Systematic Review and Meta-analysis of Eculizumab, Inebilizumab, Tocilizumab, and Satralizumab for Neuromyelitis Optica

Neuromyelitis optica is rare, autoimmune-mediated inflammation and demyelination of the central nervous system with a prevalence of 1-2 persons per 100,000 populations. We aim to generate a head-to-head comparison of these drugs with appropriate evidence to guide future trials and treatment guidelines in a patient with recurrent attacks of NMO. We searched the databases like PubMed, MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL) and Embase for studies published prior to April 2021 using the keywords. Over all 929 patients from 11 different publications were included in the study. Five studies were included for quantitative synthesis. Pooling of studies showed significant mean reduction of ARR in the monoclonal antibody group (-0.26 [-0.35, -0.17], P <0.00001, I2=0%) and the mean difference in EDSS score from baseline in monoclonal antibodies was -0.23(95% CI [-0.43, -0.03], P=0.02, I2=0%). There was no significant difference in frequency of total reported adverse events between monoclonal antibody and the comparator arm (RR: 1.01 [0.95, 1.07], P=0.74, I2=14%). Our findings, particularly seen from the context of a few RCTs, support the pursuit of larger, multi-center RCTs that evaluate the effectiveness of each of the currently available monoclonal antibodies and better describe their adverse risk profile.

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Velcro Ties in Early Postoperative Pediatric Tracheostomy Care: A Systematic Review and Meta-analysis

Otolaryngology ◽

10.1177/0194599820964727 ◽

2020 ◽

pp. 019459982096472

Author(s):

Brent A. Chang ◽

Joshua Gurberg ◽

Erin Ware ◽

Kimberly Luu

Keyword(s):

Meta Analysis ◽

Prospective Trial ◽

Final Analysis ◽

Cochrane Central Register ◽

Limited Data ◽

Cochrane Database ◽

Central Register ◽

Significant Difference ◽

Randomized Prospective Trial ◽

The Difference

Objective To systematically review the literature to determine the difference in complications between standard twill and Velcro ties following pediatric tracheostomy. Data Sources MEDLINE, Embase, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, Web of Science, and CINAHL Plus were searched up to August 2020. Review Methods Two authors independently screened articles for eligibility. Retrospective and prospective studies were included as long as there was a direct comparison between twill and Velcro ties. Quantitative and qualitative analysis was performed. The main outcomes were skin-related complications and accidental decannulation. Results Three studies were included in the final analysis: 1 randomized prospective trial and 2 retrospective studies. There were 238 patients total (137 twill, 101 Velcro). Combined analysis showed skin-related complications in 23% of the Velcro group and 44% of the twill group. Meta-analysis for skin-related complications showed no significant difference when comparing Velcro with standard twill ties (risk ratio, 0.53 [95% CI, 0.24-1.17]; P = .12, n = 238 participants from 3 studies, I2 = 66%). Accidental decannulation rates were overall low and comparable between groups (1.0% of twill, 1.4% of Velcro). Conclusion Based on limited data, skin-related complications were not statistically different between Velcro and twill ties. Accidental decannulation is rare with Velcro and standard twill ties, and both are viable options following pediatric tracheostomy.

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Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis

BMC Anesthesiology ◽

10.1186/s12871-019-0910-8 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Yang Zhou ◽

Abdul Mannan ◽

Yuan Han ◽

He Liu ◽

Hui-Lian Guan ◽

...

Keyword(s):

