scholarly journals Effects of duration of glucocorticoid therapy on relapse rate in antineutrophil cytoplasmic antibody-associated vasculitis: A meta-analysis

2010 ◽  
Vol 62 (8) ◽  
pp. 1166-1173 ◽  
Author(s):  
Michael Walsh ◽  
Peter A. Merkel ◽  
Alfred Mahr ◽  
David Jayne
Keyword(s):  
Relapse Rate ◽  
Meta Analysis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Glucocorticoid Therapy

scholarly journals FRI0190 COMPARATIVE EFFICACY AND SAFETY OF MYCOPHENOLATE MOFETIL VERSUS CYCLOPHOSPHAMIDE IN PATIENTS WITH ACTIVE ANTINEUTROPHIL CYTOPLASMIC ANTIBODY-ASSOCIATED VASCULITIS: A META-ANALYSIS OF RANDOMIZED TRIALS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 678.2-678
Author(s):  
Y. H. Lee ◽  
G. G. Song
Keyword(s):  
Mycophenolate Mofetil ◽  
Infection Rate ◽  
Relapse Rate ◽  
Meta Analysis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Remission Induction ◽  
Efficacy And Safety ◽  
Anca Associated Vasculitis ◽  
Significant Difference ◽  
Regression Test

Background:Cyclophosphamide (CYC) is effective for induction of remission of AAV, resulting in complete remission rates of around 70%. Thus, CYC has been the standard remission induction therapy for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV); however, it is toxic and causes infections, malignancies, and infertility. Therefore, other agents that are less toxic but that have similar efficacy were explored. Since the disease course of AAV usually requires long-term immunosuppression, mycophenolate mofetil (MMF), a less toxic agent compared to CYC, has been explored as an alternative to CYC.Objectives:The aim of this study is to assess the efficacy and safety of MMF versus cyclophosphamide CYC in patients with active AAV.Methods:We performed a meta-analysis of four randomized clinical trials (RCTs) (300 patients) to examine the relative efficacy and safety of MMF compared to CYC in patients with active AAV.Results:There was no significant difference in remission at 6 months between MMF and CYC (OR 1.311, 95% confidence interval [CI] 0.570 – 3.017,P= 0.524). Additionally, the relapse rate did not differ between the MMF group and CYC group (OR 1.331, 95% CI 0.497 – 3.568,P= 0.570). There was no significant difference in serious adverse event (SAE) (OR 1.232, 95% CI 0.754 – 2.014,P= 0.404) and infection rate (OR 0.958, 95% CI 0.561 – 1.634,P= 0.873) between the MMF and CYC groups. Some heterogeneity was found in the meta-analysis of remission and relapse rate (I2= 57.4%, 63.4%), but no between-study heterogeneity was found during the meta-analysis of the SAE and infection rate. Egger’s regression test showed no evidence of publication bias (Egger’s regression testP-values > 0.1).Conclusion:MMF was an equally effective alternative treatment to CYC, and MMF was comparable to CYC in patients with active AAV in terms of safety, suggesting that MMF can be used as an alternative to CYC for remission induction in AAV.References:[1]Han F, Liu G, Zhang X, Li X, He Q, He X, Li Q, Wang S, Wang H, Chen J (2011) Effects of mycophenolate mofetil combined with corticosteroids for induction therapy of microscopic polyangiitis. Am J Nephrol 33:185-192[2]Jones RB, Hiemstra TF, Ballarin J et al (2019) Mycophenolate mofetil versus cyclophosphamide for remission induction in ANCA-associated vasculitis: a randomised, non-inferiority trial. Ann Rheum Dis 78:399-405[3]Tuin J, Stassen PM, Bogdan DI, Broekroelofs J, van Paassen P, Cohen Tervaert JW, Sanders JS, Stegeman CA (2019) Mycophenolate Mofetil Versus Cyclophosphamide for the Induction of Remission in Nonlife-Threatening Relapses of Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Randomized, Controlled Trial. Clin J Am Soc Nephrol 14:1021-1028[4]Hu W, Liu C, Xie H, Chen H, Liu Z, Li L (2008) Mycophenolate mofetil versus cyclophosphamide for inducing remission of ANCA vasculitis with moderate renal involvement. Nephrol Dial Transplant 23:1307-1312Disclosure of Interests:None declared

scholarly journals Efficacy and safety of Si-Jun-Zi-Tang-based therapies for functional (non-ulcer) dyspepsia: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yaping Wang ◽  
Bin Liu ◽  
Xiuqiong Fu ◽  
Tiejun Tong ◽  
Zhiling Yu
Keyword(s):  
Relapse Rate ◽  
Large Scale ◽  
Primary Outcome ◽  
Response Rate ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Efficacy And Safety ◽  
History Of ◽  
Non Ulcer Dyspepsia

