Meta-Analysis of Controlled Pharmacologic Trials

1997 ◽  
Vol 8 (S3) ◽  
pp. 375-379 ◽  
Author(s):  
Lon S. Schneider
Keyword(s):  
Valproic Acid ◽  
Clinical Trials ◽  
Elderly Patients ◽  
Psychotropic Drugs ◽  
Meta Analysis ◽  
Behavioral Symptoms ◽  
Relative Efficacy ◽  
Behavioral Disturbances ◽  
Drug Classes ◽  
Adrenergic Blockers

Both pharmacologic and nonpharmacologic methods can be used to treat behavioral disturbances of dementia. Many drugs and drug classes have been advocated as having putative efficacy in treating nonspecific behavioral symptoms; the list includes neuroleptics, anxiolytics, antidepressants (e.g., trazodone), anticonvulsants (e.g., carbamazepine and valproic acid), lithium, β-adrenergic blockers, selegiline, and buspirone. Neuroleptics are among the most commonly prescribed psychotropic drugs for behavioral symptoms and have been described as being “modestly effective” in controlling agitation, both in patients with dementia and in elderly patients in general. To examine the relative efficacy of neuroleptics in treating behavioral disturbances of dementia, the author and colleagues performed a meta-analysis of clinical trials published in the literature from 1954 to 1989.

Clinical Experiences and Methodologic Challenges in Conducting Clinical Trials on the Behavioral Disturbances of Dementia

1996 ◽  
Vol 8 (S2) ◽  
pp. 151-164 ◽  
Author(s):  
Sanford I. Finkel ◽  
Carolyn Cooler
Keyword(s):  
Clinical Trials ◽  
Elderly Patients ◽  
Elderly People ◽  
The Elderly ◽  
Behavioral Symptoms ◽  
Pharmaceutical Companies ◽  
World Population ◽  
Clinical Experiences ◽  
Behavioral Disturbances ◽  
Burden Of Caring

With a world population increasing in size and age, the number of elderly people with behavioral distrubances in dementia (BDD) is becoming an increasing problem. The burden of caring for someone with BDD may be so great that it leads to premature institutionalization of the patient. Few clinical trials have focused on noncognitive behavioral symptoms in this group of elderly patients, and little is known about the efficacy of drugs against these symptoms. The pharmaceutical companies have recently begun to assess different medications, but clinical trials in the elderly present a variety of problems not encountered in other patient populations. This article describes how the administration, initiation, logistics, finances, and methodology of such trials must be carefully assessed. Consideration of these factors together with improved definitions of behavioral symptoms and the advances in medication in this area should lead to an improvement in the treatment and management of behavioral disorders in the elderly.

scholarly journals Valproic Acid-Induced Myoclonus in a Demented Patient: A Case Report

2009 ◽  
Vol 2009 ◽  
pp. 1-3 ◽  
Author(s):  
Tina M. Gardner ◽  
Rehan Aziz ◽  
Sunanda Muralee ◽  
Rajesh R. Tampi
Keyword(s):  
Valproic Acid ◽  
Case Report ◽  
Elderly Patients ◽  
Psychiatric Disorders ◽  
Early Onset ◽  
The Elderly ◽  
Demented Patient ◽  
Behavioral Disturbances ◽  
Neuropsychiatric Complications

Valproic acid and its derivatives are now commonly used to treat various psychiatric disorders in the elderly. Data indicates that the elderly patients are more susceptible to developing neuropsychiatric complications when treated with these medications. In this report, we describe the case of a 66-year-old woman with early-onset, Alzheimer's type dementia, who developed myoclonus when treated with a valproic acid preparation for behavioral disturbances associated with the dementia.

Pediatric Psychopharmacology: Commonly Used Medications in Children

2018 ◽  
Author(s):  
Lawrence Scahill ◽  
Jaimie Rojas
Keyword(s):  
Clinical Trials ◽  
Psychotropic Drugs ◽  
Serotonin Reuptake ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Atypical Antipsychotics ◽  
National Institutes Of Health ◽  
Pharmaceutical Companies ◽  
Federal Policies ◽  
Risks And Benefits ◽  
Drug Classes

Pediatric psychopharmacology is a relatively young field. Through the decade of the 1990s and into the early 2000s, there was an unprecedented increase in the number of new psychotropic drugs and new formulations of older drugs. During this period, there was also a series of well-intended federal policies that provided pressure and incentives for pharmaceutical companies to conduct studies of new medications in children. The National Institutes of Health also provided funding for investigator-initiated clinical trials. Although still less than optimal, we now have a body of data on stimulants, selective serotonin reuptake inhibitors, and atypical antipsychotics. These three psychotropic drug classes are the most commonly used in children and adolescents. This chapter charts the rise in use of these drug classes and presents their risks and benefits.

