Safety and effect of sildenafil on treating paediatric pulmonary arterial hypertension: a meta-analysis on the randomised controlled trials

2020 ◽  
Vol 30 (12) ◽  
pp. 1882-1889
Author(s):  
Qingyou Zhang ◽  
Bowen Xu ◽  
Jichen Lv ◽  
Zhijian Wang ◽  
Junbao Du
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Hypertensive Crisis ◽  
Control Group ◽  
Controlled Trials ◽  
Pulmonary Arterial ◽  
Randomised Controlled

AbstractBackground:Efficacy of sildenafil in treating paediatric pulmonary arterial hypertension is controversial. This systematic review aimed to explore the safety and effect of sildenafil on treating paediatric pulmonary arterial hypertension (PAH) through meta-analysis.Methods and results:In this study, the electronic databases, including the Cochran Library database, EMBASE, and MEDLINE were systemically retrieved to identify the related randomised controlled trials (RCTs). Two reviewers had independently completed study selection, data collection, and assessment of the bias risk. Amongst 938 articles researched according to our retrieval strategy, 15 papers that involved 673 cases had been screened. Relative to control group, the sildenafil group had markedly reduced mortality (RR = 0.25, 95% CI: 0.12–0.51; p < 0.0001), but difference within the mortality was not statistically significant between high- and low-dose sildenafil groups (p = 0.152). Nonetheless, difference of the mean pulmonary arterial pressure between sildenafil as well as control group was of no statistical significance. Differences in the length of hospital stay and the incidences of pulmonary hypertensive crisis between children with PAH and controls were of no statistical significance. However, the summary estimate favoured that sildenafil reduced the duration of mechanical ventilation time, as well as the length of ICU stay and inotropic support.Conclusions:Sildenafil therapy reduces the mortality of PAH patients, but its effects on the haemodynamic outcomes and other clinical outcomes are still unclear.

scholarly journals Efficacy of PD-1 or PD-L1 inhibitors and PD-L1 expression status in cancer: meta-analysis

BMJ ◽  
2018 ◽  
pp. k3529 ◽  
Author(s):  
Xian Shen ◽  
Bin Zhao
Keyword(s):  
Cell Death ◽  
Programmed Cell Death ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Clinical Benefits ◽  
American Society ◽  
Randomised Controlled ◽  
Expression Status

Abstract Objective To evaluate the relative efficacy of programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PD-L1) inhibitors versus conventional drugs in patients with cancer that were PD-L1 positive and PD-L1 negative. Design Meta-analysis of randomised controlled trials. Data sources PubMed, Embase, Cochrane database, and conference abstracts presented at the American Society of Clinical Oncology and European Society of Medical Oncology up to March 2018. Review methods Studies of PD-1 or PD-L1 inhibitors (avelumab, atezolizumab, durvalumab, nivolumab, and pembrolizumab) that had available hazard ratios for death based on PD-L1 positivity or negativity were included. The threshold for PD-L1 positivity or negativity was that PD-L1 stained cell accounted for 1% of tumour cells, or tumour and immune cells, assayed by immunohistochemistry staining methods. Results 4174 patients with advanced or metastatic cancers from eight randomised controlled trials were included in this study. Compared with conventional agents, PD-1 or PD-L1 inhibitors were associated with significantly prolonged overall survival in both patients that were PD-L1 positive (n=2254, hazard ratio 0.66, 95% confidence interval 0.59 to 0.74) and PD-L1 negative (1920, 0.80, 0.71 to 0.90). However, the efficacies of PD-1 or PD-L1 blockade treatment in patients that were PD-L1 positive and PD-L1 negative were significantly different (P=0.02 for interaction). Additionally, in both patients that were PD-L1 positive and PD-L1 negative, the long term clinical benefits from PD-1 or PD-L1 blockade were observed consistently across interventional agent, cancer histotype, method of randomisation stratification, type of immunohistochemical scoring system, drug target, type of control group, and median follow-up time. Conclusions PD-1 or PD-L1 blockade therapy is a preferable treatment option over conventional therapy for both patients that are PD-L1 positive and PD-L1 negative. This finding suggests that PD-L1 expression status alone is insufficient in determining which patients should be offered PD-1 or PD-L1 blockade therapy.

