scholarly journals Addition of Tocilizumab to the standard of care reduces mortality in severe COVID-19: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Umesha Boregowda ◽  
Abhilash Perisetti ◽  
Arpitha Nanjappa ◽  
Mahesh Gajendran ◽  
Gurusaravanan Kutti Sridharan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Interleukin 6 ◽  
Randomized Clinical Trials ◽  
Case Reports ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Original Data ◽  
Care Group ◽  
Significant Heterogeneity ◽  
Inconsistency Index

Introduction: Tocilizumab is an anti-interleukin-6 antibody that has been used for the treatment of severe coronavirus disease 2019 (COVID-19). However, the concrete evidence of its benefit in reducing the mortality in severe COVID-19 is lacking. Therefore, we performed a systematic review and meta-analysis of relevant studies that compared the efficacy of Tocilizumab in severe COVID-19 vs. standard of care alone. Methods: The literature search for studies that compared Tocilizumab and Standard of care in the treatment of COVID-19 was done using major online databases from December 2019 to June 14th, 2020. Search words Tocilizumab, anti-interleukin-6 antibody, and COVID-19 or coronavirus 2019 in various combinations were used. Articles in the form of abstracts, letters without original data, case reports, and reviews were excluded. Data was gathered on an excel sheet, and statistical analysis was performed using Review Manager 5.3. Results: Sixteen studies were eligible from 693 initial studies, including 3,641 patients (64% males). There were thirteen retrospective studies and three prospective studies. There were 2,488 patients in the standard of care group (61.7%) and 1,153 patients (68.7%) in the Tocilizumab group. The death rate in the tocilizumab group, 22.4% (258/1153), was lower than the standard of care group, 26.21% (652/2,488) (Pooled odds ratio 0.57 [95% CI 0.36-0.92] p=0.02). There was a significant heterogeneity (Inconsistency index= 80%) among the included studies. Conclusion: The addition of Tocilizumab to the standard of care might reduce the mortality in severe COVID-19. Larger randomized clinical trials are needed to validate these findings.

scholarly journals Comparing The Efficacy of Anti-Infectious Drugs For The Treatment of Mild To Severe COVID-19 Patients: A Protocol For A Systematic Review And Network Meta-Analysis of Randomized Clinical Trials.

2021 ◽  
Author(s):  
Dejene Tolossa Debela ◽  
Kidist Digamo Heraro ◽  
Abebaw Fekadu ◽  
Merga Belina ◽  
Tsegahun Manyazewal
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
English Language ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Antiviral Drug ◽  
Standard Of Care ◽  
Randomized Controlled ◽  
Primary Endpoints ◽  
Independent Review

Abstract Background: COVID-19 is a viral infection spreading at a great speed and has quickly caused an extensive burden to individuals, families, countries, and the world. No intervention has yet been proven highly effective for the treatment of COVID-19. Different drugs were being evaluated and reported through randomized clinical trials, and more are currently under trial. This review aimed to compare the efficacy of anti-infectious drugs with a comparator of the standard of care or placebo in patients with COVID-19.Methods: Two independent review authors will extract data and assess a risk of bias using RoB2. Randomized controlled trials (RCT) that evaluate single and/or combined antiviral drugs recommended by WHO latest guideline for the treatment of COVID-19 will be included. We will search for Pub Med, the Cochrane Center for Clinical Trial database (CENTRAL), clinicaltrials.gov, etc. databases for articles published in the English language between December 2019 to April 2021. We will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) involving Network Meta-analysis guidelines to design and report of the results. The primary endpoints will be time to clinical recovery and time to RNA negativity. The certainty of evidence will be evaluated using the GRADE extension of NMA. Data analysis will be performed using the frequentist NMA approach with the netmeta package implemented in R.Discussion: This review will reveal the best antiviral drug treatment for covid-19 and show the hierarchy of those drugs.Systematic review registration: The protocol was registered on PROSPERO with ID number CRD42021230919

scholarly journals Use of convalescent plasma in patients with coronavirus disease (Covid-19): Systematic review and meta-analysis

