Therapeutic trials in elderly hypertensives: meta-analysis and implications for daily practice

Abstract BACKGROUND The influence of age on balance of benefit vs. potential harm of blood pressure (BP)-lowering therapy for elderly hypertensives is unclear. We evaluated the modifying effects of age on BP lowering for various adverse outcomes in hypertensive patients older than 60 years without specified comorbidities. METHODS All relevant randomized controlled trials (RCTs) were systematically identified. Coronary heart disease, stroke, heart failure (HF), cardiovascular death, major adverse cardiovascular events (MACE), renal failure (RF), and all-cause death were assessed. Meta-regression analysis was used to explore the relationship between achieved systolic BP (SBP) and the risk of adverse events. Random-effects meta-analysis was used to pool the estimates. RESULTS Our study included 18 RCTs (n = 53,993). Meta-regression analysis showed a lower achieved SBP related with a lower risk of stroke and cardiovascular death, but an increased risk of RF. The regression slopes were comparable between populations stratifying by age 75 years. In subgroup analysis, the relative risks of a more aggressive BP lowering strategy were similar between patients aged older or less than 75 years for all outcomes except for RF (P for interaction = 0.02). Compared to treatment with final achieved SBP 140–150 mm Hg, a lower achieved SBP (<140 mm Hg) was significantly associated with decreased risk of stroke (relative risk = 0.68; 95% confidence interval = 0.55–0.85), HF (0.77; 0.60–0.99), cardiovascular death (0.68; 0.52–0.89), and MACE (0.83; 0.69–0.99). CONCLUSIONS To treat hypertension in the elderly, age had trivial effect modification on most outcomes, except for renal failure. Close monitoring of renal function may be warranted in the management of elderly hypertension.

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Meta-Analysis of Therapeutic Trials

Encyclopedia of Biopharmaceutical Statistics ◽

10.3109/9781439822463.125 ◽

2010 ◽

pp. 768-779 ◽

Cited By ~ 2

Author(s):

Joseph C. Cappelleri ◽

John P. A. Ioannidis ◽

Joseph Lau

Keyword(s):

Meta Analysis ◽

Therapeutic Trials

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There is no benefit in the use of postnatal intravenous immunoglobulin for the prevention of relapses of multiple sclerosis: findings from a systematic review and meta-analysis

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20180041 ◽

2018 ◽

Vol 76 (6) ◽

pp. 361-366 ◽

Cited By ~ 4

Author(s):

Gleysson Rodrigues Rosa ◽

Anthony Terrence O’Brien ◽

Eduardo de Almeida Guimarães Nogueira ◽

Vitor Martinez de Carvalho ◽

Sonia Castedo Paz ◽

...

Keyword(s):

Multiple Sclerosis ◽

Systematic Review ◽

Intravenous Immunoglobulin ◽

Post Partum ◽

Meta Analysis ◽

Daily Practice ◽

Number Needed To Treat ◽

The Central Nervous System ◽

Qualitative Analyses ◽

Fertile Women

ABSTRACT Multiple sclerosis (MS) is a complex autoimmune and neurodegenerative disease of the central nervous system. Since MS affects mostly fertile women, pregnancy issues often arise in daily practice. The present study assessed the use of postpartum intravenous immunoglobulin (IVIG) in MS. Methods The authors individually searched for records using PubMed, Medline, EMBASE, Cochrane, SciELO, LILACS, and Google Scholar, using the terms “multiple sclerosis” OR “MS” AND “pregnancy” OR “gestation” OR “partum” OR “post-partum” OR “puerperium” AND “immunoglobulin”. Results The initial search returned 321 papers. There were 11 eligible articles selected for the review. In total, 380 patients had received post-natal IVIG to reduce the number of postpartum relapses. The unadjusted number needed to treat was 6.3 for the quantitative and 5.8 for the qualitative analyses. Conclusion The therapeutic effect of IVIG for prevention of postnatal relapses in MS could not clearly be established in this meta-analysis.

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Update on polycystic ovary syndrome

Clinical and Experimental Reproductive Medicine ◽

10.5653/cerm.2020.04329 ◽

2021 ◽

Author(s):

Jin Ju Kim

Keyword(s):

