包括贫血、血小板减少和中性粒细胞减少。达沙替尼更有可能引起贫血、博舒替尼血小板减少症和伊马替尼中性粒细胞减少症，而尼洛替尼和氟马替尼在严重血液学不良事件方面可能具有更好的安全性。对于肝脏毒性，雷多替尼 400 mg 和伊马替尼 800 mg 分别在所有级别 ALT 和 AST 升高的发生率中排名第一的可能性最大。 在 CML 中，第二代 TKI 比伊马替尼更有效，即使最后一种药物具有相对较好的安全性。因此，由于每种第二代 TKI 都具有不同的临床疗效和安全性，并且与不同的经济因素相关，因此其选择应根据患者的具体临床情况（患者的具体疾病特征、合并症、潜在的药物相互作用等）来决定。作为他们的坚持）。然而，由于原始研究数量有限，需要额外的高质量研究才能得出第二代 TKI 是该特殊患者的最佳选择的明确结论。2024 转化癌症研究。版权所有。

Tyrosine kinase inhibitors (TKIs) have become the preferred drugs for the treatment of chronic phase (CP) chronic myeloid leukemia (CML). This study aims to compare the safety and efficacy of different TKIs as first-line treatments for CML using network meta-analysis (NMA), providing a basis for the precise clinical use of TKIs.A systematic search was conducted on PubMed, Cochrane Library, Embase, China National knowledge Infrastructure (CNKI), Wanfang, Chinese Science and Technology Periodical Databases (VIP), SinoMed and ClinicalTrials.gov to include RCTs that compared the different TKIs as first line treatment for CML. The search timeline was from inception to 21 July 2023. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the frequentist NMA methods, the efficacy and safety of different TKIs were compared, including the rates of major molecular response (MMR), complete cytogenetic response (CCyR), all grade adverse events, grade 3 or higher hematologic adverse events and liver toxicity.A total of 25 RCTs involving 6,823 patients with CML and 6 types of TKIs were included. In terms of efficacy, second-generation TKIs such as dasatinib, nilotinib, and radotinib showed certain advantages in improving patients' MMR and CCyR compared to imatinib. Additionally, imatinib 800 mg provided better MMRs and CCyRs than imatinib 400 mg. As far as safety was concerned, there was no significant difference in the incidence of all grade adverse events among the different TKIs. All TKIs can cause serious grade 3-4 hematologic adverse events, including anemia, thrombocytopenia, and neutropenia. Dasatinib more likely caused anemia, bosutinib thrombocytopenia, and imatinib neutropenia, whereas nilotinib and flumatinib might have better safety profiles in terms of severe hematologic adverse events. For liver toxicity, radotinib 400 mg and imatinib 800 mg, respectively, had the highest likelihood of ranking first in incidence rates of all grade ALT and AST elevation.In CML, second-generation TKIs are more clinically effective than imatinib even if this last drug has a relatively better safety profile. Thus, as each second-generation TKI has a distinct clinical efficacy and safety, and is associated with different economic factors, its choice should be dictated by the specific patient clinical conditions (patient's specific disease characteristics, comorbid conditions, potential drug interactions, as well as their adherence). Nevertheless, due to the limited number of original research, additional high-quality studies are needed to achieve any firm conclusion on which second-generation TKI is the best choice for that peculiar patient.2024 Translational Cancer Research. All rights reserved.