Abstract 13503: Relative Efficacy of Alirocumab, Bempedoic Acid, Evolocumab, Ezetimibe and Inclisiran Added to Statins for Reduction of Low Density Lipoprotein Cholesterol - A Network Meta-Analysis of Randomized Clinical Trials

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Peter P Toth ◽  
Sarah Bray ◽  
Gavin Worth
Keyword(s):  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Meta Analysis ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Low Density ◽  
Relative Efficacy ◽  
Low Density Lipoprotein Cholesterol

Background: Many patients with hypercholesterolemia and/or cardiovascular disease are unable to achieve sufficient low-density lipoprotein cholesterol (LDL-C) reduction with statins alone (or are statin intolerant). This is increasingly the case with clinical guidelines recommending that lower LDL-C levels are beneficial for patients. This network meta-analysis (NMA) assessed the relative efficacy of lipid lowering therapies (LLTs) added to statins for reducing LDL-C. Methods: A systematic review of randomized controlled clinical trials to May 2020 identified 48 studies for inclusion in the primary NMA. The primary NMA included studies ≥12 weeks duration in which alirocumab, bempedoic acid, evolocumab, ezetimibe, or inclisiran were added to moderate-high intensity statins (or lower intensity / no statin in statin intolerant patients). Random effects NMA was used to analyse % change in LDL-C to compare the treatment effects indirectly. Results: Over 12 weeks, all non-statin LLTs significantly reduced LDL-C from baseline versus placebo. Evolocumab 140 mg Q2W / 420 mg QM and alirocumab 150 mg Q2W were associated with largest LDL-C reductions, which were greater than those achieved with lower/alternative doses of alirocumab, bempedoic acid (± ezetimibe), ezetimibe and inclisiran (Table). Consistent results were observed in sensitivity analyses to address heterogeneity (excluding familial hypercholesterolemia and east Asian studies), in the subgroup NMA of studies in predominantly atherosclerotic cardiovascular disease patients, and in the statin intolerant subgroup NMA. Conclusions: All agents reduced LDL-C, however, the PCSK9 inhibitors evolocumab 140 mg Q2W / 420 mg QM and alirocumab 150 mg Q2W were the most effective LLT regimens for reducing LDL-C when added to statins.

scholarly journals A Systematic Review and Network Meta-Analysis on the Efficacy of Medications in the Treatment of Chronic Idiopathic Constipation in Japan

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Atsushi Nakajima ◽  
Ayako Shoji ◽  
Kinya Kokubo ◽  
Ataru Igarashi
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Bayesian Network ◽  
Systematic Reviews ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Relative Efficacy ◽  
Idiopathic Constipation ◽  
Chronic Idiopathic Constipation ◽  
Meta Analyses

Background. In the 2010s, medications with new mechanisms were introduced in Japan for the treatment of chronic idiopathic constipation (CIC). A few systematic reviews have compared medications’ relative efficacy, but the reviews included studies on patients from various races, even though the mechanism of CIC is considered to differ between races. The aim of this study was to use a systematic review and network meta-analysis to compare the relative efficacy of these medications in Japanese patients. Methods. We conducted a meta-analysis and report it here according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We identified studies by searching MEDLINE (via the PubMed interface) and the Cochrane Library and ICHUSHI databases and included randomized clinical trials that compared medications for CIC with placebo in Japanese adults. Two reviewers independently screened and assessed articles, abstracted data, and assessed the risk of bias. We pooled data by random-effects meta-analyses and also performed a Bayesian network meta-analysis to indirectly compare data. Results. The present systematic review and meta-analyses included 1460 patients in 6 randomized clinical trials: 2 on linaclotide, 3 on elobixibat, 2 on lubiprostone, and 1 on lactulose. The results of direct comparisons showed that linaclotide, elobixibat, and lubiprostone were superior to placebo in the change of spontaneous bowel movements (SBMs) within 1 week: linaclotide, 1.95 (95% CI, 1.51-2.39); elobixibat, 5.69 (95% CI, 3.31-8.07); and lubiprostone, 2.41 (95% CI, 0.82-4.01). The Bayesian network meta-analysis showed consistent results. Elobixibat 10 mg was ranked first for the increase in SBMs and complete SBMs within 1 week and the time to first SBM. Lubiprostone 48 μg was ranked first for the proportion of patients with SBM within 24 hours. Conclusion. Our direct and indirect meta-analyses revealed that the new CIC medications available in Japan have equal efficacy but that elobixibat and lubiprostone are highly likely to be more efficacious.

scholarly journals Effects of continuous positive airway pressure on elderly patients with obstructive sleep apnea: a meta-analysis

2018 ◽  
Vol 34 ◽  
pp. 66-73 ◽  
Author(s):  
Binhong Yan ◽  
Yongmei Jin ◽  
Yi Hu ◽  
Shu Li
Keyword(s):  
Clinical Trials ◽  
Obstructive Sleep Apnea ◽  
Survival Rate ◽  
Continuous Positive Airway Pressure ◽  
Elderly Patients ◽  
Airway Pressure ◽  
Cardiovascular Events ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Obstructive Sleep

Objective: the aim of the study was to evaluate the efficacy of continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea in the elderly. Method: a comprehensive search for qualified clinical trials was performed on April, 2016. Basic demographic information of enrolled subjects, study design, survival rate, cardiovascular events, quality of life scores, and neurocognitive data were extracted for analysis. Results: A total of seven clinical trials were included in this meta-analysis, in which untreated elderly patients exhibited worse survival rate than those with CPAP (OR=2.22, 95% CI=1.64 to 3.01, P< 0.00001). Treated elderly patients exhibited less cardiovascular risk than those without CPAP (RR=0.49, 95% CI=0.36 to 0.66, P<0.00001) and a statistically significant improvement on all the domains of Quebec Sleepiness Questionnaire, supported by pooled weighted mean difference. Furthermore, CPAP treatment partially improved the cognitive functions. Conclusion: CPAP treatment achieves improvements in decreasing mortality and controlling cardiovascular events and exhibits few effects on neurocognitive function. Further large-scale, well-designed interventional investigation is needed.

Sign in / Sign up

Export Citation Format

Share Document