scholarly journals Forty Years of Evidence on the Efficacy and Safety of Oral and Injectable Antibiotics for Treating Lyme Disease of Adults and Children: A Network Meta-Analysis

2021 ◽  
Author(s):  
Jiaru Yang ◽  
Shiyuan Wen ◽  
Jing Kong ◽  
Peng Yue ◽  
Wenjing Cao ◽  
...  
Keyword(s):  
Lyme Disease ◽  
Drug Administration ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Adults And Children ◽  
Routes Of Drug Administration

Some previous studies investigated the efficacy and safety of antibiotics for treating Lyme disease (LD). However, due to technical limitations, several questions regarding the routes of drug administration and the dosages of drug are still unclear, which might be causing problems for clinicians.

scholarly journals Comparative efficacy and safety of β-lactam/β-lactamase inhibitors versus cabapenems for febrile neutropenia empiric therapy: A systematic review and meta analysis

2020 ◽  
Author(s):  
Haiyang Meng ◽  
Jingyi ZHANG ◽  
Ailing ZHANG ◽  
Jie YANG ◽  
Jingli LU ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Web Of Science ◽  
Meta Analysis ◽  
Treatment Success ◽  
Empiric Therapy ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Comparative Efficacy ◽  
All Cause Mortality ◽  
Adults And Children

Abstract Background The efficacy and safety of β-lactam/β-lactamase inhibitors (BL/BLIs) versus carbapenems for febrile neutropenia empiric therapy are controversial. Methods PubMed, Embase, Cochrane library databases, Web of Science and Google scholar were searched up to 1 April 2020. Studies were included if they compared BL/BLIs versus carbapenem for febrile neutropenia patients undergoing chemotherapy for either solid tumours or haematological malignancies among adults and children. We pooled the treatment success rate, mortality and adverse events. Results Nine RCTs were included. There was no differences between carbapenems and BL/BLIs were observed in terms of treatment success without modification (RR 1.04, 95% CI 0.93–1.15), no differences were observed in the subgroups of BL/BLIs, adults and children. No significant differences were found in all-cause mortality (RR 1.15, 95% CI 0.64–2.06). Our study shows that gastrointestinal events are the most common adverse effects, nausea/vomiting were significantly more common with carbapenems (RR 2.83, 95% CI 1.35–5.92, P = 0.006), however, diarrhea were more common with BL/BLIs (RR 0.47, 95% CI 0.27–0.80, P = 0.006). Conclusions The efficacy and safety of BL/BLIs with carbapenems were comparable in empiric treatment of febrile neutropenia.

Safety and Efficacy of Eltrombopag in Children and Adults with Immune Thrombocytopenia: a Systematic Review and Meta-analysis.

2020 ◽  
Vol 18 ◽  
Author(s):  
Savvas Kolanis ◽  
Eleni Vasileiou ◽  
Emmanuel Hatzipantelis ◽  
Marina Economou ◽  
Athanasios Tragiannidis
Keyword(s):  
Receptor Agonist ◽  
Immune Thrombocytopenia ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Primary Target ◽  
Rescue Treatment ◽  
Thrombopoietin Receptor ◽  
Number Of Patients ◽  
Thrombopoietin Receptor Agonist ◽  
Adults And Children

: Immune thrombocytopenia is an immune condition where antibodies are produced against platelets. Eltrombopag is a thrombopoietin receptor agonist that stimulates and promotes platelet production approved for treating thrombocytopenia in patients with chronic immune thrombocytopenia, where other treatments as corticosteroids, splenectomy or immunoglobulins are inadequate. The aim of this meta-analysis was to evaluate the efficacy and safety of the eltrombopag in adults and children with immune thrombocytopenia. We included 7 studies with a total of 765 patients (606 adults and 159 children). We evaluated the number of patients that achieved a post treatment platelet count equal or above 50x109 /L (primary result-target) without the need of rescue treatment for at least 4 weeks. Our data showed that patients who received eltrombopag were almost 4 times more probable in achieving the primary target when compared to patients that received placebo (RR 3.84, 95% CI 2.39 to 6.14; I2 = 46%). The number of patients that needed rescue treatment and the number of bleeding incidents were reduced in the group that received eltrombopag when compared to those who received placebo (RR 0.40, 95% CI 0.25 to 0.62; I2 = 40%) (RR 0.74, 95% CI 0.62 to 0.89; I2 = 68%). The total number of side effects did not statistically differ between the two groups (RR 0.99, 95% CI 0.90 to 1.08; I2 = 14%). Our findings were similar to previously published studies and confirm that eltrombopag is safe and efficient in immune thrombocytopenia. However more clinical trials are needed in order to enhance our findings.