2021 ◽  
Author(s):  
Fernando Tortosa ◽  
Gabriela Carrasco ◽  
Martin Ragusa ◽  
Pedro Haluska ◽  
Ariel Izcovich
Keyword(s):  
Systematic Review ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Standard Of Care ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Assessment Development ◽  
Treatment Standard ◽  
Study Selection

AbstractObjetivesTo assess the effects of convalescent plasma treatment in patients with coronavirus disease (COVID-19).Study designSystematic review and Meta-analysisData sourcesA systematic search was carried out on the L · OVE (Living OVerview of Evidence) platform for COVID-19 until October 31, 2020Study selectionRandomized clinical trials in which people with probable or confirmed COVID-19 were randomized to drug treatment, standard care, or placebo. Pairs of reviewers independently screened potentially eligible articles.MethodsThe PRISMA guidelines were followed for conducting a systematic review and meta-analysis. The risk of bias of the included studies was assessed using the Cochrane risk of bias tool 2.0, and the certainty of the evidence using the recommendation assessment, development and evaluation (GRADE) approach. For each outcome, the interventions were classified into groups, from most to least beneficial or harmful.ResultsWe identified 10 RCTs (randomized controlled trials) involving 11854 patients in which convalescent plasma was compared with standard of care or other treatments. The results of five RCTs that evaluated the use of convalescent plasma in patients with COVID-19 did not show significant differences in the effect on mortality and the need for invasive mechanical ventilation.ConclusionsCurrent evidence is insufficient to recommend the use of convalescent plasma in the treatment of moderate or severe COVID-19.Contribution of the authors

scholarly journals The Clinical Efficacy and Adverse Effects of Entecavir plus Thymosin alpha-1 Combination Therapy versus Entecavir Monotherapy in HBV-related Cirrhosis: A Systematic Review and Meta-analysis

2020 ◽  
Author(s):  
Dan Peng ◽  
Hai-Yan Xing ◽  
Chen Li ◽  
Xian-Feng Wang ◽  
Min Hou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Combination Therapy ◽  
Loss Rate ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Random Effect Model ◽  
Significant Heterogeneity ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Thymosin Alpha 1

Abstract Background Previous studies have demonstrated the benefits of thymosin alpha-1 (Tα1) in anti-virus, immunological enhancement and anti-inflammation. However, it is controversial about the efficacy and safety of entecavir (ETV) plus T α1 combination therapy versus ETV monotherapy in cirrhotic patients with hepatitis B virus (HBV) infection. Methods The systematic review and meta-analysis of randomized clinical trials (RCTs) were performed to evaluate the efficacy and safety of ETV plus Tα1 combination therapy versus ETV monotherapy in HBV -related patients with cirrhosis. We performed a systematic literature search on seven databases. Relative risk (RR) and standardized mean difference (SMD) with a fixed- or random- effect model were calculated. Heterogeneity was assessed through a Cochrane Q-test and I 2 values. Results Seven RCTs involving 1144 subjects were included in the systematic review and meta-analysis. Compared with ETV monotherapy, ETV plus Tα1 combination therapy led to a higher complete response. In post treatment for 24 weeks, the HBV DNA undetectable rate and HBeAg loss rate were higher in ETV plus Tα1 group than in ETV alone group. However, after 48 and 52 weeks of treatment, there was no significant difference between the combination therapy and ETV monotherapy. At week 52 of treatment, the HBsAg loss rate of ETV plus Tα1 group was no significance with that of ETV alone group. In comparison with ETV alone, the some biochemical parameters and liver fibrosis were obviously improved by ETV plus Tα1 , and there was significant heterogeneity. In addition, the number of adverse events was significantly reduced by ETV plus Tα1, compared to ETV alone. Conclusions ETV plus Tα1 might lead to a higher clinical response and a lower comprehensive adverse reaction rate in HBV-related patients with cirrhosis, compared to ETV alone. However, the whole patients included in this meta-analysis were from Chinese mainland, so that more worldwide RCTs with a larger sample size are needed to verify the current findings.

