Association between use of antiepileptic drugs and fracture risk: A systematic review and meta-analysis

Objective Our study aimed to assess the risk of all fractures and hip fractures in patients with atrial fibrillation (AF) who took non-vitamin K antagonist oral anticoagulants (NOACs) compared to warfarin. Methods We searched PubMed, Embase, and Cochrane Library and Clinical Trials.gov Website. Reviewed related researches up to January 31, 2020, to identify studies with more than 12 months of follow-up data. The protocol for this systematic review and meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO Number: CRD42020156893). Results We included five RCT studies, and five observational studies that contained a total of 326,846 patients in our meta-analysis. Our meta-analysis showed that patients taken NOACs had no significant all fracture risk (RR = 0.91, 95% CI [0.81–1.01]) and hip fracture risk (RR = 0.92, 95% CI [0.82–1.03]) compared with those taken warfarin. Subanalysis showed that the risk of all fractures and hip fractures treated by NOACs were significant lower compared with warfarin in observational studies compared with RCT studies. Also, a subanalysis across the duration of anticoagulation showed the NOACs users have lower all fracture risk than warfarin users when the duration of anticoagulation ≤2 years (RR = 0.89, 95% CI [0.80–0.99]). Further analysis, significant lower all fracture risk in the rivaroxaban therapy (RR = 0.81; 95% CI [0.76–0.86]) compared with warfarin but no statistical significance in hip fracture. There were no significant difference of all fracture risk and hip fracture risk in dabigatran, apixaban, and edoxaban therapy compared with warfarin. Conclusion The meta-analysis demonstrated that NOACs associated with a significantly lower all fracture risk compared with warfarin when the duration of anticoagulation more than 2 years. Rivaroxaban users had lower risk of all fracture than warfarin users in AF patients. But there was no evidence to verify apixaban, edoxaban, and dabigatranin could decrease all fracture and hip fracture risk compared with warfarin.

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Effects of Anti-Diabetic Drugs on Fracture Risk: A Systematic Review and Network Meta-Analysis

Frontiers in Endocrinology ◽

10.3389/fendo.2021.735824 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yu-Sheng Zhang ◽

Yan-Dan Zheng ◽

Yan Yuan ◽

Shi-Chun Chen ◽

Bao-Cheng Xie

Keyword(s):

Systematic Review ◽

Fracture Risk ◽

Meta Analysis ◽

Statistical Significance ◽

Treatment Strategies ◽

Sex Distribution ◽

Risk Of Fracture ◽

Dipeptidyl Peptidase 4 ◽

Combining Data ◽

Glucagon Like Peptide 1

PurposeAvailable data on the effects of anti-diabetic drugs on fracture risk are contradictory. Therefore, our study aimed to analyze all available data on the effects of anti-diabetic drugs on fracture risk in type 2 diabetes mellitus (T2DM) patients.MethodsEmbase, Medline, ClinicalTrials.gov, and Cochrane CENTRAL were searched for relevant trials. All data analyses were performed with STATA (12.0) and R language (3.6.0). Risk ratio (RR) with its 95% confidence interval (CI) was calculated by combining data for the fracture effects of anti-diabetic drugs, including sodium–glucose co-transporter 2 (SGLT2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, meglitinides, α-glucosidase inhibitors, thiazolidinediones, biguanides, insulin, and sulfonylureas.ResultsOne hundred seventeen eligible randomized controlled trials (RCTs) with 221,364 participants were included in this study. Compared with placebo, trelagliptin (RR 3.51; 1.58–13.70) increased the risk of fracture, whereas albiglutide (RR 0.29; 0.04–0.93) and voglibose (RR 0.03; 0–0.11) decreased the risk of fracture. Other medications were comparable in terms of their effects on fracture risk, and no statistical significance was observed. In terms of fractures, voglibose (0.01%) may be the safest option, and trelagliptin (13.64%) may be the worst. Sensitivity analysis results were consistent with those of the main analysis. No statistically significant differences were observed in the regression coefficients of age (1.03; 0.32–2.1), follow-up duration (0.79; 0.27–1.64), and sex distribution (0.63; 0.15–1.56).ConclusionsWe found varied results on the association between the use of anti-diabetic drugs and fracture risk. Specifically, trelagliptin raised the risk of fracture, whereas voglibose and albiglutide showed benefit with statistical difference. Other drugs were comparable in terms of their effects on fracture risk. Some drugs (omarigliptin, sitagliptin, vildagliptin, saxagliptin, empagliflozin, ertugliflozin, rosiglitazone, pioglitazone, and nateglinide) may increase the risk of fracture, while others (such as dulaglutide, exenatide, liraglutide, semaglutide, lixisenatide, linagliptin, alogliptin, canagliflozin, dapagliflozin, glipizide, gliclazide, glibenclamide, glimepiride, metformin, and insulin) may show benefits. The risk of fracture was independent of age, sex distribution, and the duration of exposure to anti-diabetic drugs. When developing individualized treatment strategies, the clinical efficacy of anti-diabetic drugs must be weighed against their benefits and risks brought about by individual differences of patients.Systematic Review RegistrationThis Systematic Review was prospectively registered on the PROSPERO (https://www.crd.york.ac.uk/PROSPERO/, registration number CRD42020189464).

