scholarly journals Efficacy and Safety of Lopinavir/Ritonavir for Treatment of COVID-19: A Systematic Review and Meta-Analysis

Author(s):  
Mansour Tobaiqy ◽  
Saad Alhumaid ◽  
Abbas Al Mutair

AbstractBackgroundSince the emergence of COVID-19, the world has been desperate to find effective therapeutics and vaccinations to treat hundreds of thousands of affected patients and to suppress the spread of this global pandemic. Lopinavir-ritonavir (LPV/RTV) is an HIV antiviral combination that has been considered for treatment of this disease.Aim of the studyThis systematic review and meta-analysis aimed to assess the efficacy and safety of lopinavir/ritonavir in COVID-19 patients in the extant published research. A systematic review protocol was developed based on PRISMA-P and the PRISMA statement. Published English and non-English articles written since December 1, 2019 were selected for review from 8 electronic databases.Readily accessible full articles (cohort studies and clinical trials) which specifically mentioned lopinavir/ritonavir and patients with lab-confirmed SARS-CoV-2 or COVOID-19 of any age were included. Three researchers separately evaluated the bias in the reported articles. We conducted a systematic review and meta‐analysis with the objective of evaluation of the safety and efficacy of LPV/RTV alone or in combination with other drugs with regard to time to becoming PCR negative, time to body temperature normalization and cough relief, radiological progression, and safety. Review Manager (RevMan) was used to conduct all statistical analyses and generate the forest plots. Meta-analyses were performed using the Mantel Hazel method or the inverse variance method for dichotomous data and continuous data respectively.ResultsNon-duplicate articles (n=76) were evaluated for possible inclusion. A consensus was reached to select 29 articles for full-text screening, only 11 articles comprised 1,192 patients were included in this study, and six of which were included for meta-analysis.In terms of virological cure (PCR negative), three studies reported less time in days to achieve a virological cure for LPV/RTV arm relative to no antiviral therapy (conventional) (mean difference = −0.81 day; 95% CI, −4.44 to 2.81; P = 0.007, I2 = 80%). However, the overall effect was not significant (P = 0.66). When comparing LPV/RTV arm to umifenovir arm, a favorable affect was observed for umifenovir arm, but not statically significant (mean difference = 0.95 day; 95% CI, −1.11 to 3.01; P = 0.09, I2 = 58%).In terms of time to body normalization and cough relief (clinical cure), two studies reported on time to temperature normalization with no significant effect of LPV/RTV (n = 93) versus umifenovir (n = 71) arm), (OR = 0.87 day; 95% CI, 0.42 to 1.78; (P = 0.70), I2 = 0%), or alleviation of cough duration (p = 0.69).In terms of CT evidence of radiological progression of pneumonia/lung damage, treatment with lopinavir/ritonavir resulted in no significant decrease in the radiological progression (OR = 0.80; 95% CI, 0.42 to 1.54; P = 0.59, I2 = 81%), In terms of safety, a greater number of adverse events were reported for lopinavir/ritonavir (n=45) relative to the umifenovir arm (n=14) and conventional treatments (n=10), P = 0.004, 0,0007, respectivelyConclusionsThe small number of studies included in this systematic review and meta-analysis study did not reveal any statistically significant advantage in efficacy of lopinavir-ritonavir in COVID-19 patients, over conventional or other antiviral treatments. This result might not reflect the actual evidence.

2021 ◽  
Vol 5 (1) ◽  
pp. e001129
Author(s):  
Bill Stevenson ◽  
Wubshet Tesfaye ◽  
Julia Christenson ◽  
Cynthia Mathew ◽  
Solomon Abrha ◽  
...  

