Efficacy and safety of high-dose dual therapy forHelicobacter pylorirescue therapy: A systematic review and meta-analysis

AimsRandomised controlled trials (RCTs) demonstrated benefits of pharmacological interventions for cachexia in improving weight and appetite. However, comparative efficacy and safety are not available. We conducted a systematic review and network meta-analysis (NMA) to evaluate the relative efficacy and safety of pharmacological interventions for cachexia.MethodsPubMed, EmBase, Cochrane, and ClinicalTrials.gov were searched for RCTs until October 2019. Key outcomes were total body weight (TBW) improvement, appetite (APP) score and serious adverse events. Two reviewers independently extracted data and assessed risk of bias. NMA was performed to estimate weight gain and APP score increase at 8 weeks, presented as mean difference (MD) or standardised MD with 95% CI.Results80 RCTs (10 579 patients) with 12 treatments were included. Majority is patients with cancer (7220). Compared with placebo, corticosteroids, high-dose megestrol acetate combination (Megace_H_Com) (≥400 mg/day), medroxyprogesterone, high-dose megestrol acetate (Megace_H) (≥400 mg/day), ghrelin mimetic and androgen analogues (Androgen) were significantly associated with MD of TBW of 6.45 (95% CI 2.45 to 10.45), 4.29 (95% CI 2.23 to 6.35), 3.18 (95% CI 0.94 to 5.41), 2.66 (95% CI 1.47 to 3.85), 1.73 (95% CI 0.27 to 3.20) and 1.50 (95% CI 0.56 to 2.44) kg. For appetite improvement, Megace_H_Com, Megace_H and Androgen significantly improved standardised APP score, compared with placebo. There is no significant difference in serious adverse events from all interventions compared with placebo.ConclusionsOur findings suggest that several pharmacological interventions have potential to offer benefits in treatment of cachexia especially Megace_H and short-term use corticosteroids. Nonetheless, high-quality comparative studies to compare safety and efficacy are warranted for better management of cachexia.

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Comparative efficacy and safety of combination therapy with high-dose sulbactam or colistin with additional antibacterial agents for multiple drug-resistant and extensively drug-resistant Acinetobacter baumannii infections: a systematic review and network meta-analysis

Journal of Global Antimicrobial Resistance ◽

10.1016/j.jgar.2020.08.021 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jiating Liu ◽

Feilong Zhu ◽

Bimin Feng ◽

Zhengjie Zhang ◽

Liang Liu ◽

...

Keyword(s):

Systematic Review ◽

Antibacterial Agents ◽

Meta Analysis ◽

Multiple Drug ◽

High Dose ◽

Drug Resistant ◽

Efficacy And Safety ◽

Comparative Efficacy ◽

Extensively Drug Resistant ◽

Multiple Drug Resistant

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Efficacy and safety of high‐dose vs low‐dose leucovorin in patients with colorectal cancer: systematic review and meta‐analysis

Colorectal Disease ◽

10.1111/codi.14746 ◽

2019 ◽

Vol 22 (1) ◽

pp. 6-17

Author(s):

C.‐Y. Hsu ◽

C.‐Y. Chen ◽

Y.‐M. Lin ◽

K.‐W. Tam

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Low Dose ◽

Meta Analysis ◽

High Dose ◽

Efficacy And Safety

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Efficacy and safety of low-dose versus high-dose hydrocortisone to treat hypotension in neonates: a protocol for a systematic review and meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001200 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001200

Author(s):

Katelyn Sushko ◽

Nada Al-Rawahi ◽

Kristi Watterberg ◽

John Van Den Anker ◽

Catherine Litalien ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Critically Ill ◽

Systematic Reviews ◽

Meta Analysis ◽

Adrenal Function ◽

High Dose ◽

Cochrane Central Register ◽

Efficacy And Safety ◽

Registration Number

BackgroundImpaired adrenal function is a well-described entity in critically ill term and preterm neonates with systemic hypotension. The standard treatment for neonatal hypotension includes volume expanders and vasopressors. Recent evidence supports the use of glucocorticoids for the primary or rescue treatment of neonatal hypotension associated with impaired adrenal function. However, inconsistency regarding the prescribed dosing regimen to provide the best balance between efficacy and safety in this vulnerable population remains an area of concern.MethodsWe will conduct a systematic review and meta-analysis to evaluate low-dosing compared with high-dosing regimens of hydrocortisone for the treatment of hypotension in critically ill term, preterm and very low birth weight neonates. Ovid MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and Web of Science will be searched from inception to November 2021. Study screening and selection will be completed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Our primary outcomes will be (1) an improvement in end-organ perfusion, defined as an increase in blood pressure along with an increase in urine output or a reduction in serum lactate and (2) mortality prior to discharge. Our secondary outcomes will be the development of (1) major neurosensory abnormality, (2) bronchopulmonary dysplasia and (3) the occurrence of adverse events.DiscussionHydrocortisone may be beneficial in the treatment of hypotension associated with impaired adrenal function among critically ill neonates. However, its optimal dosing to balance desired efficacy with the risk of adverse events is yet to be determined. Our systematic review and meta-analysis aims to address this evidence gap, providing valuable knowledge for a large audience, including guideline developers, policy-makers and clinicians.PROSPERO registration numberThis protocol is submitted for registration to the international database of prospectively registered systematic reviews (PROSPERO, awaiting registration number).

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