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Treatment Outcome of Epileptic Patients Receiving Antiepileptic Drugs in Ethiopia: A Systematic Review and Meta-Analysis

Behavioural Neurology ◽

10.1155/2021/5586041 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Taklo Simeneh Yazie ◽

Belayneh Kefale ◽

Mulugeta Molla

Keyword(s):

Systematic Review ◽

Treatment Outcome ◽

Antiepileptic Drugs ◽

Addis Ababa ◽

Meta Analysis ◽

Age Groups ◽

Seizure Freedom ◽

Pharmacoresistant Epilepsy ◽

Pooled Prevalence ◽

Epileptic Patients

Background. The prevalence and incidence rate of epilepsy were found to be higher in low- and middle-income countries. Uncontrolled epilepsy has a high risk of disability, stigma, discrimination, human rights violations, and premature death. The available studies of controlled seizure in Ethiopia have showed inconsistent results which calls for systematic review and meta-analysis. Therefore, this review intended to show the pooled prevalence of controlled seizure among people with epilepsy receiving antiepileptic drugs at outpatient department. Methods. A systematic literature search was conducted using PubMed/Medline, Science Direct, PsycINFO, Hinnarri databases, and Google Scholar for grey literatures. Data were extracted with structured format prepared using Microsoft Excel and exported to Stata/MP 16.0 software for analyses. The I 2 test was used to check the heterogeneity between primary studies with a corresponding 95% confidence interval (CI). Results. A total of 23 primary studies were included in the review showing the pooled prevalence of controlled seizure to be 46% (95% CI: 35, 56). A subgroup analysis of the primary studies showed a considerable variation in magnitude of seizure freedom by study regions, age groups, and seizure-free period. The highest prevalence was found in Addis Ababa 52% (95% CI: 29, 75), pediatric patients 77% (95% CI: 71, 83), and a seizure-free period of less than six months 58% (95% CI: 32, 83). On the other hand, the lowest prevalence of controlled seizure was found in Tigray 27% (95% CI: 11, 65), adult patients 43% (95% CI: 32, 54), and a seizure-free period of six or more 41% (95% CI: 32, 51). Higher frequency of seizure before treatment (2.23, 95% CI: 1.15, 3.31) and medication nonadherence (2.7, 95% CI: 1.25, 4.15) had statistically significant association with uncontrolled seizure. Conclusion. In this review, the prevalence of controlled seizure was found to be low. This warrants that clinicians should give more focus to epileptic patients regarding monitoring and evaluation of treatment outcome of epilepsy and factors that affect seizure control in routine clinical services. The use of standardized definition of controlled seizure, designing strategies to identify pharmacoresistant epilepsy and its treatment, and increasing medication adherence are recommended in Ethiopia. The review protocol has been registered with PROSPERO registration number CRD42021215302.

