scholarly journals 2116. Comparative Effectiveness of Amphotericin B, Azoles, and Echinocandins in the Treatment of Candidemia and Invasive Candidiasis: A Systematic Review and Network Meta-Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S716-S716
Author(s):  
Koray K Demir ◽  
Guillaume Butler-Laporte ◽  
Todd C Lee ◽  
Matthew P Cheng
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Amphotericin B ◽  
Invasive Candidiasis ◽  
Meta Analysis ◽  
Treatment Success ◽  
Sensitivity Analyses ◽  
Estimation Methods ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background Current guidelines recommend the use of echinocandins, amphotericin B or fluconazole for the treatment of invasive candidiasis and candidemia. The objective of our study was to compare these agents through a systematic review of the literature and network meta-analysis of randomized controlled trials. Methods Three electronic databases (Medline, PubMed, and the Cochrane Database of Systematic Reviews) were searched from database inception to January 1 2019. Randomized controlled trials that compared triazoles, echinocandins and/or amphotericin B (either in lipid formulation or deoxycholate form) for the treatment of invasive candidiasis or candidemia were included. Among included studies, treatment success was collected as the primary outcome and was assessed by a random effect network meta-analysis using Bayesian estimation methods. A sensitivity analysis was performed for all patients with candidemia. Results Eleven randomized controlled trials met the study inclusion criteria. Of the 2,475 patients included from these trials, 684 received an echinocandin, 855 received amphotericin B and 936 received a triazole. Echinocandins were associated with the highest rate of treatment success when compared with amphotericin B (OR 1.40, 95% CI 1.02–1.93) and the triazoles (OR 1.80, 95% CI 1.32–2.51). Similarly, in the pre-specified analysis of candidemic patients, echinocandins were also more effective overall than amphotericin B (OR 1.25, 95% CI 0.84–1.87) and triazoles (OR 1.66, 95% CI 1.16–2.44). Patients treated with triazoles had a lower rate of treatment success than amphotericin B in the overall (OR 0.78, 95% CI 0.60–1.01) and candidemia sensitivity analyses (OR 0.76, 95% CI 0.56–1.01) Rank probability analysis favored echinocandins as the most effective treatment choice 98% of the time. Conclusion In our meta-analysis comparing treatment strategies for severe Candida infections, the echinocandins had the highest rate of treatment success compared with both amphotericin B and triazoles. Echinocandins should be considered as first-line agents in the treatment of invasive candidiasis and candidemia. Further research is needed to determine the minimum duration of echinocandin treatment prior to using step-down therapy. Disclosures All authors: No reported disclosures.

scholarly journals Auricular Plaster Therapy for Comorbid Insomnia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 2019 ◽  
pp. 1-17 ◽  
Author(s):  
Huimin Zhao ◽  
Dan Li ◽  
Ying Yang ◽  
Yueting Liu ◽  
Jie Li ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Large Scale ◽  
Meta Analysis ◽  
Effective Rate ◽  
Sensitivity Analyses ◽  
Controlled Trials ◽  
Comorbid Insomnia ◽  
Randomized Controlled ◽  
Significant Difference

Background. Although the effectiveness of auricular plaster therapy (APT) on primary insomnia has been systematically reviewed, no systematic review of studies has focused on the effect on comorbid insomnia. Objective. To evaluate the efficacy and safety of APT for comorbid insomnia. Methods. Fifteen databases were searched from inception to July 2018. Randomized controlled trials (RCTs) of APT as an exclusive intervention for comorbid insomnia against Western medications, sham APT or no treatment were identified. Results. Fourteen studies involving 928 participants were identified. The pooled outcomes revealed that APT was superior to control conditions for the global score on PSQI (SMD = -1.13, and 95% CI = -1.48—-0.78) and the effective rate (RR = 1.24, 95% CI = 1.13—1.36, NNT = 5, and 95% CI =4—7). Furthermore, the results of subgroup analyses were similar to the pooled results. Additionally, the pooled results were verified to be stable by sensitivity analyses. Regarding safety, no significant difference was identified between APT and Western medications. Conclusions. APT appears to be an effective and safe treatment for comorbid insomnia. However, the benefits of APT for comorbid insomnia could not be ascertained due to the paucity of the quantity and quality of the included studies. Large-scale studies using proper methodology are needed to yield a firm conclusion.

