Efficacy and safety of iguratimod combined with methotrexate vs. methotrexate alone in rheumatoid arthritis

AbstractThe current systematic review and meta-analysis aims to evaluate the efficacy and safety of iguratimod (IGU) combined with methotrexate (MTX) versus MTX alone in rheumatoid arthritis (RA). Two independent investigators searched for original randomized controlled trials (RCTs) related to the combination of IGU and MTX in RA published before November 1, 2019, in PubMed, Cochrane Library, Embase, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), and WanFang Data. Additionally, we searched clinical trial registry websites. We assessed the methodological quality of the included trials using the Cochrane Collaboration tool and the seven-point Jadad scale. Statistical analyses were performed using Review Manager (RevMan) 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Meta-regression and publication bias analyses were performed using Stata version 14 software (StataCorp., College Station, TX, USA). A total of 7 RCTs consisting of 665 participants, with 368 participants in the active arm and 297 in the placebo arm, were included in the meta-analysis. The American College of Rheumatology (ACR) value was better in the IGU + MTX group than in the MTX alone group, with a pooled relative risk (RR) for ACR20 (American College of Rheumatology 20% improvement criteria), ACR50, and ACR70 of 1.40 (95% CI, 1.13–1.74), 2.09 (95% CI, 1.67–2.61), and 2.24 (95% CI, 1.53–3.28), respectively. The results of the meta-analysis demonstrated that there was no statistical significance in adverse events (1.06 (95% CI, 0.92–1.23)). The combined treatment is an effective, safe, and economical treatment option for patients who do not respond well to methotrexate alone or for patients who cannot afford expensive biologics that have no confirmed efficacy.

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Chinese traditional medicine (GuiZhi-ShaoYao-ZhiMu decoction) as an add-on medication to methotrexate for rheumatoid arthritis: a meta-analysis of randomized clinical trials

Therapeutic Advances in Chronic Disease ◽

10.1177/2040622321993438 ◽

2021 ◽

Vol 12 ◽

pp. 204062232199343

Author(s):

Chenxi Feng ◽

Rongrong Chen ◽

Keer Wang ◽

Chengping Wen ◽

Zhenghao Xu

Keyword(s):

Rheumatoid Arthritis ◽

English Language ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Effective Rate ◽

Cochrane Library ◽

Efficacy And Safety ◽

Tender Joint ◽

American College Of Rheumatology ◽

Language Studies

Background: GuiZhi-ShaoYao-ZhiMu decoction (GSZD), a traditional Chinese herbal medication, has been frequently used as an add-on medication to methotrexate (MTX) for rheumatoid arthritis (RA) treatment in China. This meta-analysis evaluated the efficacy and safety of adding GSZD to MTX for RA treatment. Methods: We performed a systematic search of PubMed, Web of Science, EMBASE, and the Cochrane Library (all databases) for English-language studies and WanFang, VIP, and CNKI for Chinese-language studies up to 28 July 2020. Data from selected studies, mainly the response rates and rate of adverse events (AEs), were extracted independently by two authors, and a random-effects model (Mantel–Haenszel method) was used for the meta-analysis. Results: A total of 14 randomized controlled trials and 1224 patients were included (623 patients in the GSZD + MTX group and 601 patients in the MTX group). For efficacy, the meta-analysis found that combining GSZD with MTX increased the effective rate [relative risk (RR) = 1.24, 95% confidence interval (CI): 1.18–1.30, based on 1069 patients], defined as >30% efficacy, American College of Rheumatology 20, or a decrease of disease activity score 28 >0.6. Adding GSZD reduced the swollen and tender joint counts, the duration of morning stiffness, the levels of C-reactive protein and rheumatoid factor, and erythrocyte sedimentation rate. The adjuvant therapeutic effect of GSZD was independent of the dose of MTX or the combined utilization of other drugs in both groups. For safety, adding GSZD was associated with a lower rate of total AEs (RR = 0.46, 95% CI: 0.26–0.83, based on 615 patients) and gastrointestinal tract AEs (RR = 0.46, 95% CI: 0.24–0.88, based on 537 patients). Conclusion: Combining GSZD with MTX may be a more efficacious and safer strategy for treating RA compared with MTX alone. Further large studies are warranted to investigate the long-term efficacy and safety of adding GSZD to MTX for RA treatment.

