Pegfilgrastim safety and efficacy on the last chemotherapy day versus the next: systematic review and meta-analysis

2021 ◽  
pp. bmjspcare-2020-002532
Author(s):  
Xiaohua Ma ◽  
Jian Kang ◽  
Yufang Li ◽  
Xiaojian Zhang
Keyword(s):  
Breast Cancer ◽  
Observational Studies ◽  
Web Of Science ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Pooled Analysis ◽  
Efficacy And Safety ◽  
Gynaecological Malignancies ◽  
Randomised Controlled

ObjectivesTo investigate the efficacy and safety of pegfilgrastim administered on the day of chemotherapy completion (same day) versus at least 1 day after chemotherapy (next day).MethodsWe searched relevant literature published before April 2020 from the following databases: Embase, PubMed, Cochrane databases and Web of science.ResultsOne randomised controlled trial and 12 observational studies met all of the prespecified criteria for eligibility. The meta-analysis showed a significantly higher febrile neutropenia (FN) rate for the same-day group than that for the next-day arm in the first chemotherapy cycle (OR=2.56, 95% CI 1.19 to 5.48, p=0.02), and in all chemotherapy cycles (OR=1.54, 95% CI 1.29 to 1.84, p<0.00001). Results of subgroup analysis showed a higher FN rate in the same-day arm than in the next-day group for patients with breast cancer (OR=5.50, 95% CI 2.29 to 13.23, p=0.0001) and lymphoma (OR=1.53, 95% CI 1.00 to 2.34, p=0.05). The pooled analysis of studies on gynaecological malignancies showed that patients in the same-day group had a higher incidence of bone pain (OR=1.30, 95% CI 1.01 to 1.68, p=0.04) and a lower incidence of chemotherapy delay (OR=0.71, 95% CI 0.53 to 0.96, p=0.03) compared with the next-day group.ConclusionsSame-day administration of pegfilgrastim resulted in increased incidence of FN compared with the next-day schedule. This is especially true for patients with breast cancer or lymphoma. These results do not support same-day administration of pegfilgrastim .

Changing evidence over time: updated meta-analysis regarding anti-TNF efficacy in childhood chronic uveitis

Rheumatology ◽  
2020 ◽  
Author(s):  
Ilaria Maccora ◽  
Eleonora Fusco ◽  
Edoardo Marrani ◽  
Athimalaipet V Ramanan ◽  
Gabriele Simonini
Keyword(s):  
Observational Studies ◽  
Primary Outcome ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Primary Outcome Measure ◽  
Systemic Steroid ◽  
Biologic Treatment ◽  
Chronic Uveitis ◽  
Randomized Controlled

Abstract Objective To summarize evidence regarding efficacy of anti-TNFα in childhood chronic uveitis, refractory to common DMARDs. Methods An updated systematic search was conducted between November 2012 and January 2020. Studies investigating the efficacy of anti-TNFα therapy, in children of ages &lt;16 years, as the first biologic treatment for childhood chronic uveitis, refractory to topical and/or systemic steroid and at least one DMARD were eligible for inclusion. The primary outcome measure was the improvement of intraocular inflammation according to Standardization of Uveitis Nomenclature Working Group criteria. A combined estimate of the proportion of children responding to etanercept (ETA), infliximab (INF), and adalimumab (ADA) was determined. Results We identified 1677 articles of which 37 articles were eligible. Three were randomized controlled trials, one on ETA and two on ADA, and were excluded from pooled analysis. From the observational studies, a total of 487 children were identified: 226 received ADA, 213 INF and 48 ETA. The proportion of responding children was 86% (95% CI: 76%, 95%) for ADA, 68% (95% CI: 50%, 85%) for INF and 36% (95% CI: 9%, 67%) for ETA. Pooled analysis showed clear differences (χ2 = 32.2, P &lt; 0.0001): ADA and INF were both significantly superior to ETA (χ2 = 26.8, P &lt; 0.0001, and χ2 = 7.41, P &lt; 0.006, respectively), ADA significantly superior to INF (χ2 = 13.4, P &lt; 0.0002). Conclusion This meta-analysis, consistent with recent randomized controlled trial data, suggests the efficacy of ADA and INF in childhood chronic uveitis treatment. However, ADA results were superior to those of INF in this clinical setting.