Side Effects ◽

Incidence Rate ◽

Meta Analysis ◽

Cochrane Central Register ◽

Efficacy And Safety ◽

Central Register ◽

Postanesthetic Shivering ◽

Significant Difference ◽

The Difference ◽

Prophylactic Use

Abstract Background Postanesthetic shivering is a common complication of anesthesia, which accounts for much discomfort in postoperative patients and may increase postoperative complications in high-risk patients. Due to the lack of high-quality evidence, it is difficult to draw a conclusion about optimal anti-shivering medication. The main purpose of this meta-analysis was to analyze and evaluate the efficacy and safety of prophylactic use of ketamine for preventing postanesthetic shivering. Methods We searched the following databases: Medline, Embase, and the Cochrane Central Register of Controlled Trails for randomized controlled trials. The primary outcome observed was the difference of the incidence rate of postanesthetic shivering between ketamine group and placebo group. The secondary outcomes were the sedation score and incidence of the side effects caused by ketamine and any other drugs utilized in the studies. Results In this meta-analysis, we analyzed a total of 16 trials including 1485 patients. Ketamine reduced the incidence rate of postanesthetic shivering compared to a placebo (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06 to 0.26, P<0.01). Regarding side effects, there was no evident variability of the incidence of nausea and vomiting. Usage of ketamine was associated with a lower rate of hypotension and bradycardia when compared to a placebo. Hallucinations were more frequently observed in patients who received higher doses of ketamine. No significant difference was found in the incidence of postanesthetic shivering with ketamine versus other pharmacological interventions. Conclusions Ketamine can prevent postanesthetic shivering without severe side effects. However, ketamine shows no advantage over other anti-shivering drugs.

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Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: A system review and meta analysis

10.21203/rs.2.10245/v2 ◽

2019 ◽

Author(s):

Yang Zhou ◽

Abdul Mannan ◽

Yuan Han ◽

He Liu ◽

Hui-Lian Guan ◽

...

Keyword(s):

Side Effects ◽

Incidence Rate ◽

Meta Analysis ◽

Cochrane Central Register ◽

Efficacy And Safety ◽

Central Register ◽

Postanesthetic Shivering ◽

Significant Difference ◽

Risk Patients ◽

Prophylactic Use

Abstract Background Postanesthetic shivering is a common complication of anesthesia, which accounts for much discomfort in postoperative patients and may increase postoperative complications in high-risk patients. Due to the lack of high-quality evidence, it is difficult to draw a conclusion about optimal anti-shivering medication. The main purpose of this meta-analysis was to analyze and evaluate the efficacy and safety of prophylactic use of ketamine for preventing postanesthetic shivering. Methods We used a systematic approach, also known as meta-analysis, to further address postoperative shivering. We searched the following databases: Medline, EMBASE, and the Cochrane Central Register of Controlled Trails for randomized controlled trials. The primary outcome observed was the incidence rate of postanesthetic shivering. The secondary outcomes were the sedation score and incidence of the side effects caused by drugs utilized in the studies. Results In this meta-analysis, we analyzed a total of 16 trials including 1485 patients. Ketamine reduced the incidence rate of postanesthetic shivering compared to a placebo (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06 to 0.26, P＜0.01). Regarding side effects, there was no evident variability of the incidence of nausea and vomiting. Usage of ketamine was associated with a lower rate of hypotension and bradycardia when compared to a placebo. Hallucinations were more frequently observed in patients who received higher doses of ketamine. No significant difference was found in the incidence of postanesthetic shivering with ketamine versus other pharmacological interventions. Conclusions Ketamine can prevent postanesthetic shivering without severe side effects. However, ketamine shows no advantage over other anti-shivering drugs.

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Should syndesmotic screws be removed or retained? A meta-analysis

10.21203/rs.3.rs-17528/v1 ◽

2020 ◽

Author(s):

Wanjin Qin ◽

Peng Yang ◽

Nanning Lv ◽

Kaiwen Chen ◽

Huilin Yang ◽

...

Keyword(s):

Clinical Outcomes ◽

Meta Analysis ◽

Controlled Trials ◽

Cochrane Central Register ◽

Search Terms ◽

Central Register ◽

Significant Difference ◽

The Difference ◽

Mean Differences ◽

American Orthopaedic

Abstract Background The aim of this study was to evaluate the different clinical outcomes after removing or retaining syndesmotic screws, and the difference in clinical outcomes after retaining broken or loose syndesmotic screws was also evaluated. Methods A systematic literature search was performed using PubMed, Web of Science, EMBASE and the Cochrane Central Register of Controlled Trials. In this meta-analysis, we conducted online searches using the search terms “syndesmotic diastasis”, “syndesmotic injury”, “syndesmotic screw”, “syndesmotic fixation”, and “tibiofibular syndesmosis”. The analysis was performed on individual patient data from all the studies that met the selection criteria. Clinical outcomes were expressed as standard mean differences for continuous outcomes with 95% confidence intervals. Heterogeneity was assessed using the Chi 2 test and the I 2 statistic. Results There were 2 randomized controlled trials (RCTs) and 6 observational articles included in this analysis. In the comparison between retained and removed screws and the comparison between broken or loose and removed screws, no significant difference was found in terms of visual analogue scale (VAS), Olerud-Molander Ankle Score (OMAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle/hindfoot score. Broken or loose screws were associated with better AOFAS scores compared with removed or intact screws, and no significant difference was found in terms of VAS and OMAS scores. Conclusions According to our analysis, there was no significant difference in clinical outcomes between removed and retained screws. Broken or loose screws were not associated with bad functional outcomes and may even lead to better function compared with removed or retained screws.