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Efficacy and Safety of Endoscopic Intralesional Triamcinolone Injection for Benign Esophageal Strictures

Gastroenterology Research and Practice ◽

10.1155/2018/7619298 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7 ◽

Cited By ~ 3

Author(s):

Ya-Wu Zhang ◽

Feng-Xian Wei ◽

Xue-Ping Qi ◽

Zhao Liu ◽

Xiao-Dong Xu ◽

...

Keyword(s):

Meta Analysis ◽

Cochrane Collaboration ◽

Cochrane Library ◽

Efficacy And Safety ◽

Stricture Rate ◽

Increased Risk ◽

Esophageal Strictures ◽

Triamcinolone Injection ◽

The Cochrane Collaboration ◽

The Cochrane Library

Objectives.To evaluate the efficacy and safety of endoscopic intralesional triamcinolone injection (ITI) for benign esophageal strictures combined with endoscopic dilation (ED).Methods.Online databases including MEDLINE, EMBASE, the Cochrane Library, and Web of Science were comprehensively searched for prospective randomized control trials (RCTs) between 1966 and March 2018. A meta-analysis was conducted according to the methods recommended by the Cochrane Collaboration.Results.Six RCTs consisting of 176 patients were selected. Meta-analysis results showed that additional ITI had a significant advantage in terms of stricture rate and required ED sessions. Surgery-related and non-surgery-related strictures showed similar results. Additional ITI was not associated with significantly increased risk of complications.Conclusions. Our meta-analysis showed that additional ITI therapy was supposed to be effective and safe for benign esophageal strictures as it reduced the stricture rate and required ED sessions. However, more RCTs are necessary to support these findings.

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Does propofol ameliorate occurrence of postoperative cognitive dysfunction after general anaesthesia? A protocol of systematic review

Systematic Reviews ◽

10.1186/s13643-021-01610-y ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Xi Zhao ◽

Ze-qing Huang

Keyword(s):

Systematic Review ◽

Cognitive Dysfunction ◽

Short Term Memory ◽

Meta Analysis ◽

Postoperative Cognitive Dysfunction ◽

Biomedical Literature ◽

Cochrane Library ◽

Efficacy And Safety ◽

China National Knowledge Infrastructure

Abstract Background Postoperative cognitive dysfunction (POCD) is a common condition after general anesthesia (GA). Previous studies have reported that propofol can ameliorate the occurrence of such disorder. However, its results are still inconsistent. Therefore, this systematic review will assess the efficacy and safety of propofol on POCD after GA. Methods Literature sources will be sought from inception to the present in Cochrane Library, MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure for randomized controlled trials (RCTs) assessing the administration of propofol on POCD after GA. All searches will be carried out without limitations to language and publication status. Outcomes comprise of cognitive impairments changes, impairments in short-term memory, concentration, language comprehension, social integration, quality of life, and adverse events. Cochrane risk of bias tool will be utilized to assess study quality. We will evaluate the quality of evidence for each outcome using Grading of Recommendations Assessment, Development and Evaluation approach. A narrative synthesis or a meta-analysis will be undertaken as appropriate. Discussion This study will systematically and comprehensively search literature and integrate evidence on the efficacy and safety of propofol on POCD after GA. Our findings will be of interest to clinicians and health-related policy makers. Systematic review registration PROSPERO CRD42020164096

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Efficacy and Safety of Integrated Traditional Chinese Medicine and Western Medicine on the Treatment of Rheumatoid Arthritis: A Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/4348709 ◽

2020 ◽

Vol 2020 ◽

pp. 1-15 ◽

Cited By ~ 3

Author(s):

Qi Xing ◽

Ling Fu ◽

Zhichao Yu ◽

Xueping Zhou

Keyword(s):