scholarly journals Adverse events of exercise therapy in randomised controlled trials: a systematic review and meta-analysis

2019 ◽  
Vol 54 (18) ◽  
pp. 1073-1080 ◽  
Author(s):  
Andre Niemeijer ◽  
Hans Lund ◽  
Signe Nilssen Stafne ◽  
Thomas Ipsen ◽  
Cathrine Luhaäär Goldschmidt ◽  
...  
Keyword(s):  
Systematic Review ◽  
Relative Risk ◽  
Adverse Events ◽  
Exercise Therapy ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Serious Adverse Events ◽  
Randomised Controlled

ObjectiveTo evaluate the relative risk (RR) of serious and non-serious adverse events in patients treated with exercise therapy compared with those in a non-exercising control group.DesignSystematic review and meta-analysis.Data sourcesPrimary studies were identified based on The Cochrane Database of Systematic Reviews investigating the effect of exercise therapy.Eligibility criteriaAt least two of the authors independently evaluated all identified reviews and primary studies. Randomised controlled trials were included if they compared any exercise therapy intervention with a non-exercising control. Two authors independently extracted data. The RR of serious and non-serious adverse events was estimated separately.Results180 Cochrane reviews were included and from these, 773 primary studies were identified. Of these, 378 studies (n=38 368 participants) reported serious adverse events and 375 studies (n=38 517 participants) reported non-serious adverse events. We found no increase in risk of serious adverse events (RR=0.96 (95%CI 0.90 to 1.02, I2: 0.0%) due to exercise therapy. There was, however, an increase in non-serious adverse events (RR=1.19 (95%CI 1.09 to 1.30, I2: 0.0%). The number needed to treat for an additional harmful outcome for non-serious adverse events was 6 [95%CI 4 to 11).ConclusionParticipating in an exercise intervention increased the relative risk of non-serious adverse events, but not of serious adverse events. Exercise therapy may therefore be recommended as a relatively safe intervention.PROSPERO registration numberCRD42014014819.

Effects of jump training on jumping performance of handball players: A systematic review with meta-analysis of randomised controlled trials

2020 ◽  
Vol 15 (4) ◽  
pp. 584-594 ◽  
Author(s):  
Rodrigo Ramirez-Campillo ◽  
Cristian Alvarez ◽  
Antonio Garcia-Hermoso ◽  
Justin WL Keogh ◽  
Felipe García-Pinillos ◽  
...  
Keyword(s):  
Methodological Quality ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Control Group ◽  
Controlled Trials ◽  
Countermovement Jump ◽  
Jumping Performance ◽  
Jump Training ◽  
Jump Exercise ◽  
Randomised Controlled

This study aimed to assess the effects of jump training on the jumping performance of handball players compared with a control condition. The data sources utilised were PubMed, MEDLINE, Web of Science Core Collection and SCOPUS. Only peer-review randomised controlled trials were included. The inclusion criteria comprised: a jump training programme of at least 2 weeks; a control group; the assessment of the countermovement jump. The Physiotherapy Evidence Database scale was used to assess the risk of bias and methodological quality of eligible studies included in the meta-analysis. Risk of publication bias across studies was assessed using the extended Egger’s test. Cohen’s d effect sizes (ESs) were calculated from the countermovement jump and presented together with 95% confidence intervals (CIs). From 6108 records initially identified through database searching, 5 were eligible for meta-analysis. A significant improvement in countermovement jump height was observed, corresponding to 6.4 cm (95% CI = 4.9–7.9; Z = 8.4, p < 0.001), showing moderate heterogeneity ( I2 = 51.4%). The magnitude of the main effect was very large (ES = 2.2 (95% CI = 0.95–3.4), Z = 3.5, p < 0.001). Jump training is effective in increasing vertical jump performance in handball players. However, the insufficient number of studies conducted precluded analyses of moderator variables. In future, researchers are advised to conduct jump training studies of high methodological quality (e.g. randomised controlled trials) and assess different jump exercise prescriptions across handball players of different sexes, ages and competitive levels to analyse if exercise prescription and player characteristics may influence training responses.