Polycystic Ovary Syndrome ◽

Polycystic Ovary ◽

Meta Analysis ◽

Daily Practice ◽

Antral Follicle ◽

Reproductive Age ◽

Lifestyle Modifications ◽

First Line ◽

Ovary Syndrome ◽

Wide Range

Polycystic ovary syndrome (PCOS) is a common disorder in reproductive-age women. In 2018, an international evidence-based guideline announced recommendations spanning a wide range of issues on the assessment and management of PCOS. From the 166 recommendations, the present study reviews those that are of particular clinical relevance for daily practice and introduces other relevant studies that have been published since the global guideline. The 2018 guideline increased the antral follicle count cutoff for the diagnosis of PCOS from 12 to 20 when using a high-frequency probe. Hirsutism was defined as having a score of ≥4–6 based on a lower percentile of 85%–90% or cluster analysis, which was lower than the traditionally used 95th percentile-based cutoff. The diagnosis of PCOS in adolescents is challenging, and irregular menstruation was defined carefully according to years from menarche. The use of ultrasonography for the diagnosis of PCOS was restricted to those 8 years after menarche. As medication for non-fertility indications, combined oral contraceptives are the first-line drug. Metformin, in addition to lifestyle modifications, should be considered for adult patients with a body mass index ≥25 kg/m2 for the management of weight and metabolic outcomes. An aromatase inhibitor is the recommended first-line medication for ovulation induction, a subsequent individual patient data meta-analysis also reported the same conclusion. Whether the new global guideline will be fully adopted by many specialists and change clinical practice is open to question. Further studies are needed to better understand and manage PCOS patients well.

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Burnout in Palliative Care Nurses, Prevalence and Risk Factors: A Systematic Review with Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207672 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7672

Author(s):

Jose Luis Gómez-Urquiza ◽

Luis Albendín-García ◽

Almudena Velando-Soriano ◽

Elena Ortega-Campos ◽

Lucía Ramírez-Baena ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Palliative Care ◽

Working Conditions ◽

Meta Analysis ◽

Daily Practice ◽

Personal Accomplishment ◽

Work Stressors ◽

Psychological Variables ◽

Prevalence Estimation

Palliative care nurses are exposed to hard situations, death, and duel feelings in their daily practice. These, and other work stressors, can favor burnout development. Thus, it is important to analyze the prevalence and risk factors of burnout in palliative care nurses and estimate its prevalence. A systematic review and meta-analysis was done with quantitative primary studies. n = 15 studies were included with n = 6 studies including information for the meta-analysis. The meta-analytic prevalence estimation of emotional exhaustion was 24% (95% CI 16–34%), for depersonalization was 30% (95% CI 18–44%) and for low personal accomplishment was 28% with a sample of n = 693 palliative care nurses. The main variables related with burnout are occupational variables followed by psychological variables. Some interventions to improve working conditions of palliative care nurses should be implemented to reduce burnout.

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Overview of antidepressant treatment of bipolar depression

The International Journal of Neuropsychopharmacology ◽

10.1017/s1461145713000023 ◽

2013 ◽

Vol 16 (7) ◽

pp. 1673-1685 ◽

Cited By ~ 55

Author(s):

Gustavo H. Vázquez ◽

Leonardo Tondo ◽

Juan Undurraga ◽

Ross J. Baldessarini

Keyword(s):

Bipolar Depression ◽

Antidepressant Treatment ◽

Meta Analysis ◽

Unipolar Depression ◽

Placebo Treatment ◽

Research Literature ◽

Therapeutic Trials ◽

Significant Disability ◽

Short And Long Term

Abstract Bipolar depression remains a major unresolved challenge for psychiatric therapeutics. It is associated with significant disability and mortality and represents the major proportion of the approximately half of follow-up time spent in morbid states despite use of available treatments. Evidence regarding effectiveness of standard treatments, particularly with antidepressants, remains limited and inconsistent. We reviewed available clinical and research literature concerning treatment with antidepressants in bipolar depression and its comparison with unipolar depression. Research evidence concerning efficacy and safety of commonly used antidepressant treatments for acute bipolar depression is very limited. Nevertheless, an updated meta-analysis indicated that overall efficacy was significantly greater with antidepressants than with placebo-treatment and not less than was found in trials for unipolar major depression. Moreover, risks of non-spontaneous mood-switching specifically associated with antidepressant treatment are less than appears to be widely believed. The findings encourage additional efforts to test antidepressants adequately in bipolar depression, and to consider options for depression in types I vs. II bipolar disorder, depression with subsyndromal hypomania and optimal treatment of mixed agitated-dysphoric states – both short- and long-term. Many therapeutic trials considered were small, varied in design, often involved co-treatments, or lacked adequate controls.

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What proportion of people have a follow-up biopsy in randomized trials of treatments for non-alcoholic steatohepatitis?: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0250385 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250385

Author(s):

Dimitrios A. Koutoukidis ◽

Elizabeth Morris ◽

John A. Henry ◽

Yusra Shammoon ◽

Matthew Zimmerman ◽

...