BackgroundHead lice infestation is a major public health problem around the globe. Its treatment is challenging due to product failures resulting from rapidly emerging resistance to existing treatments, incorrect treatment applications and misdiagnosis. Various head lice treatments with different mechanism of action have been developed and explored over the years, with limited report on systematic assessments of their efficacy and safety. This work aims to present a robust evidence summarising the interventions used in head lice.MethodThis is a systematic review and network meta-analysis which will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement for network meta-analyses. Selected databases, including PubMed, Embase, MEDLINE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials will be systematically searched for randomised controlled trials exploring head lice treatments. Searches will be limited to trials published in English from database inception till 2021. Grey literature will be identified through Open Grey, AHRQ, Grey Literature Report, Grey Matters, ClinicalTrials.gov, WHO International Clinical Trials Registry and International Standard Randomised Controlled Trials Number registry. Additional studies will be sought from reference lists of included studies. Study screening, selection, data extraction and assessment of methodological quality will be undertaken by two independent reviewers, with disagreements resolved via a third reviewer. The primary outcome measure is the relative risk of cure at 7 and 14 days postinitial treatment. Secondary outcome measures may include adverse drug events, ovicidal activity, treatment compliance and acceptability, and reinfestation. Information from direct and indirect evidence will be used to generate the effect sizes (relative risk) to compare the efficacy and safety of individual head lice treatments against a common comparator (placebo and/or permethrin). Risk of bias assessment will be undertaken by two independent reviewers using the Cochrane Risk of Bias tool and the certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations guideline for network meta-analysis. All quantitative analyses will be conducted using STATA V.16.DiscussionThe evidence generated from this systematic review and meta-analysis is intended for use in evidence-driven treatment of head lice infestations and will be instrumental in informing health professionals, public health practitioners and policy-makers.PROSPERO registration numberCRD42017073375.


Author(s):  
Afsaneh Noormandi ◽  
Mohammad Fathalipour ◽  
Reza Daryabeygi-Khotbehsara ◽  
Soheil Hassanipour

Background and objective: COVID-19 has since been declared a global pandemic by the World Health Organization (WHO), infecting millions worldwide. The use of Interferon (INF) subtypes previously examined in the treatment of SARS and MERS is also being initiated in some clinical trials. Although different clinical trials were evaluated IFNs in the treatment of COVID-19, their efficacy and safety remain unknown. Therefore, this study aims to systematically assess IFNs efficacy and safety in treating patients with COVID-19. Methods: The protocol has been registered in the PROSPERO International Prospective Register (CRD42020200643) on 24 July 2020. This protocol has been arranged according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 checklist. Discussion: Due to lack of approved medication for the covid-19 treatment and also various mutations of this virus, evaluated the efficacy and safety of medications by various studies could help for finding treatments with high effectiveness. IFNs are one of the medications that have been administered in covid-19 infection.  Moreover, the best time of administration and dose of this medication was unknown. Although meta-analysis is a potent source for assessing the accuracy of subjects, heterogeneity of articles is a potent limitation of our work.


2021 ◽  
pp. 219256822110668
Author(s):  
Kenney K. L. Lau ◽  
Karlen K. P. Law ◽  
Kenny Y. H. Kwan ◽  
Jason P. Y. Cheung ◽  
Kenneth M. C. Cheung ◽  
...  

Study Design Systematic review and meta-analysis Objectives The present review aimed to summarize the evidence regarding differences in proprioception between children with and without adolescent idiopathic scoliosis (AIS). Methods Seven electronic databases were searched from their inception to April 10, 2021. Articles were included if they involved: (1) AIS patients aged between 10 and 18 years, (2) measurements of proprioceptive abilities, and (3) comparisons with non-AIS controls. Animal studies, case reports, commentaries, conference proceedings, research protocols, and reviews were excluded. Two reviewers independently conducted literature screening, data extraction, risks of bias assessments, and quality of evidence evaluations. Relevant information was pooled for meta-analyses. Results From 432 identified citations, 11 case-control studies comprising 1121 participants were included. The meta-analyses showed that AIS participants displayed proprioceptive deficits as compared to non-AIS controls. Moderate evidence supported that AIS participants showed significantly larger repositioning errors than healthy controls (pooled mean difference = 1.27 degrees, P < .01). Low evidence substantiated that AIS participants had significantly greater motion detection threshold (pooled mean difference = 1.60 degrees, P < .01) and abnormal somatosensory evoked potentials (pooled mean difference = .36 milliseconds, P = .01) than non-AIS counterparts. Conclusions Consistent findings revealed that proprioceptive deficits occurred in AIS patients. Further investigations on the causal relationship between AIS and proprioception, and the identification of the subgroup of AIS patients with proprioceptive deficit are needed.