scholarly journals Comparing the efficacy of anti‐infectious drugs for the treatment of mild to severe COVID-19 patients: a protocol for a systematic review and network meta-analysis of randomized clinical trials

2021 ◽  
Author(s):  
Dejene Tolossa Debela ◽  
Kidist Digamo Heraro
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
English Language ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Ethical Considerations ◽  
Primary Endpoints ◽  
Registration Number ◽  
Independent Review

Background: COVID-19 is a viral infection spreading at a great speed and has quickly caused an extensive burden to individuals, families, countries, and the world. No intervention has yet been proven highly effective for the treatment of COVID-19. Different drugs were being evaluated and reported through randomized clinical trials, and more are currently under trial. This review aimed to compare the efficacy of anti-infectious drugs with a comparator of the standard of care or placebo in patients with COVID-19. Methods and analysis: Two independent review authors will extract data and assess a risk of bias using RoB2. Randomized controlled trials (RCT) that evaluate single and/or combined antiviral drugs recommended by WHO latest guideline for the treatment of COVID-19 will be included. We will search for Pub Med, the Cochrane Center for Clinical Trial database (CENTRAL), clinicaltrials.gov, etc. databases for articles published in the English language between December 2019 to April 2021. We will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) involving Network Meta-analysis guidelines for the design and reporting of the results. The primary endpoints will be time to clinical recovery and time to RNA negativity. The certainty of evidence will be evaluated using the GRADE extension of NMA. Data analysis will be performed using the frequentist NMA approach with a netmeta package implemented in R. Ethics and dissemination: There are no ethical considerations associated with this study as we will use publicly available data from previously published studies. We plan to publish results in open access peer-reviewed journals. PROSPERO registration number: ID=CRD42021230919.

scholarly journals Lessons learned from contemporary glioblastoma randomized clinical trials through systematic review and network meta-analysis: Part 1 Newly diagnosed disease

2021 ◽  
Author(s):  
Shervin Taslimi ◽  
Vincent Ye ◽  
Gelareh Zadeh
Keyword(s):  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Standard Of Care ◽  
Lessons Learned ◽  
Significant Heterogeneity ◽  
Newly Diagnosed ◽  
Dismal Prognosis ◽  
Treatment Comparisons ◽  
Meta Analyses

Abstract Background Glioblastoma (GB) is the most common malignant brain tumour with a dismal prognosis despite standard of care (SOC). Here we used a network meta-analysis on treatments from randomized control trials (RCT) to assess effect on Overall survival (OS) and progression free survival (PFS) beyond the SOC. Methods We included RCT’s which investigated the addition of a new treatment to the SOC in patients with newly diagnosed GB. Our primary outcome was OS, with secondary outcomes including PFS and adverse reactions. Hazard ratio and its 95% confidence interval (CI) regarding OS and PFS were extracted from each paper. We utilized a frequentist network meta-analysis. We planned a subgroup analysis based on MGMT status. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Results Twenty-one studies were included representing a total of 7403 patients with GB. There was significant heterogeneity among studies impacting important factors such as timing of randomization, and sample size. A confidence analysis on the network meta-analysis results revealed a score of Low or Very Low for all treatment comparisons, across subgroups. Allowing for the hetereogeneity within the study population, Alkylating-nitrosureas (Lomustine and ACNU) and Tumor treating field (TTF) improved both OS (HR=0.53, 95%CI 0.33-0.84 and HR=0.63 95%CI 0.42-0.94 respectively) and PFS (HR=0.88, 95%CI 0.77-1.00 and HR=0.63 95%CI 0.52-0.76 respectively). Conclusions Our analysis highlights the numerous studies performed on newly diagnosed GB, with no proven consensus treatment that is superior to the current SOC. Inter-trial heterogeneity raises the need for better standardization in neuro-oncology studies.