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A Comparison of Transplant Outcomes in Peritoneal and Hemodialysis Patients: A Meta-Analysis

Blood Purification ◽

10.1159/000446272 ◽

2016 ◽

Vol 42 (2) ◽

pp. 170-176 ◽

Cited By ~ 6

Author(s):

Maozhi Tang ◽

Tianyi Li ◽

Hong Liu

Keyword(s):

Survival Rate ◽

Journal Club ◽

Meta Analysis ◽

Graft Function ◽

Cochrane Central Register ◽

Transplant Outcomes ◽

Central Register ◽

Significant Difference ◽

Short And Long Term ◽

The Impact

Background: Peritoneal dialysis (PD) and hemodialysis (HD) have been considered the 2 standard pre-transplant dialysis modalities in patients awaiting kidney transplantation. However, the impact of pretransplant dialysis on the short- and long-term post-transplant outcomes remains controversial. Methods: We searched PubMed, EMBASE and the Cochrane central register of controlled trials for this review. Twelve studies were identified by strict screening for the meta-analysis. Results: We found that pretransplant PD patients had a significantly lower incidence of delayed graft function than HD patients, with an OR 0.67 (95% CI 0.62-0.72, p < 0.05). In contrast, there was no significant difference in the incidence of acute rejection, OR 0.96 (95% CI 0.75-1.16). Pretransplant PD had a better 5-year patient survival rate than HD, with a hazard ratio 0.86 (95% CI 0.79-0.95, p < 0.05); however, there were no significant differences in the graft survival rate (p = 0.08). Conclusions: We found that PD was a better choice of pretransplant dialysis modality than HD. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=446272.

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Effects of TACE and preventive antiviral therapy on HBV reactivation and subsequent hepatitis in hepatocellular carcinoma: a meta-analysis

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyz046 ◽

2019 ◽

Vol 49 (7) ◽

pp. 646-655 ◽

Cited By ~ 1

Author(s):

Su-Su Zhang ◽

Jin-Xia Liu ◽

Jing Zhu ◽

Ming-Bing Xiao ◽

Cui-Hua Lu ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Antiviral Therapy ◽

Fixed Effects ◽

Meta Analysis ◽

Hbv Reactivation ◽

Cochrane Central Register ◽

Fixed Effects Model ◽

Central Register ◽

Significant Difference ◽

The Impact

Abstract Background and aim The impact of transarterial chemoembolization (TACE) and preventive antiviral therapy on the occurrence of hepatitis B virus (HBV) reactivation and subsequent hepatitis remains controversial. This meta-analysis aimed to evaluate the effect of TACE and preventive antiviral therapy on the risk of HBV reactivation and subsequent hepatitis. Meanwhile, we explored the role of HBeAg status in HBV reactivation after TACE. Methods We performed this meta-analysis with 11 included studies to assess the effect of TACE and preventive antiviral therapy on predicting clinical outcomes in HBV-related hepatocellular carcinoma (HCC). The pooled odds ratios (OR) were calculated using a random or fixed effects model. PUBMED, MEDLINE, EMBASE and the Cochrane Central Register of Controlled were searched for the included articles (from 2000 to December 2017). Results Our results showed that TACE significantly increased the risk of HBV reactivation (OR: 3.70; 95% CI 1.45–9.42; P < 0.01) and subsequent hepatitis (OR: 4.30; 95% CI 2.28–8.13; P < 0.01) in HCC patients. There was no significant difference in HBV reactivation after TACE between HBeAg positive and negative patients (OR: 1.28; 95% CI 0.31–5.34; P = 0.73). Preventive antiviral therapy could statistically reduce the rate of HBV reactivation (OR: 0.08; 95% CI 0.02–0.32; P < 0.01) and hepatitis (OR: 0.22; 95% CI 0.06–0.80; P = 0.02) in those with TACE treatment. Conclusions The present study suggested that TACE was associated with a higher possibility of HBV reactivation and subsequent hepatitis. Preventive antiviral therapy is significantly in favor of a protective effect.