Rheumatoid Arthritis ◽

Chinese Medicine ◽

Treatment Group ◽

Traditional Chinese Medicine ◽

Western Medicine ◽

Meta Analysis ◽

Cochrane Library ◽

Integrative Treatment ◽

Efficacy And Safety ◽

Integrated Therapy

Objective. Integrated therapy of traditional Chinese medicine (TCM) and Western medicine (WM) has gradually been applied to the treatment of rheumatoid arthritis (RA). Recently published studies have provided a wealth of data and information about the effectiveness of combination treatments, but high-quality evidence-based meta-analysis on this issue is not available yet. This study was conducted to compare and evaluate the efficacy and safety of the integrated therapy for RA. Methods. PubMed, EMBASE, and the Cochrane Library were searched up to January 2020. Randomized controlled trials (RCTs) that compared the efficacy and safety of integrative TCM-WM with WM alone for RA were included. The outcome measures contained therapeutic effects (TEs), tender joint count (TJC), swollen joint count (SJC), duration of morning stiffness (DMS), grip strength (GS), disease activity score in 28 joints (DAS28), rheumatoid factor (RF), anti-cyclic peptide containing citrulline (anti-CCP), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and adverse events (AEs) to assess the efficacy and safety of different treatments. Results. A total of 20 RCTs with 2269 patients met the inclusion criteria. TCM used in these studies included Chinese herbal decoctions and tablets or capsules made from herbs and their extracts, while WM included disease-modifying antirheumatic drugs (DMARDs), nonsteroidal anti-inflammatory drugs (NSAIDs), and glucocorticoids (GC). Compared with patients receiving WM treatment alone, patients with integrative TCM-WM treatment showed better TEs (OR = 3.03, 95% CI [2.36, 3.88]). The integrative treatment group showed reductions in TJC (MD = −1.17, 95% CI [−2.12, −0.21]), SJC (MD = −0.87, 95% CI [−1.85, 0.10]), DMS (SMD = −0.69, 95% CI [−0.98, −0.41]), DAS28 (MD = −0.43, 95% CI [−0.57, −0.29]), RF (SMD = −0.59, 95% CI [−0.91, −0.27]), anti-CCP (SMD = −0.21, 95% CI [−0.36, −0.06]), ESR (MD = −8.36, 95% CI [−12.60, −4.12]), and CRP (MD = −6.73, 95% CI [−9.38, −4.08]), and increment in GS (SMD = 0.12, 95% CI [−0.63, 0.87]). AEs, especially gastrointestinal disorders, abnormal liver function, leukopenia, skin allergies and rashes, headaches and dizziness, and alopecia, significantly decreased (OR = 0.37, 95% CI [0.29, 0.47]) in the integrative treatment group. Conclusions. The findings of this meta-analysis indicate that integrative TCM-WM could obtain effective and safe results in the treatment of RA. Using TCM as an adjunctive therapy in RA has great prospects for further development.

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Tuina for spasticity of poststroke: protocol of a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-038705 ◽

2020 ◽

Vol 10 (12) ◽

pp. e038705

Author(s):