scholarly journals The efficacy and safety of bamlanivimab treatment against COVID-19: A meta-analysis

2021 ◽  
Author(s):  
Huairong Xiang ◽  
Bei He ◽  
Yun Li ◽  
Xuan Cheng ◽  
Qizhi Zhang ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Observational Studies ◽  
Randomized Clinical Trials ◽  
Web Of Science ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Control Group ◽  
Efficacy And Safety ◽  
Positive Treatment ◽  
The Cochrane Library

Background: Bamlanivimab is routinely used in the treatment of coronavirus disease 2019 (COVID-19) in worldwide. We performed a meta-analysis to investigate the efficacy and safety of bamlanivimab treatment in patients with COVID-19. Methods: We searched articles from Web of Science, PubMed, Embase, the Cochrane Library and MedRxiv between 30 January 2020 and August 5, 2021. We selected randomized clinical trials (RCTs) and observational studies with a control group to assess the efficiency of bamlanivimab in treating patients with COVID-19. Results: Our meta-analysis retrieved 3 RCTs and 7 cohort studies including 14461 patients. Bmlanivimab may help outpatients to prevent hospitalization or emergency department visit (RR 0.41 95%CI 0.29 to 0.58), reduce ICU admission (RR 0.47 95%CI 0.23 to 0.92) and mortality (RR 0.32 95%CI 0.13 to 0.77) from the disease. The combination of bamlanivimab and etesevimab may had a greater potential for positive treatment outcome. Conclusion: Bamlanivimab has demonstrated clinical efficacy on mild or moderate ill patients with COVID-19 to prevent hospitalization, reduce severity and mortality from the disease. Combinations of two or more monoclonal antibody increase the effect. Well-designed clinical trials to identify the clinical and biochemical characteristics in COVID-19 patients'population that could benefit from bamlanivimab are warranted in the future.

Efficacy and Safety of Neoadjuvant Immunotherapy in Triple Negative Breast Cancer: Meta-analysis of randomized controlled trials

2021 ◽  
Author(s):  
Yakup Ergun ◽  
Cengiz Karacin ◽  
Baran Akagunduz ◽  
Sema Turker ◽  
Yusuf Acikgoz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled

Abstract Aim: In this meta-analysis; The efficacy and safety of randomized controlled trials (RCTs) using immunotherapy in the neoadjuvant treatment of triple negative breast cancer were investigated.Material and Method: To determine the studies to be evaluated in this meta-analysis, PubMed, Cochrane Library databases, and the studies published/presented in ASCO, ESMO, and SABCS congresses were thoroughly searched. Studies published/presented until January 01, 2021, were included. PCR, by definition, was defined as the absence of invasive cancer cells in the breast and axillary lymph nodes (ypT0 / Tis and N0). If there were at least two studies that shared the same subgroup results, subgroup analyzes were also performed. This meta-analysis was performed using Review Manager, version 5.4 (RevMan), a proprietary software provided by Cochrane Collaboration.Results: A total of 5 RCTs were included in the study, and 1498 patients were analyzed. In a pooled analysis of these studies, pCR was 58.8% in the immunotherapy arm and 42.6% in the placebo arm. According to the random-effects model, OR was found to be 1.77 (95% CI 1.23-2.56). In the pooled analysis of 3 studies reporting results according to PD-L1 level, immunotherapy significantly increased pCR in the PD-L1 positive group (67% vs. 49%, OR: 1.99, 95% CI 1.47-269). In the PD-L1 negative group, although immunotherapy increased pCR numerically, it was not statistically significant (42% vs. 33%, OR: 1.44, 95% CI 0.97-2.14). According to the lymph node status, the results were shared in 2 studies. In the joint analysis of these two studies, pCR was significantly increased with immunotherapy in those with positive lymph nodes (63% vs. 39%, OR: 2.52 95% CI 1.69-3.77). In those with negative lymph nodes, although immunotherapy increased pCR numerically, the difference was not significant (62% vs. 54%, OR: 1.36 95% 0.94-1.97).Conclusion: The addition of immunotherapy to neoadjuvant chemotherapy increases pCR. This increase was especially pronounced in high-risk patients with lymph node-positive and in the group with positive for PD-L1.

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