Changing evidence over time: updated meta-analysis regarding anti-TNF efficacy in childhood chronic uveitis

Rheumatology ◽  
2020 ◽  
Author(s):  
Ilaria Maccora ◽  
Eleonora Fusco ◽  
Edoardo Marrani ◽  
Athimalaipet V Ramanan ◽  
Gabriele Simonini
Keyword(s):  
Observational Studies ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Primary Outcome Measure ◽  
Systemic Steroid ◽  
Biologic Treatment ◽  
Chronic Uveitis ◽  
Randomized Controlled

Abstract Objective To summarize evidence regarding efficacy of anti-TNFα in childhood chronic uveitis, refractory to common DMARDs. Methods An updated systematic search was conducted between November 2012 and January 2020. Studies investigating the efficacy of anti-TNFα therapy, in children of ages <16 years, as the first biologic treatment for childhood chronic uveitis, refractory to topical and/or systemic steroid and at least one DMARD were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation according to Standardization of Uveitis Nomenclature Working Group criteria. A combined estimate of the proportion of children responding to etanercept (ETA), infliximab (INF), and adalimumab (ADA) was determined. Results We identified 1677 articles of which 37 articles were eligible. Three were randomized controlled trials, one on ETA and two on ADA, and were excluded from pooled analysis. From the observational studies, a total of 487 children were identified: 226 received ADA, 213 INF and 48 ETA. The proportion of responding children was 86% (95% CI: 76%, 95%) for ADA, 68% (95% CI: 50%, 85%) for INF and 36% (95% CI: 9%, 67%) for ETA. Pooled analysis showed clear differences (χ2 = 32.2, P < 0.0001): ADA and INF were both significantly superior to ETA (χ2 = 26.8, P < 0.0001, and χ2 = 7.41, P < 0.006, respectively), ADA significantly superior to INF (χ2 = 13.4, P < 0.0002). Conclusion This meta-analysis, consistent with recent randomized controlled trial data, suggests the efficacy of ADA and INF in childhood chronic uveitis treatment. However, ADA results were superior to those of INF in this clinical setting.

Perioperative Beta-Blocker for Atrial Fibrillation after Cardiac Surgery: A Meta-Analysis

2020 ◽  
Author(s):  
Sue Hyun Kim ◽  
Myoung-jin Jang ◽  
Ho Young Hwang
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Beta Blocker ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Randomized Controlled ◽  
Online Databases ◽  
The Impact

Abstract Background This meta-analysis was conducted to evaluate the impact of perioperative use of beta-blocker (BB) on postoperative atrial fibrillation (POAF) after cardiac surgery other than isolated coronary artery bypass grafting (CABG). Methods Five online databases were searched. Studies were included if they (1) enrolled patients who underwent cardiac surgery other than isolated CABG and (2) demonstrated the impact of perioperative use of BB on POAF based on the randomized controlled trial or adjusted analysis. The primary outcome was the occurrence rates of POAF after cardiac surgery. A meta-regression and subgroup analysis were performed according to the proportion of patients with cardiac surgery other than isolated CABG and the timing of BB use, respectively. Results Thirteen articles (5 randomized and 8 nonrandomized studies: n = 25,496) were selected. Proportion of enrolled patients undergoing cardiac surgery other than isolated CABG ranged from 7 to 100%. The BBs were used in preoperative, postoperative, and both periods in 5, 5, and 3 studies, respectively. The pooled analyses showed that the risk of POAF was significantly lower in patients with perioperative BB than those without (odds ratio, 95% confidence interval = 0.56, 0.35–0.91 and 0.70, 0.55–0.91 in randomized and nonrandomized studies, respectively). The risk of POAF was lower in the BB group irrespective of the proportion of nonisolated CABG. Benefit regarding in-hospital mortality was inconclusive. Perioperative stroke and length of stay were not significantly different between BB and non-BB groups. Conclusions Perioperative use of BB is effective in preventing POAF even in patients undergoing cardiac surgery other than isolated CABG, although it did not translate into improved clinical outcomes.