Keyword(s):

Systematic Review ◽

Large Scale ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Serious Adverse Events ◽

Trial Conduct ◽

Alcoholic Steatohepatitis ◽

Therapeutic Trials ◽

Trial Length

Background and aim Trials of treatments for non-alcoholic steatohepatitis require endpoint assessment with liver biopsies. Previous large-scale trials have calculated their sample size expecting high retention but on average did not achieve this. We aimed to quantify the proportion of participants with a valid follow-up biopsy. Methods We conducted a systematic review of MEDLINE and Embase until May 2020 and included randomized clinical trials of any intervention in non-alcoholic steatohepatitis with at least 1-year follow-up. We were guided by Cochrane methods to run a meta-analysis with generalized linear mixed models with random effects. Results Forty-one trials (n = 6,695) were included. The proportion of participants with a valid follow-up biopsy was 82% (95%CI: 78%-86%, I2 = 92%). There was no evidence of a difference by location, trial length, or by allocated treatment group. Reasons for missing follow-up biopsies were, in ranked order, related to participants (95 per 1,000 participants (95%CI: 69–129, I2 = 92%), medical factors, protocol, trial conduct, and other/unclear. Biopsy-related serious adverse events occurred in 16 per 1,000 participants (95% CI: 8–33, I2 = 54%). No biopsy-related deaths were reported. Conclusions The proportion of participants with a valid follow-up biopsy in therapeutic trials in non-alcoholic steatohepatitis is on average 82%, with around 1 in 10 participants declining a follow-up biopsy. These findings can inform adequately-powered trials.

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Interventions to Improve Medication Adherence in Patients with Schizophrenia or Bipolar Disorders: A Systematic Review and Meta-Analysis

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph181910213 ◽

2021 ◽

Vol 18 (19) ◽

pp. 10213

Author(s):

Elke Loots ◽

Eva Goossens ◽

Toke Vanwesemael ◽

Manuel Morrens ◽

Bart Van Rompaey ◽

...

Keyword(s):

Systematic Review ◽

Medication Adherence ◽

Selection Criteria ◽

Meta Analysis ◽

Bipolar Disorders ◽

Daily Practice ◽

Improve Medication Adherence ◽

Different Types ◽

Family Based

Adherence to prescribed medication regimes improves outcomes for patients with severe mental illness such as schizophrenia or bipolar disorders. The aim of this systematic review and meta-analysis was to compare the effectiveness among interventions to improve medication adherence in patients with schizophrenia or bipolar disorders. Literature published in the last decade was searched for interventions studies to improve adherence in patients with schizophrenia or a bipolar disorder. Interventions were categorised on the basis of type, and the context and effectiveness of the interventions were described. Two review authors independently extracted and assessed data, following criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. The GRADEPro (McMaster University, 2020, Ontario, Canada) was used for assessing the quality of the evidence. Twenty-three publications met the selection criteria. Different types of interventions aiming to improve adherence were tested: educational, behavioural, family-based, technological, or a combination of previous types. Meta-analysis could be performed for 10 interventions. When considered separately by subgroups on the basis of intervention type, no significant differences were found in adherence among interventions (p = 0.29; I2 = 19.9%). This review concluded that successful interventions used a combination of behavioural and educational approaches that seem easy to implement in daily practice.

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Asthma out of control? A structured review of recent patient surveys

BMC Pulmonary Medicine ◽

10.1186/1471-2466-6-s1-s2 ◽

2006 ◽

Vol 6 (S1) ◽

Cited By ~ 40

Author(s):

Stephen T Holgate ◽

David Price ◽

Erkka Valovirta

Keyword(s):

Meta Analysis ◽

Treatment Options ◽

Symptom Control ◽

Asthma Management ◽

Daily Practice ◽

Patient Perspectives ◽

Patient Centered ◽

Disease Etiology ◽

Patient Surveys ◽

Key Issues

Abstract Background An understanding of the needs and behaviors of asthma patients is important in developing an asthma-related healthcare policy. The primary goal of the present review was to assess patient perspectives on key issues in asthma and its management, as captured in patient surveys. Methods Local, national, and multinational asthma surveys were reviewed to assess patient perspectives, and where possible healthcare provider (HCP) perspectives, on key issues, including diagnosis, treatment, control, quality of life, and other patient-centered outcomes. Twenty-four surveys, conducted or published between 1997 and 2003 in Europe and North America, were included in this review. Substantial differences among studies prevented a formal meta-analysis; instead, data were pooled to allow for general comparisons and qualitative analysis. Results The results indicate that patients' knowledge of the underlying causes of asthma and treatment options remains inadequate. Moreover, patients often tolerate poor symptom control, possess meager knowledge of correct drug usage, and display insufficient adherence to therapy. Many patients have a low expectation of receiving an appropriate therapy or of having a positive encounter with the HCP. Among HCPs, there is evidence of inadequate understanding of disease etiology and poor or unstructured communication with patients, resulting often in inaccurate assessment of disease severity. Moreover, patients often underreport their symptoms and severity, which in turn could lead to misclassification and undertreatment. Conclusion Improving patient education about the importance of achieving optimal asthma control, along with improved communication between patients and HCPs, emphasizing treatment options and optimal treatment of inflammation, may lead to better outcomes and improved asthma management in daily practice.

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