Abstract Background The traditional Chinese medicine formula Si-Jun-Zi-Tang (SJZT) has a long history of application in the treatment of functional dyspepsia (non-ulcer dyspepsia, FD)-like symptoms. SJZT-based therapies have been claimed to be beneficial in managing FD. This study aimed to assess the efficacy and safety of SJZT-based therapies in treating FD by meta-analysis. Methods Systematic searches for RCTs were conducted in seven databases (up to February 2019) without language restrictions. Data were analyzed using Cochrane RevMan software version 5.3.0 and Stata software version 13.1, and reported as relative risk (RR) or odds ratio (OR) with 95% confidence intervals (CIs). The primary outcome was response rate and the secondary outcomes were gastric emptying, quality of life, adverse effects and relapse rate. The quality of evidence was evaluated according to criteria from the Cochrane risk of bias. Results A total of 341 potentially relevant publications were identified, and 12 RCTs were eligible for inclusion. For the response rate, there was a statically significant benefit in favor of SJZT-based therapies (RR = 1.23; 95% CI 1.17 to 1.30). However, the benefit was limited to modified SJZT (MSJZT). The relapse rate of FD patients received SJZT-based therapies was lower than that of patients who received conventional medicines (OR = 0.23; 95% CI 0.10 to 0.51). No SJZT-based therapies-related adverse effect was reported. Conclusion SJZT-based prescriptions may be effective in treating FD and no serious side-effects were identified, but the effect on response rate appeared to be limited to MSJZT. The results should be interpreted with caution as all the included studies were considered at a high risk of bias. Standardized, large-scale and strictly designed RCTs are needed to further validate the benefits of SJZT-based therapies for FD management. Trial registration Systematic review registration: [PROSPERO registration: CRD42019139136].

scholarly journals Glucocorticoids and steroid sparing medications monotherapies or in combination for IgG4-RD: a systematic review and network meta-analysis

Rheumatology ◽  
2019 ◽  
Vol 59 (4) ◽  
pp. 718-726 ◽  
Author(s):  
Dina Omar ◽  
Yu Chen ◽  
Ye Cong ◽  
Lingli Dong
Keyword(s):  
Adverse Events ◽  
Maintenance Therapy ◽  
Relapse Rate ◽  
Induction Therapy ◽  
Remission Rate ◽  
Meta Analysis ◽  
Immunosuppressive Agents ◽  
Current Evidence ◽  
Treatment Groups ◽  
Events Data

Abstract Objective To assess the safety and efficacy of glucocorticoids (GCs), immunosuppressive agents (IM) and rituximab (RTX), alone or in combination, for the treatment of IgG4-RD. Methods Relevant articles published were searched in the databases with relevant key words. Network meta-analysis was conducted, with various outcomes including relapse rate, remission rate and adverse events. Data were calculated with odds ratio (ORs) and 95% CI. P-score was used to rank the treatments. Results A total of 15 studies involving 1169 patients were included. Network meta-analysis indicated that RTX maintenance therapy had the lowest relapse rate of all treatments (OR = 0.10, 95% CI [0.01, 1.63]), whereas GCs + IM was associated with a lower relapse rate compared with GCs alone (OR = 0.39, 95% CI [0.20, 0.80]). Further, patients treated with GCs + IM had a higher remission rate than those given GCs (OR= 3.36, 95% CI [1.44, 7.83]), IM (OR= 55.31, 95% CI [13.73, 222.73]) monotherapies or RTX induction therapy only (OR= 7.38, 95% CI [1.56, 34.94]). The rate of adverse events was comparable among the different treatment groups. Conclusion Treatment of IgG4-RD patients with GCs and IM was associated with higher remission rates and lower relapse rates, as well as comparable safety profiles compared with GC, IM and RTX induction therapy. RTX maintenance therapy had a larger reduction in the relapse rate compared with GC and IM. The current evidence should be carefully scrutinized as the included studies were observational in design. Larger randomized controlled trials are needed to confirm.

scholarly journals Cross-phenotype analysis of Immunochip data identifies KDM4C as a relevant locus for the development of systemic vasculitis

2018 ◽  
Vol 77 (4) ◽  
pp. 589-595 ◽  
Author(s):  
Lourdes Ortiz-Fernández ◽  
Francisco David Carmona ◽  
Raquel López-Mejías ◽  
Maria Francisca González-Escribano ◽  
Paul A Lyons ◽  
...  
Keyword(s):  
Systemic Vasculitis ◽  
Meta Analysis ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Nucleotide Polymorphism ◽  
Single Nucleotide ◽  
Control Of Gene Expression ◽  
Immune Mediated ◽  
Phenotype Analysis ◽  
Functional Consequences ◽  
Shared Genetic

ObjetiveSystemic vasculitides represent a heterogeneous group of rare complex diseases of the blood vessels with a poorly understood aetiology. To investigate the shared genetic component underlying their predisposition, we performed the first cross-phenotype meta-analysis of genetic data from different clinically distinct patterns of vasculitis.MethodsImmunochip genotyping data from 2465 patients diagnosed with giant cell arteritis, Takayasu’s arteritis, antineutrophil cytoplasmic antibody-associated vasculitis or IgA vasculitis as well as 4632 unaffected controls were analysed to identify common susceptibility loci for vasculitis development. The possible functional consequences of the associated variants were interrogated using publicly available annotation data.ResultsThe strongest association signal corresponded with an intergenic polymorphism located between HLA-DQB1 and HLA-DQA2 (rs6932517, P=4.16E-14, OR=0.74). This single nucleotide polymorphism is in moderate linkage disequilibrium with the disease-specific human leucocyte antigen (HLA) class II associations of each type of vasculitis and could mark them. Outside the HLA region, we identified the KDM4C gene as a common risk locus for vasculitides (highest peak rs16925200, P=6.23E-07, OR=1.75). This gene encodes a histone demethylase involved in the epigenetic control of gene expression.ConclusionsThrough a combined analysis of Immunochip data, we have identified KDM4C as a new risk gene shared between systemic vasculitides, consistent with the increasing evidences of the crucial role that the epigenetic mechanisms have in the development of complex immune-mediated conditions.

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