Comparative Effectiveness of Glycyrrhizic Acid Preparations Aimed at Preventing and Treating Anti-Tuberculosis Drug-Induced Liver Injury: A Network Meta-Analysis of 97 Randomized Controlled Trials

Phytomedicine ◽  
2022 ◽  
pp. 153942
Author(s):  
Jin-Yu Gong ◽  
Huan Ren ◽  
Si-Yin Peng ◽  
Kai Xing ◽  
Li Fan ◽  
...  
Keyword(s):  
Liver Injury ◽  
Randomized Controlled Trials ◽  
Comparative Effectiveness ◽  
Glycyrrhizic Acid ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Randomized Controlled

scholarly journals Prophylactic Therapy of Silymarin (Milk Thistle) on Antituberculosis Drug-Induced Liver Injury: A Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Lina Tao ◽  
Xiaoyu Qu ◽  
Yue Zhang ◽  
Yanqing Song ◽  
Si-xi Zhang
Keyword(s):  
Liver Injury ◽  
Liver Function ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Prophylactic Therapy ◽  
Antituberculosis Drug ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Randomized Controlled

Background. Prophylactic therapy with silymarin to prevent the development of antituberculosis drug-induced liver injury (anti-TB DILI) has been under debate. We aimed to evaluate the effect of silymarin in the prevention of anti-TB DILI. Methods. We searched MEDLINE, PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) up to 30th November 2018. Randomized controlled trials (RCTs) that compared silymarin and placebo to prevent anti-TB DILI were included. All statistical analyses were conducted using STATA 12.0 software. Standardized mean difference (SMD) and risk ratio (RR) with 95% confidence intervals (CIs) were used to evaluate the effect of silymarin. The quality of included studies was assessed according to Cochrane handbook. Funnel plots and Egger’s tests were carried out to evaluate publication bias. Sensitivity analysis was conducted to assess the influence of each study. Results. A total of 1198 patients from five RCTs (585 with silymarin and 613 with placebo groups) were included. Overall, silymarin significantly reduced the occurrence of anti-TB DILI at week 4 [RR: 0.33, 95% CI (0.15, 0.75)]. In addition, silymarin exerted protective effect on liver function in patients undergoing anti-TB drugs [SMD = − 0.15, 95% CI (−0.24, −0.07), P < 0.001 (ALT); SMD =−0.14, 95% CI (−0.23, −0.06), P = 0.001(AST); SMD =−0.12, 95% CI (−0.20, −0.03), P = 0.008 (ALP)]. Silymarin led to similar AEs in placebo groups [OR: 1.09, 95% CI (0.86, 1.39), P = 0.47]. Conclusion. Prophylactic therapy of silymarin is contributed to a noticeably reduced risk of development of anti-TB DILI four weeks after the initiation. In addition, silymarin significantly improved the liver function in patients who are receiving anti-TB drugs.

Comparative effectiveness of systemic treatments for metastatic castration-sensitive prostate cancer: A parametric survival network meta-analysis of randomized controlled trials.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 5532-5532
Author(s):  
Lin Wang ◽  
Channing Judith Paller ◽  
Hwanhee Hong ◽  
Anthony De Felice ◽  
Caleb Alexander ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Randomized Controlled Trials ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Time Varying ◽  
Randomized Controlled ◽  
Systemic Treatments ◽  
Parametric Survival

5532 Background: Treatment decision-making for metastatic castration-sensitive prostate cancer (mCSPC) is complicated by the unclear comparative effectiveness and widely varying costs of competing strategies. Objective: To compare the effectiveness and safety of systemic treatments for mCSPC. Methods: We searched bibliographic databases, regulatory documents, and trial registries for randomized controlled trials testing active drugs added to androgen deprivation therapy (ADT) for mCSPC. We used Cochrane risk-of-bias tool (version 2) to assess trial quality and Bayesian network meta-analysis (NMA) to estimate the relative effects of competing treatments. In addition to combing published time-invariant hazard ratios (HRs), we reconstructed survival data from Kaplan Meier curves to enable parametric survival NMA that allows time-varying HR. Results: Seven trials with 7,236 patients were included comparing six treatments (Table). Risk of bias is a concern for trials with open label (N=4), missing data (N=3), or unprespecified analysis (N=3). Ordered from the most to the least effective, treatments significantly improving overall survival (OS) include abiraterone acetate, apalutamide, and docetaxel; treatments significantly improving radiographic progression-free survival (rPFS) include enzalutamide, abiraterone, apalutamide, and docetaxel. (see HRs in Table) Allowing time-varying HR produced similar treatment rankings. Serious adverse events (SAE) were substantially increased for docetaxel (odds ratio [OR] 104.17, 95% credible interval [CI] 24.85-1012.32) and slightly increased for abiraterone (OR 1.42, 95% CI 1.11-1.83). Conclusions: Abiraterone provided the largest OS benefit with slightly increased risk of SAE. Apalutamide offered comparable OS benefit with abiraterone without increasing SAE risk. Although enzalutamide delayed rPFS to the greatest extent, longer follow-up is needed to examine its OS benefit. [Table: see text]

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