scholarly journals Benefits of local consolidative treatment in oligometastases of solid cancers: a stepwise-hierarchical pooled analysis and systematic review

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Chai Hong Rim ◽  
In-Soo Shin ◽  
Sunmin Park ◽  
Hye Yoon Lee
Keyword(s):  
Observational Studies ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Small Cell ◽  
Cochrane Library ◽  
Small Cell Lung ◽  
Lung Cancers ◽  
Randomized Controlled ◽  
Grade 3 ◽  
Available Information

AbstractWe conducted a meta-analysis of articles published in PubMed, MEDLINE, EMBASE, and Cochrane library to investigate the effectiveness of local consolidative therapy (LCT) against oligometastases. Data from randomized controlled trials (RCTs), balanced studies, and all studies combined were analyzed in a hierarchical manner. Pooled analyses of 31 studies (including seven randomized trials) investigating the effectiveness of LCT on overall survival revealed odds ratios of 3.04, 2.56, and 1.41 for all studies, balanced studies, and RCTs, respectively (all p < 0.05). The benefit of LCT was more prominent in patients with non-small cell lung and colorectal cancers than in those with prostate and small cell lung cancers. Moreover, the benefit of LCT was smaller in patients with high metastatic burdens (p = 0.054). In four of 12 studies with available information, additional grade ≥3 toxicities due to LCTs were reported. Overall, LCT is beneficial for patients with oligometastases, although such benefits are less evident in RCTs than in observational studies. Appropriate LCTs should be carefully selected considering their feasibility, disease type, and metastatic burden.

scholarly journals Complication Differences Between the Tumescent and Non-Tumescent Dissection Techniques for Mastectomy: A Meta-Analysis

2022 ◽  
Vol 11 ◽  
Author(s):  
Yi Yang ◽  
Juanying Zhu ◽  
Xinghua Qian ◽  
Jingying Feng ◽  
Fukun Sun
Keyword(s):  
Skin Necrosis ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Random Effects Model ◽  
Pooled Data ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Dissection Techniques ◽  
Alloplastic Reconstruction

PurposeWe conducted a systematic literature search and pooled data from studies to compare the incidence of complications between the tumescent and non-tumescent techniques for mastectomy.MethodsWe searched PubMed, Embase, BioMed Central, Ovid, and CENTRAL databases for studies comparing the two mastectomy techniques up to November 1st, 2020. We used a random-effects model to calculate odds ratios (OR) with 95% confidence intervals (CI).ResultsNine studies were included with one randomized controlled trial (RCT). Meta-analysis indicated no statistically significant difference in the incidence of total skin necrosis (OR 1.18 95% CI 0.71, 1.98 I2 = 82% p=0.52), major skin necrosis (OR 1.58 95% CI 0.69, 3.62 I2 = 71% p=0.28), minor skin necrosis (OR 1.11 95% CI 0.43, 2.85 I2 = 72% p=0.83), hematoma (OR 1.19 95% CI 0.80, 1.79 I2 = 4% p=0.39), and infections (OR 0.87 95% CI 0.54, 1.40 I2 = 54% p=0.56) between tumescent and non-tumescent groups. Analysis of studies using immediate alloplastic reconstruction revealed no statistically significant difference in the incidence of explantation between the two groups (OR 0.78 95% CI 0.46, 1.34 I2 = 62% p=0.37). Multivariable-adjusted ORs on total skin necrosis were available from three studies. Pooled analysis indicated no statistically significant difference between tumescent and non-tumescent groups (OR 1.72 95% CI 0.72, 4.13 I2 = 87% p=0.23).ConclusionLow-quality evidence derived mostly from non-randomized studies is indicative of no difference in the incidence of skin necrosis, hematoma, seroma, infection, and explantation between the tumescent and non-tumescent techniques of mastectomy. There is a need for high-quality RCTs to further strengthen the evidence.

