Hydroxychloroquine and mortality risk of patients with COVID-19: a systematic review and meta-analysis of human comparative studies

AbstractBackgroundGlobal COVID-19 deaths reached at least 400,000 fatalities. Hydroxychloroquine is an antimalarial drug that elicit immunomodulatory effects and had shown in vitro antiviral effects against SRAS-CoV-2. This drug divided opinion worldwide in the medical community but also in the press, the general public and in public health policies. The aim of this systematic review and this meta-analysis was to bring a new overview on this controversial drug and to assess whether hydroxychloroquine could reduce COVID-19 mortality risk in hospitalized patients.Methods and FindingsPubmed, Web of Science, Cochrane Library, MedRxiv and grey literature were searched until 10 June 2020. Only studies of COVID-19 patients treated with hydroxychloroquine (with or without azithromycin) compared with a comparative standard care group and with full-text articles in English were included. Studies reporting effect sizes as Odds Ratios, Hazard Ratio and Relative Risk for mortality risk and the number of deaths per groups were included. This meta-analysis was conducted following PRISMA guidelines and registered on PROSPERO (Registration number: CRD42020190801). Independent extraction has been performed by two independent reviewers. Effect sizes were pooled using a random-effects model.The initial search leaded to 112 articles, from which 16 articles met our inclusion criteria. 15 studies were retained for association between hydroxychloroquine and COVID-19 survival including 15,081 patients (8,072 patients in the hydroxychloroquine arm and 7,009 patients in the standard care arm with respectively, 1,578 deaths and 1,423 deaths). 6 studies were retained for hydroxychloroquine with azithromycin. Hydroxychloroquine was not significantly associated with mortality risk (pooled Relative Risk RR=0.82 (95% Confidence Interval: 0.62-1.07, I2=82, Pheterogeneity<0.01, n=15)) within hospitalized patients, nor in association with azithromycin (pooled Relative Risk RR=1.33 (95% CI: 0.92-1.92, I2=75%, Pheterogeneity<0.01, n=6)), nor in the numerous subgroup analysis by study design, median age population, published studies (vs unpublished articles), level of bias risk. However, stratified analysis by continents, we found a significant decreased risk of mortality associated with hydroxychlroquine alone but not with azithromycin among European (RR= 0.62 (95%CI: 0.41-0.93, n=7)) and Asian studies (RR=0.36 (95%CI:0.18-0.73, n=1)), with heterogeneity detected across continent (Pheterogeneity between=0.003). These finding should be interpreted with caution since several included studies had a low quality of evidence with a small sample size, a lack of adjustment on potential confounders or selection and intervention biases.ConclusionOur meta-analysis does not support the use of hydroxychloroquine with or without azithromycin to reduce COVID-19 mortality in hospitalized patients. It raises the question of the hydroxychloroquine use outside of clinical trial. Additional results from larger randomised controlled trials are needed

Download Full-text

Impact of interstitial lung disease on mortality in ANCA-associated vasculitis: A systematic literature review and meta-analysis

Chronic Respiratory Disease ◽

10.1177/1479973121994562 ◽

2021 ◽

Vol 18 ◽

pp. 147997312199456

Author(s):

Peining Zhou ◽

Jing Ma ◽

Guangfa Wang

Keyword(s):

Systematic Review ◽

Interstitial Lung Disease ◽

Confidence Interval ◽

Lung Disease ◽

Mortality Risk ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Anca Associated Vasculitis ◽

Retrospective Cohort Studies

Several retrospectivee described the association of interstitial lung disease (ILD) and ANCA-associated vasculitis (AAV). However, the relationship between the ILD and mortality in AAV patients have not been established so far. This study aims to estimate the relevance of AAV-associated-ILD (AAV-ILD) and mortality risk by conducting a systematic review and meta-analysis.A comprehensive systematic review was conducted in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses). PubMed, Embase.com and the Cochrane Library (Wiley) were searched for original observational studies. Summary estimates were derived with a random-effects model and reported as risk ratio (RR), tested for publication bias and heterogeneity. Ten retrospective cohort studies were included, comprising 526 AAV-ILD patients enrolled from 1974 to 2018. Meta-analysis yielded a pooled RR of 2.90 (95% confidence interval 1.77–4.74) for death among those with AAV-ILD compared to control group. UIP pattern was associated with an even poorer prognosis in comparison to non-UIP pattern (RR 4.36, 95% confidence interval 1.14–16.78). Sensitivity analysis suggested that the meta-RR result was not skewed by a single dominant study. ILD might be associated with a higher mortality risk in AAV patients.