Qiongshuai Zhang ◽

Guangcheng Ji ◽

Fang Cao ◽

Yihan Sun ◽

Guanyu Hu ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Short Form ◽

Meta Analysis ◽

Biomedical Literature ◽

Primary Data ◽

Cochrane Library ◽

Efficacy And Safety ◽

Quality Of Life Scale

IntroductionSpasticity is a common complication of poststroke, tuina is a widely used rehabilitation treatment, although there is a lack of supportive evidence on efficacy and safety for patients with poststroke spasticity. The aim of this systematic review is to assess and synthesis evidence of efficacy and safety of tuina for spasticity of poststroke.Methods and analysisA comprehensive electronic search of EMBASE, MEDLINE, Cochrane Library, Web of Science, Wiley, Springer, PEDro, Chinese Science Citation Database, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific and Journal Database (VIP), Wanfang Database (Wanfang), Japanese medical database (CiNii), Korean Robotics Institute Summer Scholars and Thailand Thai-Journal Citation Index Centre will be conducted to search literatures of randomised controlled trials of tuina for spasticity of poststroke survivors range from the establishment to 1 January 2020.There is no time of publication limitations. The primary outcome will be measured with the Modified Ashworth Scale, and the second outcome will include Fugl-Meyer Assessment Scale, surface electromyogram RMS value, the Modified Barthel Index, Stroke Specific Quality of Life Scale, quality of life 36-Item Short-Form Health Survey and Visual Analogue Scale. Cochrane Handbook for Systematic Reviews of Interventions will be used to assess the risk of bias, and GRADE will be used to access the confidence in cumulative evidence. The protocol will be conducted according to approach and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015.Ethics and disseminationEthical approval will not be required, for no primary data of individual patients were collected. We will publish the findings in a peer-reviewed journal.PROSPERO registration numberCRD42020163384.

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Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-211836 ◽

2017 ◽

Vol 77 (1) ◽

pp. 98-103 ◽

Cited By ~ 78

Author(s):

Claire Rempenault ◽

Bernard Combe ◽

Thomas Barnetche ◽

Cécile Gaujoux-Viala ◽

Cédric Lukas ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Inflammatory Diseases ◽

Meta Analysis ◽

Survival Rates ◽

Cochrane Library ◽

Diabetes Incidence ◽

American College Of Rheumatology ◽

European League Against Rheumatism ◽

Mean Differences ◽

High Density Cholesterol

ObjectiveCardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Hydroxychloroquine (HCQ) has been shown to improve survival rates in other inflammatory diseases. We aimed to assess the available literature on the cardiovascular impact of HCQ in patients with RA.MethodsWe systematically searched for studies evaluating the effects of HCQ on cardiovascular outcomes of known risk factors for CVD in patients with RA. Databases searched were MEDLINE (via PubMed), EMBase, Cochrane Library and the American College of Rheumatology and European League Against Rheumatism annual meetings. A meta-analysis was performed with a random-effects model, estimating mean differences (MDs), HRs and 95% CIs. Data were extracted by one investigator and independently checked by another.ResultsThe literature search revealed 185 articles and abstracts of interest; further examination resulted in 16 studies fulfilling the criteria. The MDs between HCQ users and non-users in levels of total, low-density and high-density cholesterol and triglycerides were −9.8 (95% CI −14.0 to −5.6), −10.6 (95% CI −14.2 to −7.0), +4.1 (95% CI 2.2 to 6.0) and −19.2 (95% CI −27.2 to −11.1), respectively. Diabetes incidence was lower for HCQ ever users than never users (HR 0.59 (95% CI 0.49 to 0.70)). HCQ seemed to decrease insulin resistance and incidence of CVD, but data were too few for meta-analysis.ConclusionBesides its limited efficacy for disease activity and progression, HCQ may benefit the metabolic profile and to a lesser extent cardiovascular events in patients with RA, which suggests its usefulness combined with other conventional synthetic disease-modifying antirheumatic drugs.

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Unravelling the Ameliorative Effects of Probiotics in Rheumatoid Arthritis: A Meta-analysis of Randomized, Controlled Trials

10.21203/rs.3.rs-1055162/v1 ◽

2021 ◽

Author(s):

Dongsong Liu ◽

Qin Xu ◽

Feng Zhang ◽

Hong Cao ◽

Xuesong Wang

Keyword(s):

Rheumatoid Arthritis ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Joint Inflammation ◽