scholarly journals Immediate loading of short implants: A systematic review

2021 ◽  
Vol 13 (1) ◽  
pp. 15-21
Author(s):  
Mahdi Hadilou ◽  
Pooya Ebrahimi ◽  
Behnaz Karimzadeh ◽  
Ashkan Ghaffary ◽  
Leila Gholami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dental Implants ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Immediate Loading ◽  
Significant Heterogeneity ◽  
Marginal Bone Loss ◽  
Manual Search ◽  
Short Implants ◽  
Loading Methods

Background. This systematic review aimed to determine the effectiveness and outcomes of immediate loading methods for short dental implants. Methods. The authors independently conducted an electronic search in the PubMed, Embase, EBSCO, ProQuest, and Cochrane databases for relevant articles published until November 15, 2020. The references of the included studies were assessed, and a manual search was conducted in Google Scholar and PubMed to find additional relevant studies. Results. Finally, three studies were selected and included in this systematic review. Significant heterogeneity existed in the design of the included studies, and due to the low number of the included studies, the authors could not perform a meta-analysis. The studies showed that the survival rate of immediate-loaded short implants is comparable to conventional loading methods. However, more marginal bone loss is expected. Overall, the immediate loading of short dental implants might be clinically successful. Conclusion. Based on the results, immediate loading protocols might be safely used for short implants. However, caution should be exercised in interpreting these results. Future welldesigned randomized clinical trials with more participants and study power are necessary to support the findings of this systematic review.

scholarly journals Effects of Quran Recitation on the Reduction of Preoperative Anxiety in Elective Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Vahideh Zarea Gavgani ◽  
Mortaza Ghojazadeh ◽  
Fatemeh Sadeghi-Ghyassi ◽  
Tahmineh Khodapanah
Keyword(s):  
Systematic Review ◽  
Publication Bias ◽  
Subgroup Analysis ◽  
Randomized Clinical Trials ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Preoperative Anxiety ◽  
Cochrane Library ◽  
Qualitative Synthesis ◽  
Inconsistency Index

Abstract Background: Anxiety is a common reaction among patients undergoing surgery. This study aim to assess effectiveness of Quran recitation on reducing the preoperative anxiety.Methods: A systematic review of the citations in the Medline, EMBASE, Cochrane Library, PsycInfo, Arab World Research Source and other relevant databases was performed to collect the data. Randomized clinical trials about the effect of Quran recitation on the reduction of preoperative anxiety in elective surgery were included without any Language and date restriction. Interventions with self-reading/self-recitation were excluded. The Cochran’s Q statistic and the (I2) with 50 percent threshold was used for calculation of the heterogeneity and inconsistency index. Subgroup analysis was conducted based on the type of surgery. The funnel plot has been used to evaluate the possibility of the publication bias.Results:Twelve studies were included in the qualitative synthesis and nine studies included in the quantitative synthesis. Our meta-analysis showed a significant reduction in the anxiety level with Quran recitation. The heterogeneity of the included studies was statistically significant (Q=23.05, I2=65.29, P=0.003). The pooled effect size of the anxiety was d=−8.893; 95% CI=[−10.763 to −7.022] (P < 0.001). The subgroup analysis showed that Quran recitation has a beneficial effect on reducing anxiety in both major and minor surgeries.There was no publication bias (t=0.907, P=0.39) in the studies.Conclusion: Quran recitation can be considered as a non-invasive and peaceful intervention to reduce preoperative anxiety in elective surgery.

scholarly journals 1136 Cochlear Implant Outcomes in Patients with Otosclerosis: A Systematic Review

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C M Lam ◽  
H L Cornwall ◽  
A Chaudhry ◽  
J Muzaffar ◽  
M Bance ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cochlear Implantation ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Significant Heterogeneity ◽  
Patient Counselling ◽  
Study Objective ◽  
Patient Reported ◽  
Hearing Outcomes