Download Full-text

Daily sodium consumption and CVD mortality in the general population: systematic review and meta-analysis of prospective studies

Public Health Nutrition ◽

10.1017/s1368980014000949 ◽

2014 ◽

Vol 18 (4) ◽

pp. 695-704 ◽

Cited By ~ 37

Author(s):

Rosana Poggio ◽

Laura Gutierrez ◽

María G Matta ◽

Natalia Elorriaga ◽

Vilma Irazola ◽

...

Keyword(s):

Systematic Review ◽

Relative Risk ◽

General Population ◽

Prospective Studies ◽

Meta Analysis ◽

Cochrane Library ◽

Random Effects Models ◽

Meta Regression ◽

Cvd Mortality

AbstractObjectiveThe purpose of the present study was to determine whether elevated dietary Na intake could be associated with CVD mortality.DesignWe performed a systematic review and meta-analysis of prospective studies representing the general population. The adjusted relative risks and their 95 % confidence intervals were pooled by the inverse variance method using random-effects models. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed.SettingsMEDLINE (since 1973), Embase (since 1975), the Cochrane Library (since 1976), ISI Web of Science, Google Scholar (until September 2013) and secondary referencing were searched for inclusion in the study.SubjectEleven prospective studies with 229 785 participants and average follow-up period of 13·37 years (range 5·5–19 years).ResultsHigher Na intake was significantly associated with higher CVD mortality (relative risk=1·12; 95 % CI 1·06, 1·19). In the sensitivity analysis, the exclusion of studies with important relative weights did not significantly affect the results (relative risk=1·08; 95 % CI 1·01, 1·15). The meta-regression analysis showed that for every increase of 10 mmol/d in Na intake, CVD mortality increased significantly by 1 % (P=0·016). Age, hypertensive status and length of follow-up were also associated with increased CVD mortality.ConclusionsHigher Na intake was associated with higher CVD mortality in the general population; this result suggests a reduction in Na intake to prevent CVD mortality from any cause.

Download Full-text

The effectiveness of psychological interventions for anxiety in the perinatal period: A systematic review and meta-analysis

10.1101/2022.01.14.22269296 ◽

2022 ◽

Author(s):

Natalie Clinkscales ◽

Katherine Berlouis ◽

Lisa Golds ◽

Angus MacBeth

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Perinatal Period ◽

Small Sample ◽

Treatment Modalities ◽

Cochrane Library ◽

Psychological Interventions ◽

Inclusion Criteria ◽

Compulsive Disorder ◽

Perinatal Anxiety

Background: Anxiety disorders are a relatively common occurring mental health issue during pregnancy and the perinatal period. There is evidence that untreated perinatal anxiety is a risk factor for adverse outcomes for mother and infant. Despite their potential acceptability to users, psychological interventions research for this population is still in its infancy. This systematic review and meta-analysis aimed to comprehensively evaluate the evidence of the effectiveness of psychological interventions for reducing perinatal anxiety. Method: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases searched included EMBASE, MEDLINE, PsychINFO, MIDIRS, CINAHL and the Cochrane Library. Search terms included: Psychological Therapy, Perinatal Period, Antenatal, Postnatal, Anxiety, Obsessive Compulsive Disorder and Phobia. Results: The search strategy identified 2025 studies. A total of 21 studies published between 2004 and 2021 fulfilled inclusion criteria. Of those, 17 were included in the meta-analysis. Overall results indicated that psychological interventions were more effective than control conditions in reducing symptoms of perinatal anxiety with a medium post treatment effect size. Significant effect sizes were also identified for online, face-to-face, group and guided self-help treatment modalities. Limitations: A small sample of studies are represented and limited to articles published in English. The review was unable to draw specific conclusions about what works (i.e. therapeutic modality/delivery) for whom (i.e. specific diagnoses) due to purposefully broad inclusion criteria. The longer-term effects of psychological interventions for perinatal anxiety and infant outcomes could not be established. Conclusions: This review demonstrates that psychological interventions are effective in reducing symptoms of both anxiety and comorbid anxiety and depression in the antenatal and postnatal periods. The results also demonstrate the efficacy of delivering such interventions in multiple settings, including online, and in group format. Further research is required to optimise treatment delivery to individual needs.