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Different Targets of Monoclonal Antibodies in Neuromyelitis Optica Spectrum Disorders: A Meta-Analysis Evidenced From Randomized Controlled Trials

Frontiers in Neurology ◽

10.3389/fneur.2020.604445 ◽

2020 ◽

Vol 11 ◽

Author(s):

Tao Xue ◽

Jiahao Yu ◽

Shujun Chen ◽

Zilan Wang ◽

Yanbo Yang ◽

...

Keyword(s):

Monoclonal Antibody ◽

Monoclonal Antibodies ◽

Adverse Events ◽

Randomized Controlled Trials ◽

Neuromyelitis Optica ◽

Meta Analysis ◽

Antibody Therapy ◽

Controlled Trials ◽

Monoclonal Antibody Therapy ◽

Randomized Controlled

Background: Neuromyelitis optica spectrum disorder (NMOSD), an autoimmune inflammatory disorder of the central nervous system, often leads to vision loss or paralysis. This meta-analysis focused on the assessment of the monoclonal antibody therapy in NMOSD and compared different targets of monoclonal antibodies with each other in terms of efficacy and safety outcomes.Method: We searched through the databases of MEDLINE, EMBASE, Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov for randomized controlled trials (RCTs) evaluating monoclonal antibody therapy in NMOSD up to April 2020.Results: We identified seven randomized controlled trials (RCTs), including 775 patients (monoclonal antibody group, n = 485 and placebo group, n = 290). Monoclonal antibody therapy decreased relapse risk (RR 0.33, 95% CI 0.21–0.52, P < 0.00001), annualized relapse rate (ARR) (mean −0.28, 95% CI −0.35−0.20, P < 0.00001), expanded disability status scale score (EDSS) (mean −0.19, 95% CI −0.32−0.07, P = 0.002) and serious adverse events (RR 0.78, 95% CI 0.61–1.00, P = 0.05). However, we did not observe any significant difference in terms of adverse events or mortality. Further, the subgroup analysis demonstrated that the anti-complement protein C5 monoclonal antibody (eculizumab) might have a lower relapse risk (RR 0.07, 95% CI 0.02–0.23, P < 0.0001) in the AQP4 seropositive patients, and anti-interleukin-6 receptor monoclonal antibodies (satralizumab and tocilizumab) showed decreased EDSS score (mean −0.17, 95% CI −0.31−0.02, P = 0.02) more effectively than other monoclonal antibodies.Conclusions: Monoclonal antibodies were effective and safe in NMOSD. Different targets of monoclonal antibodies might have their own advantages.

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Endoscopic and Robotic Parotidectomy for the Treatment of Parotid Tumors: A Systematic Review and Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.748885 ◽

2021 ◽

Vol 11 ◽

Author(s):

Shanwen Chen ◽

Mei Zhao ◽

Dong Wang ◽

Yi Zhao ◽

Jianxin Qiu ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Central Register ◽

Intraoperative Bleeding ◽

Incision Length ◽

Medical Databases ◽

Parotid Tumors ◽

Central Register ◽

Quantitative Synthesis

BackgroundThe goal of this review was to introduce endoscopic/robotic parotidectomy (EP/RP) and compare EP/RP against conventional parotidectomy (CP) regarding the intraoperative and postoperative parameters in the treatment of parotid tumors.MethodsA systematic literature search of medical databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) was performed from inception to November 2020 to generate relevant studies.ResultsA total of 13 eligible studies (572 patients) were included for systematic review, and 7 out of 13 comparable studies for the quantitative synthesis of outcomes. Patients who underwent EP were characterized by less intraoperative bleeding volume, shorter incision length, and higher satisfaction postoperatively (WMD, 95% CI, -42.80; - 58.23 to -27.37; p < 0.01; WMD, 95% CI, -5.64; -7.88 to -3.39; p < 0.01; SMD, 95% CI, 1.88; 1.46 to 2.31; p < 0.01, respectively). However, operative time and risk of facial palsy exhibited no significant differences (WMD, 95% CI, -11.17; -26.71 to 4.34; p = 0.16; OR, 95% CI,0.71; 0.39 to 1.32; p = 0.28, respectively).ConclusionsOur findings suggest that the current evidence does not adequately support EP is equally safe and effective as CP. In certain selected cases, endoscopic technology has its unique advantages. For patients with strong cosmetic needs, endoscopic or robotic techniques may be an alternative through adequate preoperative evaluations.Systematic Review RegistrationInternational Prospective Register of Systematic Reviews, identifier CRD42020210299.