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Association ofABCB1gene polymorphisms and their haplotypes with response to antiepileptic drugs: a systematic review and meta-analysis

Pharmacogenomics ◽

10.2217/pgs.10.212 ◽

2011 ◽

Vol 12 (5) ◽

pp. 713-725 ◽

Cited By ~ 41

Author(s):

Batoul Sadat Haerian ◽

Kheng Seang Lim ◽

Chong Tin Tan ◽

Azman Ali Raymond ◽

Zahurin Mohamed

Keyword(s):

Systematic Review ◽

Antiepileptic Drugs ◽

Meta Analysis

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Authors’ Reply: Veganism, vegetarianism, bone mineral density, and fracture risk: a systematic review and meta-analysis

Nutrition Reviews ◽

10.1093/nutrit/nuz010 ◽

2019 ◽

Vol 77 (6) ◽

pp. 452-453

Author(s):

Isabel Iguacel ◽

María L Miguel-Berges ◽

Alejandro Gómez-Bruton ◽

Luis A Moreno ◽

Cristina Julian

Keyword(s):

Bone Mineral Density ◽

Systematic Review ◽

Fracture Risk ◽

Bone Mineral ◽

Meta Analysis ◽

Mineral Density

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Impact of antiepileptic drugs for seizure prophylaxis on short and long-term functional outcomes in patients with acute intracerebral hemorrhage: A meta-analysis and systematic review

Seizure ◽

10.1016/j.seizure.2019.04.017 ◽

2019 ◽

Vol 69 ◽

pp. 140-146 ◽

Cited By ~ 1

Author(s):

Brian Spoelhof ◽

Julian Sanchez-Bautista ◽

Andres Zorrilla-Vaca ◽

Peter W. Kaplan ◽

Salia Farrokh ◽

...

Keyword(s):

Systematic Review ◽

Intracerebral Hemorrhage ◽

Antiepileptic Drugs ◽

Functional Outcomes ◽

Meta Analysis ◽

Seizure Prophylaxis ◽

Short And Long Term ◽

Acute Intracerebral Hemorrhage

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Aspirin and fracture risk: a systematic review and exploratory meta-analysis of observational studies

BMJ Open ◽

10.1136/bmjopen-2018-026876 ◽

2020 ◽

Vol 10 (2) ◽

pp. e026876 ◽

Cited By ~ 2

Author(s):

A L Barker ◽

Sze-Ee Soh ◽

Kerrie M Sanders ◽

Julie Pasco ◽

Sundeep Khosla ◽

...

Keyword(s):

Systematic Review ◽

Fracture Risk ◽

Observational Studies ◽

Meta Analysis ◽

Large Population ◽

Mineral Density ◽

Random Effects Models ◽

Manual Search ◽

Relative Risks ◽

Hip Bmd

ObjectivesThis review provides insights into the potential for aspirin to preserve bone mineral density (BMD) and reduce fracture risk, building knowledge of the risk-benefit profile of aspirin.MethodsWe conducted a systematic review and exploratory meta-analysis of observational studies. Electronic searches of MEDLINE and Embase, and a manual search of bibliographies was undertaken for studies published to 28 March 2018. Studies were included if: participants were men or women aged ≥18 years; the exposure of interest was aspirin; and relative risks, ORs and 95% CIs for the risk of fracture or difference (percentage or absolute) in BMD (measured by dual energy X-ray absorptiometry) between aspirin users and non-users were presented. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Checklists for observational studies. Pooled ORs for any fracture and standardised mean differences (SMDs) for BMD outcomes were calculated using random-effects models.ResultsTwelve studies met the inclusion criteria and were included in the meta-analysis. Aspirin use was associated with a 17% lower odds for any fracture (OR 0.83, 95% CI 0.70 to 0.99; I2=71%; six studies; n=511 390). Aspirin was associated with a higher total hip BMD for women (SMD 0.03, 95% CI −0.02 to 0.07; I2=0%; three studies; n=9686) and men (SMD 0.06, 95% CI −0.02 to 0.13, I2=0%; two studies; n=4137) although these associations were not significant. Similar results were observed for lumbar spine BMD in women (SMD 0.03, 95% CI −0.03 to 0.09; I2=34%; four studies; n=11 330) and men (SMD 0.08; 95% CI −0.01 to 0.18; one study; n=432).ConclusionsWhile the benefits of reduced fracture risk and higher BMD from aspirin use may be modest for individuals, if confirmed in prospective controlled trials, they may confer a large population benefit given the common use of aspirin in older people.

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