Download Full-text

Prevalence and risk factors associated with birth asphyxia among neonates delivered in Ethiopia: A systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0255488 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255488

Author(s):

Ritbano Ahmed ◽

Hassen Mosa ◽

Mohammed Sultan ◽

Shamill Eanga Helill ◽

Biruk Assefa ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Birth Asphyxia ◽

Public Health Problem ◽

Cochrane Library ◽

Chronic Hypertension ◽

Factors Associated ◽

Pooled Prevalence

Background A number of primary studies in Ethiopia address the prevalence of birth asphyxia and the factors associated with it. However, variations were seen among those studies. The main aim of this systematic review and meta-analysis was carried out to estimate the pooled prevalence and explore the factors that contribute to birth asphyxia in Ethiopia. Methods Different search engines were used to search online databases. The databases include PubMed, HINARI, Cochrane Library and Google Scholar. Relevant grey literature was obtained through online searches. The funnel plot and Egger’s regression test were used to see publication bias, and the I-squared was applied to check the heterogeneity of the studies. Cross-sectional, case-control and cohort studies that were conducted in Ethiopia were also be included. The Joanna Briggs Institute checklist was used to assess the quality of the studies and was included in this systematic review. Data entry and statistical analysis were carried out using RevMan 5.4 software and Stata 14. Result After reviewing 1,125 studies, 26 studies fulfilling the inclusion criteria were included in the meta-analysis. The pooled prevalence of birth asphyxia in Ethiopia was 19.3%. In the Ethiopian context, the following risk factors were identified: Antepartum hemorrhage(OR: 4.7; 95% CI: 3.5, 6.1), premature rupture of membrane(OR: 4.0; 95% CI: 12.4, 6.6), primiparas(OR: 2.8; 95% CI: 1.9, 4.1), prolonged labor(OR: 4.2; 95% CI: 2.8, 6.6), maternal anaemia(OR: 5.1; 95% CI: 2.59, 9.94), low birth weight(OR = 5.6; 95%CI: 4.7,6.7), meconium stained amniotic fluid(OR: 5.6; 95% CI: 4.1, 7.5), abnormal presentation(OR = 5.7; 95% CI: 3.8, 8.3), preterm birth(OR = 4.1; 95% CI: 2.9, 5.8), residing in a rural area (OR: 2.7; 95% CI: 2.0, 3.5), caesarean delivery(OR = 4.4; 95% CI:3.1, 6.2), operative vaginal delivery(OR: 4.9; 95% CI: 3.5, 6.7), preeclampsia(OR = 3.9; 95% CI: 2.1, 7.4), tight nuchal cord OR: 3.43; 95% CI: 2.1, 5.6), chronic hypertension(OR = 2.5; 95% CI: 1.7, 3.8), and unable to write and read (OR = 4.2;95%CI: 1.7, 10.6). Conclusion According to the findings of this study, birth asphyxia is an unresolved public health problem in the Ethiopia. Therefore, the concerned body needs to pay attention to the above risk factors in order to decrease the country’s birth asphyxia. Review registration PROSPERO International prospective register of systematic reviews (CRD42020165283).

