Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies

Background and Aims Recovery outcomes for opioid substitution treatment are poorer than those for alcohol and other drugs. In order to understand why this is and to synthesise the findings of a large number of qualitative studies, we conducted a systematic review and thematic synthesis to understand facilitators of and barriers to recovery from opioid dependency. Methods Electronic databases (Pubmed, PsychInfo, CINAHL and Embase) were searched. English language studies exploring the views of adult service user and stakeholders with experiences of opioid substitution treatment were considered for inclusion. Included studies were inductively analysed using thematic synthesis. During analysis, the socioecological model was selected as an analytical framework for organising and making links between themes as it captured the complexity of the topic well. ResultsFrom 3646 screened papers, we included 37 studies reporting the views of 1212 staff and service users. Studies highlighted complex interactions between factors influencing recovery across the five levels of the socioecological model (intrapersonal, inter-personal, organisational, community and policy). Early life experiences of trauma were common; lack of support (both psychological and social) was also a recurring theme resulting in feelings of disconnection and isolation. Stigma played a particularly important role in an individual’s capacity to recover from opioid dependency and cut-across all levels of the socioecological model. Conclusions Interventions targeted at the individual level fail to take account of the complexity of recovery within opioid substitution treatment and may ignore the complex socio-political context that service users and services exist within. Stigma permeates all levels of the opioid substitution treatment system; we suggest that addressing this is likely to improve healthcare encounters, help-seeking, increase access to social support and facilitate community reintegration for individuals receiving opioid substitution treatment.

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Remdesivir for the Treatment of Severe SARS-CoV-2 (COVID-19): A Systematic Review and Meta-Analysis

International Journal of Regenerative Medicine ◽

10.31487/j.rgm.2020.04.01 ◽

2020 ◽

pp. 1-8

Author(s):

Zhipeng Yan ◽

Ka Shing Cheung ◽

Eric Ho-Yin Lau ◽

Ching-Lung Lai

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Clinical Improvement ◽

Risk Ratio ◽

Mortality Risk ◽

Subgroup Analysis ◽

Meta Analysis ◽

Controlled Trials ◽

Invasive Ventilation ◽

Randomized Controlled

Background: Coronavirus Disease in 2019 (COVID-19) is a pandemic caused by SARS-CoV-2 infection. Over 53 million people have been infected with over 1.3 million deaths. However, there is no standard treatment or vaccines to date. Recently, several randomized controlled trials and cohort studies have demonstrated the efficacy of remdesivir for the treatment of severe COVID-19 patients. This is a systematic review and meta-analysis to define its efficacy. Methods: A systematic review was done on databases (PubMed, Embase, Medline, Cochrane) on 9 Nov 2020. Search keywords were remdesivir, COVID-19, SARS-CoV-2, randomized controlled trials and cohort studies. Studies with high-evidence values were selected to evaluate its clinical efficacy in terms of risk ratio, time to clinical improvement, and mortality risk. Subgroup analysis was performed based on baseline hospitalization status, age and ethnicity. Results: Of the 1328 studies, 6 studies were selected and pooled for meta-analysis. Remdesivir was associated with clinical improvement (risk ratio 1.14, 95% CI 1.02-1.28, p=0.02). It shortened the mean time of clinical improvement by 3.32 days (95% CI -4.37 to -2.28, p<0.001). However, its use was not associated with reduced mortality risk (risk ratio 0.75, 95% CI 0.40–1.40). In subgroup analysis, remdesivir was associated with clinical improvement in patients without the need of invasive ventilation (risk ratio 1.90, 95% CI 1.58-2.29, p<0.001; hazard ratio 2.22, 95% CI, 1.64-3.02), and age less than 70 years (risk ratio 2.14, 95% CI 1.39-3.28, p<0.001). Conclusion: Remdesivir is effective in the treatment of severe COVID-19 patients, in particular those without invasive ventilation

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