scholarly journals Meta-Analysis of Randomized Controlled Trials on Treatment of Pulmonary Arterial Hypertension

2010 ◽  
Vol 74 (7) ◽  
pp. 1458-1464 ◽  
Author(s):  
Bing He ◽  
Fengwen Zhang ◽  
Xueying Li ◽  
Chaoshu Tang ◽  
Guosheng Lin ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Pulmonary Arterial

Effects of different delivering matrices of β-glucan on lipids in mildly hypercholesterolaemic individuals: a meta-analysis of randomised controlled trials

2020 ◽  
pp. 1-14
Author(s):  
Dengfeng Xu ◽  
Hechun Liu ◽  
Chao Yang ◽  
Hui Xia ◽  
Da Pan ◽  
...  
Keyword(s):  
Randomised Controlled Trials ◽  
Ldl Cholesterol ◽  
Meta Analysis ◽  
Hdl Cholesterol ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Significant Difference ◽  
Liquid Products ◽  
Randomised Controlled

Abstract β-Glucan has been reported for its health benefits on blood lipids in hypercholesterolaemic individuals for years. However, people have paid little attention to the effects of β-glucan in populations with mild hypercholesterolaemia as well as the various delivering matrices. Our objective was to perform a meta-analysis to analyse the effects of β-glucan with different delivering matrices in mildly hypercholesterolaemic individuals. After conducting a comprehensive search in Web of Science, PubMed, Scopus and Cochrane Library, a total of twenty-one randomised controlled trials involving 1120 participants were identified to measure the pooled effect. The overall results indicated that consuming a dose of ≥3 g/d of β-glucan for at least 3 weeks could significantly reduce total cholesterol (TC) (−0·27 mmol/l, 95 % CI −0·33, −0·21, P < 0·001) and LDL-cholesterol (−0·26 mmol/l, 95% CI −0·32, −0·20, P < 0·001) compared with the control group in mildly hypercholesterolaemic individuals, while no significant difference was observed in TAG (−0·03 mmol/l, 95% CI −0·11, 0·06, P = 0·521) and HDL-cholesterol (0·01 mmol/l, 95% CI −0·03, 0·04, P = 0·777). There was evidence for modest unexplained heterogeneity in the meta-analysis. In conclusion, β-glucan can significantly reduce risk factors like TC and LDL-cholesterol for CVD in mildly hypercholesterolaemic individuals; furthermore, it appears that the effects of food matrices with both ‘solid products’ and ‘liquid products’ where β-glucan was incorporated into were ranked as the best way to exert its beneficial properties, while ‘liquid’ and ‘solid’ products were ranked as the second and third positions, respectively.

scholarly journals Efficacy and Adverse Effects of Atropine for Myopia Control in Children: A Meta-Analysis of Randomised Controlled Trials

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
ChunWen Chen ◽  
JingYan Yao
Keyword(s):  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Rebound Effect ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
High Dose ◽  
Myopia Progression ◽  
Statistical Heterogeneity ◽  
Randomised Controlled