Efficacy and safety of the antileukotriene drugs: relevant data. RAACI experts conclusion

2020 ◽  
Vol 17 (3) ◽  
pp. 121-129
Author(s):  
Natalya I. Il`ina ◽  
Oksana M. Kurbacheva ◽  
Natalya M. Nenasheva ◽  
Natalya G. Astafieva ◽  
Evgenij K. Beltyukov ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Adverse Events ◽  
Bronchial Asthma ◽  
Drug Administration ◽  
Expert Opinion ◽  
Adverse Reactions ◽  
Efficacy And Safety ◽  
The World ◽  
Adults And Children ◽  
Expert Commission

In many countries of the world and in Russia, in particular, the pharmacological use of antagonists of cysteinyl receptors LT1 (CysLTR) is a long-proven and well-proven pharmacotherapy of bronchial asthma (BA) and allergic rhinitis (AR) in adults and children. Among antileukotriene drugs the most commonly used medication for the treatment of these diseases is the original montelukast, which is considered a safe drug associated with the appearance of only a few adverse reactions, usually not differing in type and frequency from those that occur with placebo. Currently, there are a large number of generics of montelukast, therefore, practitioners have many questions regarding the benefits and risks of montelukast therapy for patients with BA and AR. In 2020 FDA (Food and Drug Administration USA) analyzed the risk of adverse events during Montelukast treatment and indicated them on the packaging of the drug (original montelukast and its generics). This contributed to the creation of an expert commission to study this issue and form an expert opinion, which is demonstrated in our publication.

Safety and efficacy of direct acting oral anticoagulants and vitamin K antagonists in nonvalvular atrial fibrillation – a network meta-analysis of real-world data

VASA ◽  
2019 ◽  
Vol 48 (2) ◽  
pp. 134-147 ◽  
Author(s):  
Mirko Hirschl ◽  
Michael Kundi
Keyword(s):  
Real World ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Nonvalvular Atrial Fibrillation ◽  
Real World Data ◽  
Hazard Ratios ◽  
Direct Acting ◽  
Event Rates

Abstract. Background: In randomized controlled trials (RCTs) direct acting oral anticoagulants (DOACs) showed a superior risk-benefit profile in comparison to vitamin K antagonists (VKAs) for patients with nonvalvular atrial fibrillation. Patients enrolled in such studies do not necessarily reflect the whole target population treated in real-world practice. Materials and methods: By a systematic literature search, 88 studies including 3,351,628 patients providing over 2.9 million patient-years of follow-up were identified. Hazard ratios and event-rates for the main efficacy and safety outcomes were extracted and the results for DOACs and VKAs combined by network meta-analysis. In addition, meta-regression was performed to identify factors responsible for heterogeneity across studies. Results: For stroke and systemic embolism as well as for major bleeding and intracranial bleeding real-world studies gave virtually the same result as RCTs with higher efficacy and lower major bleeding risk (for dabigatran and apixaban) and lower risk of intracranial bleeding (all DOACs) compared to VKAs. Results for gastrointestinal bleeding were consistently better for DOACs and hazard ratios of myocardial infarction were significantly lower in real-world for dabigatran and apixaban compared to RCTs. By a ranking analysis we found that apixaban is the safest anticoagulant drug, while rivaroxaban closely followed by dabigatran are the most efficacious. Risk of bias and heterogeneity was assessed and had little impact on the overall results. Analysis of effect modification could guide the clinical decision as no single DOAC was superior/inferior to the others under all conditions. Conclusions: DOACs were at least as efficacious as VKAs. In terms of safety endpoints, DOACs performed better under real-world conditions than in RCTs. The current real-world data showed that differences in efficacy and safety, despite generally low event rates, exist between DOACs. Knowledge about these differences in performance can contribute to a more personalized medicine.

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