Download Full-text

Safety and efficacy of mycophenolate mofetil in treating neuromyelitis optica spectrum disorders: a protocol for systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-040371 ◽

2020 ◽

Vol 10 (11) ◽

pp. e040371

Author(s):

Mengyu Han ◽

Luqi Nong ◽

Ziqiang Liu ◽

You Chen ◽

Yang Chen ◽

...

Keyword(s):

Systematic Review ◽

Mycophenolate Mofetil ◽

Neuromyelitis Optica ◽

Meta Analysis ◽

Grey Literature ◽

Relevant Literature ◽

Biomedical Literature ◽

Cochrane Library ◽

Neuromyelitis Optica Spectrum Disorders ◽

Spectrum Disorders

IntroductionNeuromyelitis optica spectrum disorders (NMOSD) is an inflammatory and heterogeneous astrocyte disorder of the central nervous system with the characteristic of higher incidence in women and Asian people. Most patients with NMOSD have a course of recurrence and remission that is prone to cause paralysis and blindness. Several studies have confirmed the efficacy and promising prospect of mycophenolate mofetil (MMF) in the treatment of NMOSD. Yet its therapeutic effect and safety are controversial. Although there has been two published literature that is relevant to the topic of this study, both of them have certain defects, and they can only provide answers about the efficacy or safety of MMF in the treatment of NMOSD from partial perspectives or conclusions. This research aims to perform a direct and comprehensive systematic review and meta-analysis to evaluate MMF’s effectiveness and safety in treating NMOSD.Methods and analysisThis systematic review will cover all comparative researches, from randomised controlled trials to cohort studies, and case–control study. A relevant literature search will be conducted in PubMed, Web of Science, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database and Chinese Biomedical Literature Database from their inception to 31 June 2020. We will also search registers of clinical trials, potential grey literature and abstracts from conferences. There are no limits on language and publication status. The reporting quality and risk of bias will be assessed by two researchers independently. Expanded Disability Status Scales and annualised relapse rate will be evaluated as the primary outcome. The secondary outcomes will consist of the frequency and severity of adverse events, best-corrected visual acuity, relapse-free rate and time to the next attack. A meta-analysis will be performed using RevMan V.5.3 software provided by the Cochrane Collaboration and Stata V.12.0.Ethics and disseminationBecause the data used for this systematic review will be exclusively extracted from published studies, ethical approval and informed consent of patients will not be required. The systematic review will be published in a peer-reviewed journal, presented at conferences and will be shared on social media platforms.PROSPERO registration numberCRD42020164179.

Download Full-text

Do Tooth- and Cavity-related Aspects of Noncarious Cervical Lesions Affect the Retention of Resin Composite Restorations in Adults? A Systematic Review and Meta-analysis

Operative Dentistry ◽

10.2341/19-091-l ◽

2020 ◽

Vol 45 (3) ◽

pp. E124-E140

Author(s):

AMO Correia ◽

E Bresciani ◽

AB Borges ◽

DM Pereira ◽

LC Maia ◽

...

Keyword(s):

Systematic Review ◽

Latin American ◽

Randomized Clinical Trials ◽

Retention Rate ◽

Meta Analysis ◽

Grey Literature ◽

Composite Resins ◽

Cochrane Library ◽

Cervical Lesions ◽

Composite Restorations

SUMMARY Purpose: The purpose was to perform a systematic review and meta-analysis based on the following research question: do tooth- and cavity-related aspects of noncarious cervical lesions (NCCLs) affect the retention of composite restorations? Methods: Randomized clinical trials (RCTs) that evaluated the retention rate of resin restorations in NCCLs were included for the identification and comparison of their characteristics. The search was conducted in PubMed and adapted for Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), Cochrane Library, and System for Information on Grey Literature in Europe (SIGLE) without restrictions until July 2018. Unpublished and ongoing trial registries were also searched. The Cochrane Collaboration tool was used for assessing risk of bias. The quality of the evidence was graded using the Grading of Recommendations: Assessment, Development and Evaluation. Using the random effects model, a meta-analysis was conducted for each aspect (arch distribution, tooth location, wear facets, dentin sclerosis, shape, size, depth, occluso-gingival distance, and margin location). Results: We retrieved 6738 articles. After removal of duplicates and nonrelevant articles, 24 RCTs remained. The anterior tooth location favored the retention rates of restoration of NCCLs (relative risk [RR], 1.08; 95% confidence interval [CI], 1.00-1.16). The presence of wear facets is a risk factor for the retention of restorations (RR, 0.91; 95% CI, 0.83-0.99). The evidence was moderate for arch distribution and low or very low for all other factors because of heterogeneity, imprecision, and inconsistency. Conclusion: The tooth location and the presence of wear facets can affect the retention of composite resins in NCCLs.