scholarly journals Supervised Exercises Compared With Radial Extracorporeal Shock-Wave Therapy for Subacromial Shoulder Pain: 1-Year Results of a Single-Blind Randomized Controlled Trial

2011 ◽  
Vol 91 (1) ◽  
pp. 37-47 ◽  
Author(s):  
Kaia Engebretsen ◽  
Margreth Grotle ◽  
Erik Bautz-Holter ◽  
Ole Marius Ekeberg ◽  
Niels Gunnar Juel ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Shoulder Pain ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Extracorporeal Shock Wave Therapy ◽  
Primary Outcome Measure ◽  
Shock Wave Therapy ◽  
Randomized Controlled ◽  
Extracorporeal Shock Wave ◽  
Single Blind

Background Evidence from a recent randomized controlled trial indicated that supervised exercises (SE) were more effective than radial extracorporeal shock-wave therapy (rESWT) for the treatment of subacromial shoulder pain in the short to medium term. Little knowledge exists about the long-term results of rESWT for subacromial pain. Objective The aim of this study was to evaluate the results of rESWT and SE provided to patients with subacromial shoulder pain after 1 year. Design This was a single-blind randomized controlled trial. Setting The study was conducted in the outpatient clinic of the Physical Medicine and Rehabilitation Department at Oslo University Hospital, Ullevaal, Norway. Patients One hundred four patients with subacromial shoulder pain lasting at least 3 months participated. Patients were randomly assigned to either an rESWT group (n=52) or an SE group (n=52). Intervention The rESWT intervention consisted of one session weekly for 4 to 6 weeks. The SE intervention consisted of two 45-minute sessions per week for up to 12 weeks. Measurements The primary outcome measure was the Shoulder Pain and Disability Index. Secondary outcome measures were questions regarding pain and function and work status. Results After 1 year, an intention-to-treat analysis showed no significant differences between the 2 groups for the primary outcome measure (−7.6 points, 95% confidence interval=−16.6 to 0.5) and pain, function, and medication use. Twenty-nine participants (60%) in the SE group versus 24 participants (52%) in the rESWT group were categorized as clinically improved. Thirty-eight participants in the SE group were at work compared with 30 participants in the rESWT group (odds ratio=1.1, 95% confidence interval=1.0 to 1.2). Fewer patients in the SE group had received additional treatments between 18 weeks and 1 year. Limitations The lack of a placebo control group, the lack of a cost-benefit analysis, and the small sample size were limitations of the study. Conclusion No significant difference was found between the SE and rESWT groups at the 1-year follow-up. More participants in the SE group had returned to work.

Acupuncture for episodic tension-type headache: a multicentre randomized controlled trial

Cephalalgia ◽  
2000 ◽  
Vol 20 (7) ◽  
pp. 632-637 ◽  
Author(s):  
AR White ◽  
K-L Resch ◽  
JCK Chan ◽  
CD Norris ◽  
SK Modi ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Outcome Measure ◽  
Controlled Trial ◽  
Primary Outcome Measure ◽  
Tension Type Headache ◽  
Control Procedure ◽  
Randomized Controlled ◽  
Type Headache ◽  
To Receive ◽  
Time Point

A multicentre, randomized clinical trial was undertaken to test the hypothesis that acupuncture is more efficacious than sham control procedure in the prevention of episodic tension-type headache. Fifty subjects were randomized to receive a course of treatment with either brief acupuncture or a sham procedure. Subjects were followed up for 3 months. Changes in headache were assessed by daily diary, the primary outcome measure being the number of days with headache. No significant differences were found between the changes in the two groups for any measure at any time point. Results also show that patient blinding was successful. In conclusion, this study does not provide evidence that this form of acupuncture is effective in the prevention of episodic tension-type headache.