Objectives. To explore the rebound effects and safety of atropine on accommodation amplitude in slowing myopia progression. Methods. We conducted a meta-analysis to testify proper dosage of atropine in children with myopia. We searched in PubMed, EMBASE, Ovid, and the Cochrane Library up to March 30, 2021. We selected randomised controlled trials (RCTs) that evaluated the efficacy of atropine for controlling myopia progression in children. We performed the inverse variance random-effects model to pool the data using mean difference (MD) for continuous variables. Statistical heterogeneity was assessed using the I2 test. Additionally, we conducted subgroup analyses and sensitivity analyses. Results. Seventeen RCTs involving 2955 participants were included. Myopia progression was significantly less in the atropine group than that of the control group, with MD = 0.38 D per year (95% confidence interval, 0.20 to 0.56). Less axial elongation was shown with MD = −0.19 mm per year (95% CI, −0.25 to −0.12). There was a statistically difference among various doses ( p = 0.00001 ). In addition, 1.0% atropine showed the rebound effect with MD = −0.54 D per year (95% CI, −0.81 to −0.26) and was more effective in the latter six months than in the former one. Less accommodation amplitude was shown in 0.01% atropine. Conclusion. The efficacy of atropine is dose dependent, and 0.01% atropine may be the optimal dose in slowing myopia progression in children with no accommodation dysfunction. A rebound effect is more prominent in high-dose atropine in the former cessation after discontinuation.

Abstract 16011: An Outcomes Assessment of Vasodilator Therapy in Pulmonary Arterial Hypertension Through Meta-Analysis of 31 Randomized Controlled Trials

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
John J Ryan ◽  
Saurav Chatterjee ◽  
Nathan Hatton ◽  
Neel Patel ◽  
Josef Stehlik ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Mortality Benefit ◽  
Randomized Controlled ◽  
Pulmonary Vasodilators ◽  
Pulmonary Arterial

Introduction: Pulmonary Arterial Hypertension (PAH) is a rapidly progressive disease with high mortality. We reviewed randomized controlled trials (RCTs) to evaluate the effect of pulmonary vasodilators on mortality in PAH. Hypothesis: Our objective was to determine the effect of PAH medicines on survival, and the impact of trial design on outcomes. Methods: We conducted a meta-analysis using MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus (inceptions-May 2014) of all RCTs treating PAH with pulmonary vasodilators. Data on all-cause mortality and hemodynamics were abstracted. Summary relative risks (RR) and 95% confidence intervals (CI) for outcomes were calculated using a random effects model comparing various pulmonary vasodilators with control. Results: The analysis included 31 RCTs (6,271 patients, 77% female, range of mean age 30-57 years). Median follow up was 12 weeks (18 trials had ≤ 12 weeks follow up, and only 5 followed patients ≥ 6 months). When analyzed together (n = 14), FDA-approved pulmonary vasodilators demonstrated a mortality benefit with RR = 0.77 (95% CI = 0.60 - 099, I 2 = 0%). When analyzed by vasodilator type, prostacyclins were the only class of agents with significant mortality benefit, RR = 0.61 (95% CI 0.38-0.98, I 2 = 1%). Oral pulmonary vasodilators demonstrated no significant benefit on PAH mortality, RR = 0.85 (95% CI 0.65-1.12, I 2 = 0.0%), but we could not exclude a clinically meaningful benefit or harm. Many studies reported ≤1 death in at least one treatment arm. When we limited the analysis to only studies with at least 2 deaths in both treatment arms (n=9), the mortality benefit for pulmonary vasodilators was no longer significant (RR 0.86, CI 0.66-1.12, I 2 =0%), but the point estimate was below 1 and we could not exclude a reduction or increase in risk. For studies with the shorter follow up of ≤ 12 weeks, the RR of mortality for active treatment arm was 0.54 (95% CI 0.35-0.83), compared to trials with > 12 weeks of follow up where the RR of mortality was not significant at 0.91 (95% CI 0.67-1.22). Conclusion: There is an observed mortality benefit for prostacyclins in PAH. For the oral pulmonary vasodilators, there is no observed mortality benefit based on either design of trials, length of follow up or efficacy of the agents studied.

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