Download Full-text

Silver Diamine Fluoride Has Efficacy in Controlling Caries Progression in Primary Teeth: A Systematic Review and Meta-Analysis

Caries Research ◽

10.1159/000478668 ◽

2017 ◽

Vol 51 (5) ◽

pp. 527-541 ◽

Cited By ~ 27

Author(s):

Ana Cláudia Chibinski ◽

Letícia Maíra Wambier ◽

Juliana Feltrin ◽

Alessandro Dourado Loguercio ◽

Denise Stadler Wambier ◽

...

Keyword(s):

Systematic Review ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Grey Literature ◽

Active Material ◽

Risk Of Bias ◽

Cochrane Library ◽

Silver Diamine Fluoride ◽

Caries Progression

A systematic review was performed to evaluate the efficacy of silver diamine fluoride (SDF) in controlling caries progression in children when compared with active treatments or placebos. A search for randomized clinical trials that evaluate the effectiveness of SDF for caries control in children compared to active treatments or placebos with follow-ups longer than 6 months was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and grey literature. The risk of bias tool from the Cochrane Collaboration was used for quality assessment of the studies. The quality of the evidence was evaluated using the GRADE approach. Meta-analysis was performed on studies considered at low risk of bias. A total of 5,980 articles were identified. Eleven remained in the qualitative synthesis. Five studies were at “low,” 2 at “unclear,” and 4 studies at “high” risk of bias in the key domains. The studies from which the information could be extracted were included for meta-analysis. The arrestment of caries at 12 months promoted by SDF was 66% higher (95% CI 41-91%; p < 0.00001) than by other active material, but it was 154% higher (95% CI 67-85%; p < 0.00001) than by placebos. Overall, the caries arrestment was 89% higher (95% CI 49-138%; p < 0.00001) than using active materials/placebo. No heterogeneity was detected. The evidence was graded as high quality. The use of SDF is 89% more effective in controlling/arresting caries than other treatments or placebos. The quality of the evidence was graded as high.

Download Full-text

Antiepileptic Drug Exposure during Pregnancy and Neonatal Birth Weight Outcomes: Protocol for a Systematic Review and Meta-analysis.

10.21203/rs.3.rs-74193/v1 ◽

2020 ◽

Author(s):

Alekhya Lavu ◽

Christine Vaccaro ◽

Walid Shouman ◽

Silvia Alessi-Severini ◽

Sherif Eltonsy

Keyword(s):

Systematic Review ◽

Birth Weight ◽

Antiepileptic Drug ◽

Drug Exposure ◽

Meta Analysis ◽

Grey Literature ◽

Cochrane Library ◽

Neonatal Birth Weight ◽

Weight Outcomes ◽

In Pregnancy

Abstract Background: The prevalence of epilepsy in pregnant women is estimated at 0.3- 1%. Antiepileptic drug (AED) exposure in-utero has been associated with various adverse health outcomes in neonates including adverse birth weight outcomes. Methods: To summarize the evidence on the association between AED exposure in pregnancy and adverse birthweight outcomes. Studies assessing AED exposure in pregnancy and neonatal birth weight outcome including small for gestational age (SGA), low birth weight (LBW), birth weight (BW), length head circumference and cephalization index will be identified in MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL, IPA, and Global Health. Open grey, Theses Canada and ProQuest Dissertations will be used to locate grey literature. Eligible study designs include experimental and observational studies. Studies will be assessed for risk of bias using the Newcastle-Ottawa Scale and Meta-analysis will be conducted using a random-effects model. Discussion: The results from this review could improve clinicians’ prescribing decisions by highlighting the safest AEDs for women who are pregnant or planning to conceive based on the best evidence currently available. Systematic review registration: submitted (19/08/2020))