Cochrane Library ◽

Controlled Trials ◽

Tender Joint ◽

Randomized Controlled ◽

American College Of Rheumatology ◽

Hs Crp

Abstract Background: Recent studies have shown that rational regulation of the gut microbiota, known as probiotic supplements, have beneficial consequences on rheumatoid arthritis (RA). However, their efficacy as an adjunct therapy remains controversial. Methods: PubMed, Embase, Scopus, Web of science and Cochrane Library was performed to retrieve the existing data from the published randomized, controlled trials (RCTs) comparing probiotics with placebo in RA through August 2021. Among eight RCTs were eligible for inclusion in this meta-analysis, and all data were analyzed by StataSE 12.1 software. Results: The probiotic has achieved significant improvement in visual analogue scales (VAS), high sensitive C-reactive protein (hs-CRP), tumor necrosis factor (TNF-α) and interleukin (IL-1β). Probiotic may have a beneficial role in disease activity score in 28 joints (DAS28). However, probiotic does not have a significant effect on tender joint, swollen joint and lipid levels and not yet achieve obvious improvement in American College of Rheumatology 20% improvement criteria (ACR20). Conclusion: Probiotics have a beneficial effect on improving RA to some extent, especially on alleviating joint inflammation. However, the number of studies was too small to determine if a strain-, dose-, or duration-response effect was present. More multi-centered, large-sample RCTs are needed to explore the benefits of probiotic to RA patients in the future.

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Efficacy and Safety of Keluoxin Capsule in the Treatment of Diabetic Kidney Disease

10.21203/rs.3.rs-1111126/v1 ◽

2021 ◽

Author(s):

Jingxin Zhou ◽

Wenhua Zhang ◽

Jie Yang ◽

Qiaoqiao Liu ◽

Yizhen Lu ◽

...

Keyword(s):

Systematic Review ◽

Kidney Disease ◽

Diabetic Kidney Disease ◽

Meta Analysis ◽

Risk Of Bias ◽

Biomedical Literature ◽

Health Concern ◽

Cochrane Library ◽

Efficacy And Safety ◽

Diabetic Kidney

Abstract Background: Diabetic kidney disease (DKD), which is a serious complication of diabetes and the leading cause of end-stage renal disease, becomes a major health concern worldwide. Keluoxin capsule, a Chinese patent medicine used for DKD, has been widely used in diabetic kidney disease, but its efficacy and safety have not yet been clarified. Therefore, the aim of this systematic review and meta-analysis is to summarize the efficacy and safety of Keluoxin capsule in the treatment of DKD. Methods: A systematic literature search will be conducted in PubMed, Cochrane Library, EMBASE, China National Knowledge Infrastructure, WANFANG database, VIP, SinoMED, and Chinese Biomedical Literature Database (CBM) to ensure all possible randomized controlled trials (RCT) studies on K eluoxin capsule to November 1, 2021. The primary outcome to be assessed will include the change in albuminuria and estimated glomerular filtration rate (eGFR), while secondary outcomes will be serum creatinine, blood urea nitrogen, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol, and triglycerides, etc and adverse events. The quality of the included studies and the risk of bias will be independently assessed by two reviewers using the risk of bias assessment tool from Cochrane Handbook. We will conduct random-effects model meta-analysis using Review Manager software (Revman5.3). Discussion: This systematic review and meta-analysis will objectively evaluate the effect of Keluoxin capsule for DKD, and provide evidence for Keluoxin capsule in the treatment of DKD. Ethics and dissemination : Ethics approval is not required for this study. We aim to publish the results of this systematic review in a peer-reviewed journal. INPLASY registration number: INPLASY 2021110067.

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Facial Alveolar Bone Thickness and Modifying Factors of Anterior Maxillary Teeth: A Systematic Review and Meta-Analysis of Cone-Beam Computed Tomography Studies

10.21203/rs.3.rs-35757/v1 ◽

2020 ◽

Author(s):

Julio Rojo-Sanchis ◽

David Soto-Peñaloza ◽

David Peñarrocha-Oltra ◽

Miguel Peñarrocha-Diago ◽

Jose Viña-Almunia

Keyword(s):