scholarly journals Autogenic Training for Reducing Chronic Pain: a Systematic Review and Meta-analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Antonia Kohlert ◽  
Katharina Wick ◽  
Jenny Rosendahl
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Randomized Controlled Trials ◽  
Passive Control ◽  
Meta Analysis ◽  
Autogenic Training ◽  
Sensitivity Analyses ◽  
Controlled Trials ◽  
Control Groups ◽  
Randomized Controlled

Abstract Background Autogenic training (AT) is frequently used as therapeutic approach in multimodal pain therapy. The aim of this systematic review and meta-analysis is to investigate the efficacy of AT in individuals suffering from chronic pain in comparison to passive and active control groups. Methods A comprehensive literature search in Medline, Web of Science, PsycInfo, and PubPsych and manual searches (last search April 7, 2021) were conducted to locate randomized controlled trials (RCTs). Treatment guidelines and references of relevant articles and previous reviews were checked. ProQuest Dissertations and Theses Full Text database, DART-Europe E-theses Portal, Networked Digital Library of Theses and Dissertations (NDLTD), and the Theses Database of the German National Library were screened to identify any unpublished material. Results A total of 13 eligible studies (k = 15 comparisons) including 576 participants were identified. Random-effects meta-analyses revealed a significantly positive, moderate effect of AT on the primary outcome pain compared to passive control groups (g = 0.58, 95% CI [0.36; 0.79], k = 9, I2 = 0%). In comparison with other psychological interventions, no difference was found (g = − 0.05, 95% CI [− 0.30; 0.20], k = 6, I2 = 0%). Sensitivity analyses proved the robustness of findings. Overall risk-of-bias judgment was ‘some concerns’ in the majority of studies. Conclusions Beneficial effects of AT on pain reduction were demonstrated, but findings are prone to bias. Furthermore, high methodological quality RCTs are needed to strengthen the promising evidence of AT for individuals with chronic pain.

Interventions to Reduce Alcohol Harms in Low and Middle Income Countries: a Systematic Review and Meta Analysis

2018 ◽  
Author(s):  
Joao Ricardo Nickenig Vissoci
Keyword(s):  
Systematic Review ◽  
Alcohol Use ◽  
Randomized Controlled Trials ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
World Health ◽  
Controlled Trials ◽  
Middle Income ◽  
Brief Motivational Intervention ◽  
Randomized Controlled

BackgroundHarmful alcohol use leads to a large burden of disease and disability which disportionately impacts LMICs. The World Health Organization and the Lancet have issued calls for this burden to be addressed, but issues remain, primarily due to gaps in information. While a variety of interventions have been shown to be effective at reducing alcohol use in HICs, their efficacy in LMICs have yet to be assessed. This systematic review describes the current published literature on alcohol interventions in LMICs and conducts a meta analysis of clinical trials evaluating interventions to reduce alcohol use and harms in LMICs.MethodsIn accordance with PRISMA guidelines we searched the electronic databases Pubmed, EMBASE, Scopus,Web of Science, Cochrane, and Psych Info. Articles were eligible if they evaluated an intervention targeting alcohol-related harm in LMICs. After a reference and citation analysis, we conducted a quality assessment per PRISMA protocol. A meta-analysis was performed on the 39 randomized controlled trials that evaluated an alcohol-related outcome.ResultsOf the 3,801 articles from the literature search, 87 articles from 25 LMICs fit the eligibility and inclusion criteria. Of these studies, 39 randomized controlled trials were included in the meta-analysis. Nine of these studies focused specifically on medication, while the others focused on brief motivational intervention, brain stimulation, AUDIT-based brief interventions, WHO ASSIST-based interventions, group based education, basic screening and interventions, brief psychological or counseling, dyadic relapse prevention, group counseling, CBT, motivational + PTSD based interview, and health promotion/awareness. Conclusion Issues in determining feasible options specific to LMICs arise from unstandardized interventions, unequal geographic distribution of intervention implementation, and uncertain effectiveness over time. Current research shows that brain stimulation, psychotherapy, and brief motivational interviews have the potential to be effective in LMIC settings, but further feasibility testing and efforts to standardize results are necessary to accurately assess their effectiveness.

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