2020 ◽  
pp. 019459982095796
Author(s):  
Claudia I. Cabrera ◽  
Alexander Joseph Jones ◽  
Noah Philleo Parker ◽  
Amy Emily Lynn Blevins ◽  
Mark S. Weidenbecher

Objective To evaluate the difference in pharygocutaneous fistula (PCF) development between pectoralis major flap onlay and interpositional reconstructions after salvage total laryngectomy (STL). Data Sources Medline, Cochrane, Embase, Web of Science, CINAHL, and ClinicalTrials.gov. Review Methods A systematic review was performed during January 2020. English articles were included that described minor and major PCF rates after STL reconstructed with pectoralis major onlay or interposition. PCFs were classified as major when conservative therapy was unsuccessful and/or revision surgery was needed. Articles describing total laryngopharyngectomies were excluded. Meta-analyses of the resulting data were performed. Results Twenty-four articles met final criteria amassing 1304 patients. Three articles compared onlay with interposition, and 18 compared onlay with primary closure. Pectoralis interposition demonstrated elevated odds ratio (OR) of PCF formation as compared with onlay (OR, 2.34; P < .001). Onlay reconstruction reduced overall (OR, 0.32; P < .001) and major (OR, 0.21; P < .001) PCF development as compared with primary pharyngeal closure alone. Data were insufficient to compare interposition against primary closure. Conclusions This research shows evidence that pectoralis onlay after STL diminishes the odds of total and major PCF development. Pectoralis interposition reconstruction showed elevated odds of PCF formation as compared with pectoralis onlay.


2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Chen X. Chen ◽  
Bruce Barrett ◽  
Kristine L. Kwekkeboom

This systematic review examines the efficacy of oral ginger for dysmenorrhea. Key biomedical databases and grey literature were searched. We included randomized controlled trials comparing oral ginger against placebo or active treatment in women with dysmenorrhea. Six trials were identified. Two authors independently reviewed the articles, extracted data, and assessed risk of bias. Discrepancies were resolved by consensus with a third reviewer. We completed a narrative synthesis of all six studies and exploratory meta-analyses of three studies comparing ginger with placebo and two studies comparing ginger with a nonsteroidal anti-inflammatory drug (NSAID). Ginger appeared more effective for reducing pain severity than placebo. The weighted mean difference on a 10 cm visual analogue scale was 1.55 cm (favoring ginger) (95% CI 0.68 to 2.43). No significant difference was found between ginger and mefenamic acid (an NSAID). The standardized mean difference was 0 (95% CI −0.40 to 0.41). Available data suggest that oral ginger could be an effective treatment for menstrual pain in dysmenorrhea. Findings, however, need to be interpreted with caution because of the small number of studies, poor methodological quality of the studies, and high heterogeneity across trials. The review highlights the need for future trials with high methodological quality.


2021 ◽  
Author(s):  
Li Jia ◽  
Mingming Zhou ◽  
Li Sun ◽  
Luhai Yu ◽  
Xiangyan He

Abstract Atrial fibrillation(AF) increases the risk of ischemic stroke and systemic embolism in patients. Moreover, Asian patients with AF are more likely to have ischemic stroke than non-Asian patients. Oral anticoagulants could effectively prevent thrombotic events. Dabigatran and Rivaroxaban are two most commonly used novel oral anticoagulants (NOACs) in Asia, but those clinicial studies in relation with them are mostly in American and European countries. Therefore, whether there are differences between Dabigatran and Rivaroxaban among Asian patients with AF in terms of efficacy and safety is still unknown. This systematic review and meta-analysis will mainly assess clinical efficacy and safety of Dabigatran versus Rivaroxaban in Asian patients with AF by a pooled analysis. We will follow the PRISMA (preferred reporting items for systematic reviews and meta-analyses) and the reporting MOOSE (Meta-analyses of Observational Studies in Epidemiology) when performing this study. Then Cochrane Library,Web of Science, PubMed and China national knowledge infrastructure will be searched for eligible retrospective investigation that report the efficacy and safety outcomes of AF patients who utilised Dabigatran or Rivaroxaban for stroke prevention in Asian countries. The abovementioned database will be comprehensively searched from inception to September 30, 2019 to locate all potentially eligible studies. Outcome measures will include safety and efficacy indicators. Safety indicators include intracranial hemorrhage, major bleeding and gastrointestinal bleeding. Efficacy indicators include systemic embolism and stroke. New evidence for clinical profile of Dabigatran versus Rivaroxaban in AF patients will be provided for decision-making of Asian patients.PROSPERO registration number: CRD42020156197