Alveolar Bone ◽

Meta Analysis ◽

Cochrane Collaboration ◽

Cochrane Library ◽

Asian Populations ◽

Modifying Factors ◽

Secondary Objective ◽

Maxillary Premolars ◽

Maxillary Incisors ◽

The Cochrane Collaboration

Abstract Background: Understanding the anatomy of the facial alveolar bone (FAB), provides a prognostic tool for estimating the degree of dimensional ridge alterations after tooth extraction. This study aimed to systematically review the FAB thickness of anterior maxillary teeth measured by CBCT scans. A secondary objective was to assess the facial distance from the cementoenamel junction (CEJ) to the bone crest.Methods: An electronic search was made of Medline, Embase, Web of Science, Cochrane Library and Google Scholar up to December 2019. Studies that analyze and quantitatively compare FAB thickness at maxillary teeth by CBCT scans were included. The methodological quality of the included studies was appraised using the ROBINS-I tool from the Cochrane Collaboration. A meta-analysis of single means, subgroup analysis and meta-regression of covariates were conducted.Results: Twenty-nine studies, including 17,321 teeth, were selected. Seventeen studies considered the facial bone crest, and 12 the CEJ as a reference point for their measurements. Mean FAB thickness was ≤ 1 mm in maxillary incisors and canines (0.75-1.05 mm) and 1-2 mm in premolars. Patients over 50 years of age and females exhibited a thinner FAB at some apico-coronal locations of maxillary incisors and canines. Thicker gingival phenotypes were associated with a thicker FAB in maxillary incisors and canines. The geographical setting proved to be an effect modifier that could explain up to 87% of the heterogeneity in FAB thickness, being Asian populations that showed the lowest FAB thickness values. The CEJ-bone crest distance was 2-2.5 mm in all teeth analyzed. Population over 50 years of age exhibited greater CEJ-bone crest distances, and males also showed a trend for greater distance. The prevalence of bone dehiscences at maxillary incisors and canines was 12.3-20.1%; while the prevalence of fenestrations was between 6.4% and 23.8%.Conclusions: Facial alveolar bone is thin, heterogeneous in width along its apico-coronal dimensions, and increases in thickness in maxillary premolars. The prevalence of < 1 mm FAB thickness was 69.9% in central incisors, 64.5% in lateral incisors, 55% in canines and 40.4% at first premolars. The CEJ-bone crest distance presented homogeneous and similar values in all teeth analyzed.

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The Efficacy and Safety of Simple-Needling Therapy for Treating Ankylosing Spondylitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2020/4276380 ◽

2020 ◽

Vol 2020 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Yichen Xuan ◽

Hui Huang ◽

Yiyong Huang ◽

Duanyong Liu ◽

Xiuwu Hu ◽

...

Keyword(s):

Systematic Review ◽

Ankylosing Spondylitis ◽

Randomized Controlled Trials ◽

Chinese Literature ◽

Meta Analysis ◽

Biomedical Literature ◽

Cochrane Library ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled

Background. Clinical investigators have found that the use of needling in the treatment of ankylosing spondylitis (AS) has a good clinical application prospect in recent years. However, these studies were insufficient to provide evidence for the efficacy and safety of simple-needling for AS. So, we performed a systematic review and meta-analysis to evaluate the efficacy and safety of simple-needling for treating AS. Methods. We searched the PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wangfang database (Wanfang), Chinese Science and Technology Periodical Database (VIP), and any other gray literature sources for randomized controlled trials (RCTs) that used simple-needling to treat AS before June 2019 with the language restriction of Chinese and English. Researchers evaluated the retrieved literature studies and extracted valid data according to relevant requirements and used RevMan5.3 software for meta-analysis. Results. A total of 10 studies were included, all of which were Chinese literature studies, involving 729 patients. Compared with the control groups, simple-needling groups had a better effect on the clinical effective rate (RR = 1.20, 95% CI (1.11, 1.29), P<0.00001), TCM syndrome score (MD = −5.26, 95% CI (−5.99, −4.53), P<0.00001), symptom score (MD = −8.08, 95% CI (−10.18, −5.97), P<0.00001), and Schober test outcome (MD = 0.39, 95% CI (0.15, 0.64), P=0.002). Sensibility analysis was based on the leave-one-out cross-validation procedure, and the results showed no significant changes. Most studies did not describe adverse reactions. The funnel plot suggested publication bias on clinical effectiveness. Conclusions. This systematic review and meta-analysis demonstrated that simple-needling was effective as an intervention for AS. However, due to the low quality of the methodology of included studies, the designs of clinical trials were not rigorously standardized. Therefore, it is necessary to carry out multiquality RCTs for verification.

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