Systematic review and meta-analysis of effectiveness of preoperative embolization in surgery for metastatic spine disease

2017 ◽  
Vol 10 (6) ◽  
pp. 596-601 ◽  
Author(s):  
Panya Luksanapruksa ◽  
Jacob M Buchowski ◽  
Sasima Tongsai ◽  
Weerasak Singhatanadgige ◽  
Jack W Jennings
Keyword(s):  
Observational Studies ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Spinal Metastases ◽  
Mean Difference ◽  
Control Group ◽  
Preoperative Embolization ◽  
Inclusion Criteria ◽  
Qualitative Synthesis ◽  
Randomized Controlled

BackgroundPreoperative embolization (PE) may decrease intraoperative blood loss (IBL) in decompressive surgery of hypervascular spinal metastases. However, no consensus has been found in other metastases and no meta-analysis which reviewed the benefit of PE in spinal metastases has been conducted.ObjectiveTo assess IBL in spinal metastases surgery in a randomized controlled trial (RCT) and cohort studies comparing PE and a control group of non-embolized patients.MethodsA systematic search of relevant publications in PubMed and EMBASE was undertaken. Inclusion criteria were RCTs and observational studies in patients with spinal metastases who underwent spine surgery and reported IBL. Meta-analysis was performed using standardized mean difference (SMD) and mean difference (MD) of IBL. Heterogeneity was assessed using the I2 statistic.ResultsA total of 265 abstracts (126 from PubMed and 139 from Embase) were identified through database searching. The reviewers selected six studies for qualitative synthesis and meta-analysis. The pooled SMD of the included studies was 0.58 (95% CI −0.10 to 1.25, p=0.09). Sensitivity analysis revealed that, if the study by Rehak et al was omitted, the pooled SMD was significantly changed to 0.88 (95% CI 0.39 to 1.36, p<0.001) and PE reduced the IBL significantly. The pooled MD was 708.3 mL (95% CI −224.4 to 1640.9 mL, p=0.14). If the results of the Rehak et al study were omitted, the pooled MD was significantly changed to 1226.9 mL (95% CI 345.8 to 2108.1 mL, p=0.006).ConclusionsPE can be effective in reducing IBL in spinal metastases surgery in both renal cell carcinoma and mixed primary tumor groups.

Pegfilgrastim safety and efficacy on the last chemotherapy day versus the next: systematic review and meta-analysis

2021 ◽  
pp. bmjspcare-2020-002532
Author(s):  
Xiaohua Ma ◽  
Jian Kang ◽  
Yufang Li ◽  
Xiaojian Zhang
Keyword(s):  
Breast Cancer ◽  
Observational Studies ◽  
Web Of Science ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Pooled Analysis ◽  
Efficacy And Safety ◽  
Gynaecological Malignancies ◽  
Randomised Controlled

ObjectivesTo investigate the efficacy and safety of pegfilgrastim administered on the day of chemotherapy completion (same day) versus at least 1 day after chemotherapy (next day).MethodsWe searched relevant literature published before April 2020 from the following databases: Embase, PubMed, Cochrane databases and Web of science.ResultsOne randomised controlled trial and 12 observational studies met all of the prespecified criteria for eligibility. The meta-analysis showed a significantly higher febrile neutropenia (FN) rate for the same-day group than that for the next-day arm in the first chemotherapy cycle (OR=2.56, 95% CI 1.19 to 5.48, p=0.02), and in all chemotherapy cycles (OR=1.54, 95% CI 1.29 to 1.84, p<0.00001). Results of subgroup analysis showed a higher FN rate in the same-day arm than in the next-day group for patients with breast cancer (OR=5.50, 95% CI 2.29 to 13.23, p=0.0001) and lymphoma (OR=1.53, 95% CI 1.00 to 2.34, p=0.05). The pooled analysis of studies on gynaecological malignancies showed that patients in the same-day group had a higher incidence of bone pain (OR=1.30, 95% CI 1.01 to 1.68, p=0.04) and a lower incidence of chemotherapy delay (OR=0.71, 95% CI 0.53 to 0.96, p=0.03) compared with the next-day group.ConclusionsSame-day administration of pegfilgrastim resulted in increased incidence of FN compared with the next-day schedule. This is especially true for patients with breast cancer or lymphoma. These results do not support same-day administration of pegfilgrastim .