2018 ◽  
Vol 52 (8) ◽  
pp. 751-767 ◽  
Author(s):  
Dan J Siskind ◽  
Michael Lee ◽  
Arul Ravindran ◽  
Qichen Zhang ◽  
Evelyn Ma ◽  
...  

Background: Although clozapine is the most effective medication for treatment refractory schizophrenia, only 40% of people will meet response criteria. We therefore undertook a systematic review and meta-analysis of global literature on clozapine augmentation strategies. Methods: We systematically reviewed PubMed, PsycInfo, Embase, Cochrane Database, Chinese Biomedical Literature Service System and China Knowledge Resource Integrated Database for randomised control trials of augmentation strategies for clozapine resistant schizophrenia. We undertook pairwise meta-analyses of within-class interventions and, where possible, frequentist mixed treatment comparisons to differentiate treatment effectiveness Results: We identified 46 studies of 25 interventions. On pairwise meta-analyses, the most effective augmentation agents for total psychosis symptoms were aripiprazole (standardised mean difference: 0.48; 95% confidence interval: −0.89 to −0.07) fluoxetine (standardised mean difference: 0.73; 95% confidence interval: −0.97 to −0.50) and, sodium valproate (standardised mean difference: 2.36 95% confidence interval: −3.96 to −0.75). Memantine was effective for negative symptoms (standardised mean difference: −0.56 95% confidence interval: −0.93 to −0.20). However, many of these results included poor-quality studies. Single studies of certain antipsychotics (penfluridol), antidepressants (paroxetine, duloxetine), lithium and Ginkgo biloba showed potential, while electroconvulsive therapy was highly promising. Mixed treatment comparisons were only possible for antipsychotics, and these gave similar results to the pairwise meta-analyses. Conclusions: On the basis of the limited data available, the best evidence is for the use of aripiprazole, fluoxetine and sodium valproate as augmentation agents for total psychosis symptoms and memantine for negative symptoms. However, these conclusions are tempered by generally short follow-up periods and poor study quality.


2020 ◽  
Vol 54 (1) ◽  
Author(s):  
Erin Jane L. Tababa ◽  
Rowena Natividad S. Flores-Genuino ◽  
Charissa Mia D. Salud-Gnilo

Objective. The study aimed to assess the efficacy and safety of Senna alata (akapulko) plant extracts compared with topical antifungals in the treatment of superficial fungal skin infections. Methods. A systematic review and meta-analysis of randomized controlled trials that studied patients with diagnosed cutaneous tinea or dermatophytosis (excluding hair and nail), tinea versicolor, or cutaneous candidiasis, via microscopy or culture, and compared the efficacy and safety of S. alata (akapulko) extract versus topical antifungals. Two authors independently screened titles and abstracts of merged search results from electronic databases (The Cochrane Skin Group Specialized Register, CENTRAL, MEDLINE, EMBASE (January 1990 to December 2011), Health Research and Development Information Network (HERDIN), and reference lists of articles), assessed eligibility, assessed the risk of bias using the domains in the Cochrane Risk Bias tool and collected data using a pretested Data extraction form (DEF). Meta-analyses were performed when feasible. Results. We included seven RCTs in the review. There is low certainty of evidence that S. alata 50% lotion is as efficacious as sodium thiosulfate 25% lotion (RR 0.91, 95% CI, 0.79 to 1.04; 4 RCTs, n=216; p=0.15; I2=52%) and high quality evidence that S. alata cream is as efficacious as ketoconazole (RR 0.95, 95% CI, 0.82 to 1.09; 1 RCT, n=40; p=0.44) and terbinafine cream (RR 0.93, 95% CI, 0.86 to 1.01; 1 RCT, n=150; p=0.09) in mycologic cure. For adverse effects, there is very low certainty of evidence of increased harm with S. alata 50% lotion compared to sodium thiosulfate 25% lotion (RR 1.26, 95% CI, 0.46, 3.44; 2 RCTs, n=120; p=0.65; I2=19%). Adverse effects were few and mild. Conclusion. S. Alata 50% lotion may be as efficacious as sodium thiosulfate 25% lotion and is as efficacious as ketoconazole 2% and terbinafine 1% creams. There is insufficient evidence to compare the safety of S. alata 50% lotion with sodium thiosulfate 25% lotion


PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251460
Author(s):  
Zubing Mei ◽  
Qin Feng ◽  
Peixin Du ◽  
Bin Li ◽  
Chenyang Fang ◽  
...  

Introduction A high prevalence of cryptoglandular and Crohn’s perianal fistulas has been reported worldwide, and several surgical options are available for the management of anal fistula, with varying clinical efficacy. However, currently, the available evidence for the effectiveness of these surgical approaches are lacking and of concern in terms of the credibility and strength. The purpose of this study is to evaluate the credibility of the published systematic reviews and meta-analyses that assess the efficacy and safety of the surgical options for cryptoglandular and Crohn’s perianal fistulas through an umbrella review. Methods and analysis A systematic search in PubMed, Embase and Cochrane library will be performed from inception to December 2020 without any language restriction. We will include systematic reviews and meta-analyses that investigate the efficacy and safety of surgical approaches in the management of cryptoglandular and Crohn’s perianal fistulas. Two reviewers will independently screen search results through reading the titles or abstracts. Relevant information will be extracted from each eligible systematic review or meta-analysis. Based on random effects model summary estimates along with their p values, 95% prediction intervals, between-study heterogeneity, small-study effects and excess significance, we will classify the evidence from convincing (class I) to weak (class IV). Findings will be summarized using quantitative synthesis combined with a narrative approach. Cryptoglandular and Crohn’s perianal fistulas will be summarized separately. Two authors will independently perform the literature search, data extraction, and quality assessment of each included systematic review and meta-analysis. Any unresolved conflicts or doubts will be resolved by discussion or by consulting a senior author. The risk of bias of the systematic reviews will be assessed using a 16-item Assessment of Multiple Systematic Reviews 2 (AMSTAR2) checklist. The strength of evidence for the included systematic reviews will be classified as "high", "moderate", "low", or "critically low" quality. Ethics and dissemination Ethics approval is not required as we will collect data from the published systematic reviews and meta-analyses without using individual patient data. The results of this umbrella review will be published in a peer-reviewed journal and will be presented at an anorectal disease conference. PROSPERO registration number CRD42020200754.


Author(s):  
Leila BAGHERI ◽  
Ali Mohammad NAZARI ◽  
Reza CHAMAN ◽  
Ashraf GHIASI ◽  
Zahra MOTAGHI

Background: Abortion is the ending of pregnancy due to removing an embryo or fetus before it can survive outside the uterus. Some women suffer from psychological disorders such as anxiety, depression and grief after abortion. Early detection of high-risk women after abortion and psychological intervention is one of the healing methods than can lead to improving outcomes but its effectiveness is not clear. The present meta-analysis evaluated the efficacy of this approach. Methods: The international and national electronic databases were searched from Jan 1998 until Aug 2018 including Medline, Web of Knowledge, Ovid, Embase, PubMed, Scopus, Cochrane, ScienceDirect, PsycINFO, ProQuest, Google Scholar, Iranmedex, Scientific Information Database (SID), and Magiran. The pooled mean difference with the random-effects model was used for meta-analyses. The preferred reporting items for systematic reviews and meta-analyses guidelines adhered in this study. Results: We enrolled 7 relevant studies involving 918 subjects into the meta-analysis process. The metaanalysis of the interventions aiming at prevention of post-abortion grief yielded a pooled standardized mean difference (SMD) of −0.03 (95% CI: −0.40−0.34; Z=0.16; P=0.87) at post-test and of -0.21 (95% CI:-0.53- 0.10; Z=1.32; P=0.19) at follow-up. Conclusion: This systematic review found psychotherapy-based interventions are effective in post-abortion grief treatment but; we found psychotherapy-based interventions are somewhat effective in short-term postabortion grief and it has a better effect on long-term grief.


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