Download Full-text

Decreased mortality and increased side effects in COVID-19 patients treated with IL-6 receptor antagonists: systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-00726-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Jishnu Malgie ◽

Jan W. Schoones ◽

Maurice P. Zeegers ◽

Bart G. Pijls

Keyword(s):

Systematic Review ◽

Side Effects ◽

Mortality Risk ◽

Meta Analysis ◽

Standard Of Care ◽

Baseline Risk ◽

Cochrane Library ◽

Receptor Antagonists ◽

Impaired Liver Function ◽

Baseline Mortality

AbstractThere is controversy whether IL-6 (receptor) antagonists are beneficial in treating COVID-19 patients. We therefore update our systematic review to answer the following research questions: (1) Do patients hospitalized for COVID-19 treated with IL-6 (receptor) antagonists have lower mortality compared to standard of care? (2) Do patients hospitalized for COVID-19 treated with IL-6 (receptor) antagonists have more side effects compared to standard of care? The following databases were search up to December 1st 2020: PubMed, PMC PubMed Central, MEDLINE, WHO COVID-19 Database, Embase, Web-of-Science, COCHRANE LIBRARY, Emcare and Academic Search Premier. In order to pool the risk ratio (RR) and risk difference of individual studies we used random effects meta-analysis. The search strategy retrieved 2975 unique titles of which 71 studies (9 RCTs and 62 observational) studies comprising 29,495 patients were included. Mortality (RR 0.75) and mechanical ventilation (RR 0.78) were lower and the risk of neutropenia (RR 7.3), impaired liver function (RR 1.67) and secondary infections (RR 1.26) were higher for patients treated with IL-6 (receptor) antagonists compared to patients not treated with treated with IL-6 (receptor) antagonists. Our results showed that IL-6 (receptor) antagonists are effective in reducing mortality in COVID-19 patients, while the risk of side effects was higher. The baseline risk of mortality was an important effect modifier: IL-6 (receptor) antagonists were effective when the baseline mortality risk was high (e.g. ICU setting), while they could be harmful when the baseline mortality risk was low.

Download Full-text

Increased risk of liver-related outcomes in chronic hepatitis B patients with metabolic syndrome: A systematic review and meta-analysis

Digestive Diseases ◽

10.1159/000521768 ◽

2022 ◽

Author(s):

Khin Naing Thin ◽

Andrew Tran ◽

Jie Li ◽

Eunice Yewon Lee ◽

Hongli Yang ◽

...

Keyword(s):

Systematic Review ◽

Metabolic Syndrome ◽

Chronic Hepatitis ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Small Sample Size ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Library ◽

Increased Risk

Introduction: Chronic hepatitis B (CHB) patients with metabolic syndrome (MetS) may present increased risk of liver-related outcomes (LROs) but prior studies were limited by small sample size and/or conflicting results. Using a systematic review and meta-analytic approach, we aimed to determine the association between MetS and LROs in CHB. Methods: Two researchers independently screened studies from the PubMed, Embase, Web of Science, and Cochrane Library databases from inception to January 21, 2020 and extracted the data. Estimates were pooled using a random-effects model. Results: We screened 2,228 articles and included 10 eligible studies (18,360 CHB patients, 2,557 with MetS). MetS was significantly associated with LROs overall (OR=2.45, 95%CI=1.39-4.32) but not the individual LRO components but subgroup analyses were limited by small study numbers. Discussion/Conclusion: MetS is associated with almost 3 folds higher risk of LROs in CHB and should be considered in management decisions. However, additional studies are needed.

Download Full-text