Abstract Introduction In otosclerosis, spongiotic bone replaces normal bone in the ossicular chain. Focal deposits may also be found within the cochlea leading to sensorineural hearing loss refractory to conventional treatment. Cochlear implantation can play an important role in the management of otosclerosis in these patients. Our study objective is to establish hearing outcomes following cochlear implantation in patients with otosclerosis. Method Systematic review and narrative synthesis. Databases searched: Medline, PubMed, Embase, Web of Science, Cochrane Collection and ClinicalTrials.gov. No limits placed on language or year of publication. Review conducted in accordance with the PRISMA statement. Results Searches identified 68 studies meeting the inclusion criteria and reporting outcomes in a minimum of 481 patients with at least 516 implants. The methodological quality of included studies was modest, predominantly consisting of case reports and non-controlled case series with small numbers of patients. Significant heterogeneity existed in terms of outcomes and methods of reporting, which precluded a meta-analysis. Access to good rehabilitation support is essential to achieving the good hearing outcomes and Patient Reported Outcome Measures that can be expected by 12 months post-implantation in most cases. There was significant association between the radiological severity of otosclerosis and an increase in surgical and post-operative complications. Post-operative facial nerve stimulation can occur and may require deactivation of electrodes and subsequent hearing detriment. Conclusions Hearing outcomes are typically good, but patients should be counselled on associated surgical complications which may compromise hearing. Modern diagnostic techniques may help to identify potentially difficult cases to aid operative planning and patient counselling.

scholarly journals Association of l-Arginine Supplementation with Markers of Endothelial Function in Patients with Cardiovascular or Metabolic Disorders: A Systematic Review and Meta-Analysis

Nutrients ◽  
2018 ◽  
Vol 11 (1) ◽  
pp. 15 ◽  
Author(s):  
Josianne Rodrigues-Krause ◽  
Mauricio Krause ◽  
Ilanna Rocha ◽  
Daniel Umpierre ◽  
Ana Fayh
Keyword(s):  
Systematic Review ◽  
Randomized Clinical Trials ◽  
Metabolic Diseases ◽  
Data Extraction ◽  
Meta Analysis ◽  
Eligibility Criteria ◽  
Inconsistency Index ◽  
Statistical Heterogeneity ◽  
Nitrite Nitrate ◽  
Arginine Supplementation

l-Arginine supplementation is a potential therapy for treating cardiovascular and metabolic diseases. However, the use of distinct l-arginine sources, intervened populations, and treatment regimens may have yielded confusion about their efficacy. This research constitutes a systematic review and meta-analysis summarizing the effects of l-arginine supplementation compared to placebo in individuals with cardiovascular disease (CVD), obesity, or diabetes. Eligibility criteria included randomized clinical trials and interventions based on oral supplementation of l-arginine with a minimum duration of three days; comparison groups consisted of individuals with the same disease condition receiving an oral placebo substance. The primary outcome was flow-mediated dilation, and secondary outcomes were nitrite/nitrate (NOx) rate and asymmetric dimethylarginine (ADMA). Statistical heterogeneity among studies included in the meta-analyses was assessed using the inconsistency index (I2). Fifty-four full-text articles from 3761 retrieved references were assessed for eligibility. After exclusions, 13 studies were included for data extraction. There was no difference in blood flow after post-ischemic hyperemia between the supplementation of l-arginine and placebo groups before and after the intervention period (standardized mean difference (SMD) = 0.30; 95% confidence intervals (CIs) = −0.85 to 1.46; I2 = 96%). Sensitivity analysis showed decreased heterogeneity when the studies that most favor arginine and placebo were removed, and positive results in favor of arginine supplementation were found (SMD = 0.59; 95% CIs = 0.10 to 1.08; I2 = 75%). No difference was found in meta-analytical estimates of NOx and ADMA responses between arginine or placebo treatments. Overall, the results indicated that oral l-arginine supplementation was not associated with improvements on selected variables in these patients (PROSPERO Registration: CRD42017077289).

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