Short-course versus long-course antibiotics in prosthetic joint infections: a systematic review and meta-analysis of one randomized controlled trial plus nine observational studies

2019 ◽  
Vol 74 (9) ◽  
pp. 2507-2516 ◽  
Author(s):  
Hung-Teng Yen ◽  
Ronan W Hsieh ◽  
Chung-yen Huang ◽  
Tzu-Chun Hsu ◽  
Timothy Yeh ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Observational Studies ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Randomized Controlled ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Short Course ◽  
Prosthetic Joint Infections ◽  
Long Course

Abstract Background Prosthetic joint infections (PJIs) often require long-course antibiotic therapy. However, recent studies argue against the current practice and raise concerns such as the development of antibiotic resistance, side effects of medications and medical costs. Objectives To review and compare the outcomes of short-course and long-course antibiotics in PJIs. Methods We conducted a systemic review and meta-analysis using a predefined search term in PubMed and EMBASE databases. Studies that met the inclusion criteria from inception to June 2018 were included. The quality of the included studies was assessed. Results A total of 10 articles and 856 patients were analysed, comprising 9 observational studies and 1 randomized controlled trial. Our meta-analysis showed no significant difference between short-course and long-course antibiotics (relative risk = 0.87, 95% CI = 0.62–1.22). Additionally, the older the studied group was, the more short-course antibiotics were favoured. Conclusions When treating PJI patients following debridement, antibiotics and implant retention, an 8 week course of antibiotic therapy for total hip arthroplasty and a 75 day course for total knee arthroplasty may be a safe approach. For two-stage exchange, a shorter duration of antibiotic treatment during implant-free periods is also generally safe with the usage of antibiotic-loaded cement spacers.

A systematic review and meta-analysis of the safety of Hydroxychloroquine in a randomized controlled trial and observational studies

2021 ◽  
Vol 16 ◽  
Author(s):  
Mahanjit Konwar ◽  
Miteshkumar Maurya ◽  
Urmila M. Thatte ◽  
Nithya J. Gogtay ◽  
Debdipta Bose
Keyword(s):  
Systematic Review ◽  
Active Treatment ◽  
Observational Studies ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Random Effect ◽  
Safety Data ◽  
Total Sample ◽  
Randomized Controlled ◽  
Newcastle Ottawa Scale

Introduction: Hydroxychloroquine (HCQ) has recently become the focus of attention in the current COVID-19 pandemic. With an increase in the off-label use of HCQ, concern for the safety of HCQ has been raised. We, therefore, performed this systematic review to analyze the safety data of HCQ against placebo and active treatment in various disease conditions. Methods: We searched PubMed, Embase, and Cochrane for Randomized Controlled trials (RCTs) and Observational studies (OSs) that evaluated HCQ for the treatment of any disease other than COVID19 in adult patients up to May 2020. We assessed the quality of the included studies using Risk of Bias 2 (for RCTs) and Newcastle–Ottawa Scale (for OSs). Data were analyzed with random-effect meta-analysis. Sensitivity and subgroup analyses were performed to identify heterogeneity. Results: A total of 6641 studies were screened, and 49 studies (40 RCTs and 9 OSs) with a total sample size of 35044 patients were included. The use of HCQ was associated with higher risks of TDAEs as compared to placebo/no active treatment [RR 1.47, 95%CI 1.03-2.08]. When HCQ was compared with active treatments, the risks of AEs [RR 0.74, 95% CI 0.63-0.86] and TDAEs were less in the HCQ arm [RR 0.57, 95% CI 0.39-0.81]. The outcomes did not differ in the sensitivity analysis. Conclusion: The results suggest that the use of HCQ was associated with a lower risk of AEs and TDAEs as compared to active treatment, whereas posing higher risk of TDAEs as compared to placebo.

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