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Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: A system review and meta analysis

10.21203/rs.2.10245/v3 ◽

2019 ◽

Author(s):

Yang Zhou ◽

Abdul Mannan ◽

Yuan Han ◽

He Liu ◽

Hui-Lian Guan ◽

...

Keyword(s):

Side Effects ◽

Incidence Rate ◽

Meta Analysis ◽

Cochrane Central Register ◽

Efficacy And Safety ◽

Central Register ◽

Postanesthetic Shivering ◽

Significant Difference ◽

The Difference ◽

Prophylactic Use

Abstract Background Postanesthetic shivering is a common complication of anesthesia, which accounts for much discomfort in postoperative patients and may increase postoperative complications in high-risk patients. Due to the lack of high-quality evidence, it is difficult to draw a conclusion about optimal anti-shivering medication. The main purpose of this meta-analysis was to analyze and evaluate the efficacy and safety of prophylactic use of ketamine for preventing postanesthetic shivering. Methods We used a systematic approach, also known as meta-analysis, to further address postoperative shivering. We searched the following databases: Medline, Embase, and the Cochrane Central Register of Controlled Trails for randomized controlled trials. The primary outcome observed was the difference of the incidence rate of postanesthetic shivering between ketamine group and placebo group . The secondary outcomes were the sedation score and incidence of the side effects caused by ketamine and any other drugs utilized in the studies. Results In this meta-analysis, we analyzed a total of 16 trials including 1485 patients. Ketamine reduced the incidence rate of postanesthetic shivering compared to a placebo (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06 to 0.26, P＜0.01). Regarding side effects, there was no evident variability of the incidence of nausea and vomiting. Usage of ketamine was associated with a lower rate of hypotension and bradycardia when compared to a placebo. Hallucinations were more frequently observed in patients who received higher doses of ketamine. No significant difference was found in the incidence of postanesthetic shivering with ketamine versus other pharmacological interventions. Conclusions Ketamine can prevent postanesthetic shivering without severe side effects. However, ketamine shows no advantage over other anti-shivering drugs.

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Safety and efficacy of different antibiotic regimens in patients with ocular toxoplasmosis: systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-021-01758-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

John E. Feliciano-Alfonso ◽

Juliana Muñoz-Ortiz ◽

María Alejandra Marín-Noriega ◽

Andrés Vargas-Villanueva ◽

Laura Triviño-Blanco ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Posterior Uveitis ◽

Ocular Toxoplasmosis ◽

Controlled Trials ◽

Cochrane Central Register ◽

Treatment Regimens ◽

Central Register ◽

Quantitative Synthesis ◽

Clinical Trials Registry

Abstract Background Ocular toxoplasmosis (OT) is the most common cause of posterior uveitis, which leads to visual impairment in a large proportion of patients. Antibiotics and corticosteroids lower the risk of permanent visual loss by controlling infection and inflammation. However, there remains disagreement regarding optimal antibiotic therapy for OT. Therefore, this systematic review and meta-analysis were performed to determine the effects and safety of existing antibiotic treatment regimens for OT. Methods MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, LILACS, WHO International Clinical Trials Registry Platform portal, ClinicalTrials.gov, and Gray Literature in Europe (“OpenGrey”) were searched for relevant studies; manual searches of reference lists were performed for studies identified by other methods. All published and unpublished randomized controlled trials that compared antibiotic schemes known to be effective in OT at any dosage, duration, and administration route were included. Studies comparing antibiotics with placebo were excluded. This review followed standard methodological procedures recommended by the Cochrane group. Results Ten studies were included in the narrative summary, of which four were included for quantitative synthesis (meta-analysis). Interventions were organized into three groups: intravitreal clindamycin versus pyrimethamine + sulfadiazine, trimethoprim + sulfamethoxazole versus other antibiotics, and other interventions. The first comparison favored intravitreal clindamycin (Mean difference (MD) = 0.10 logMAR; 95% confidence interval = 0.01 to 0.22). However, this finding lacks clinical relevance. Other outcomes showed no statistically significant differences between the treatment groups. In general, the risk of performance bias was high in evaluated studies, and the quality of the evidence found was low to very low. Conclusions No antibiotic scheme was superior to others, and the selection of a treatment regimen depends on multiple factors; therefore, treatment should be chosen based on safety, sulfa allergies, and availability.

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