scholarly journals Side effect profile and comparative tolerability of 21 antidepressants in the acute treatment of major depression in adults: protocol for a network meta-analysis

2019 ◽  
Vol 22 (2) ◽  
pp. 61-66 ◽  
Author(s):  
Anneka Tomlinson ◽  
Orestis Efthimiou ◽  
Katharine Boaden ◽  
Emma New ◽  
Sarah Mather ◽  
...  
Keyword(s):  
Major Depression ◽  
Adverse Events ◽  
Web Application ◽  
Acute Treatment ◽  
First Generation ◽  
Second Generation ◽  
Meta Analysis ◽  
Number Of Patients ◽  
Reference Selection ◽  
Depth Analysis

IntroductionWe have recently compared all second-generation as well as selected first-generation antidepressants in terms of efficacy and acceptability in the acute treatment of major depression. Here we present a protocol for a network meta-analysis aimed at extending these results, updating the evidence base and comparing all second-generation as well as selected first-generation antidepressants in terms of specific adverse events and tolerability in the acute treatment of major depression in adults.Methods and analysisWe will include all double-blind randomised controlled trials comparing one active drug with another or with placebo in the acute treatment major depression in adults. We will compare the following active agents: agomelatine, amitriptyline, bupropion, citalopram, clomipramine, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, levomilnacipran, milnacipran, mirtazapine, nefazodone, paroxetine, reboxetine, sertraline, trazodone, venlafaxine, vilazodone and vortioxetine. The main outcomes will include the total number of patients experiencing specific adverse events; experiencing serious adverse events; and experiencing at least one adverse event. Published and unpublished studies will be retrieved through relevant database searches, trial registries and websites; reference selection and data extraction will be completed by at least two independent reviewers. For each outcome we will undertake a network meta-analysis to synthesise all evidence. We will use local and global methods to evaluate consistency. We will perform all analyses in R. We will assess the quality of evidence contributing to network estimates with the Confidence in Network Meta-Analysis web application.DiscussionThis work will provide an in- depth analysis and an insight into the specific adverse events of individual antidepressants.Ethics and disseminationThis review does not require ethical approval.PROSPERO registration numberCRD42019128141.

scholarly journals Comparative efficacy and acceptability of first-generation and second-generation antidepressants in the acute treatment of major depression: protocol for a network meta-analysis

BMJ Open ◽  
2016 ◽  
Vol 6 (7) ◽  
pp. e010919 ◽  
Author(s):  
Toshi A Furukawa ◽  
Georgia Salanti ◽  
Lauren Z Atkinson ◽  
Stefan Leucht ◽  
Henricus G Ruhe ◽  
...  
Keyword(s):  
Major Depression ◽  
Acute Treatment ◽  
First Generation ◽  
Second Generation ◽  
Meta Analysis ◽  
Comparative Efficacy

scholarly journals Antihistamine effects and safety of fexofenadine: a systematic review and Meta-analysis of randomized controlled trials

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Cheng-zhi Huang ◽  
Zhi-hui Jiang ◽  
Jian Wang ◽  
Yue Luo ◽  
Hua Peng
Keyword(s):  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Safety Profile ◽  
First Generation ◽  
Second Generation ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Psychomotor Function ◽  
Randomized Controlled ◽  
Sedative Effects

Abstract Background As a new generation antihistamine, fexofenadine has been widely used in allergic diseases. However, there is still a lack of collective evidence regarding the antihistamine effects and safety profiles of fexofenadine relative to other antihistamine drugs and placebo. Therefore, we aimed to systematically evaluate the antihistamine effects and safety of fexofenadine. Methods An electronic literature search of randomized controlled trials (RCTs) was performed using Embase, Cochrane and PubMed from establishment to January 1st, 2018. RCTs comparing the antihistamine effects or safety (adverse events, sedative effects, and cognitive/psychomotor function) of fexofenadine with either other antihistamines or placebo for healthy subjects and patients with allergy were selected. Results Fifty-one studies of 14,551 participants met the inclusion criteria. When compared with the first-generation antihistamines, fexofenadine produced significantly lower adverse events frequency (OR = 0.446; 95% CI: 0.214 to 0.929, P = 0.031), significantly lower sedative effects frequency (OR = 0.265; 95% CI: 0.072 to 0.976, P = 0.046) and significantly less change of all cognitive/psychomotor function. When compared with the second-generation antihistamines, fexofenadine produced significantly marginal sedative effects (OR = 0.59; 95% CI, 0.38 to 0.93; P = 0.02) and significantly less change of most of the cognitive/psychomotor function. When compared with placebo, fexofenadine produced more significant antihistamine effects. Conclusions Fexofenadine has a positive antihistamine effect, which is probably no worse than the second-generation antihistamines. Fexofenadine probably has a favorable safety profile, which is more likely better than that of the first-generation antihistamines. There is lack of data to support that fexofenadine has a better overall safety profile compared to the second-generation antihistamines, however, some presently available evidence on sedative effects and certain aspects of cognitive/psychomotor function favors fexofenadine. Therefore, fexofenadine may be worthy of recommendation for safety related workers.

P4126Safety of magnetic resonance imaging in patients with non-conditional cardiac implantable electronic devices: A systematic review and meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D Padmanabhan ◽  
M Farwati ◽  
A Izath ◽  
A Al-Masry ◽  
D Kella ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Adverse Events ◽  
Meta Analysis ◽  
Electronic Devices ◽  
Binary Outcomes ◽  
Resonance Imaging ◽  
Pacing Threshold ◽  
Cardiac Implantable Electronic Devices ◽  
Number Of Patients

Abstract Recent guideline statements approve the performance of magnetic resonance imaging (MRI) in patients with non-conditional cardiac implantable electronic devices (CIEDs) under certain closely monitored conditions. Data from current registries may have lower power to discern changes that may occur in the CIED after the MRI. Objective We aimed to systematically review the literature to identify the adverse events and significance of changes in device function associated with performing MRI in patients with CIEDs Methods A comprehensive literature search of the databases was performed between 1980- 2017. Two independent reviewers selected studies and extracted data. A random-effects model was used for meta-analysis. Results A total of 7,422 patients underwent 8,865 MRI studies. No death occurred post MRI. Clinical adverse events were extremely rare (mostly less than 1%) and are summarized in Table 1. No significant changes in the pooled mean effect size estimate was noted for the changes in the lead parameters (pacing threshold, sensing and impedance) Binary outcomes post magnetic resonance imaging in patients with non-conditional cardiac implantable electronic devices Outcome Sample size Number of patients Rate SE LL of CI UL of CI Death 7401 0 0 0 0 0 Atrial arrhythmia 7173 10 0.001 0.0004 0.0007 0.0024 Ventricular arrhythmia 7371 9 0.0012 0.0004 0.0006 0.0022 Oversensing 4981 17 0.0034 0.0008 0.0020 0.0053 Inhibition of pacing 7371 6 0.0008 0.0003 0.0003 0.0016 Lead Failure/Generator Failure 7475/7475 2/8 0.0002/0.0011 0.0001/0.0004 0.0001/0.0005 0.0009/0.002 Power on Reset 1388 105 0.0131 0.0014 0.0107 0.0161 Did not complete scan 6851 13 0.0019 0.0005 0.0011 0.0031 Chest pain 7080 11 0.0021 0.0004 0.0008 0.0027. Lead threshold rise (>0.5v/>50%-A/V) 5076/6246 12/16 0.0024/0.0026 0.0007/0.0006 0.0013/0.0015 0.0040/0.0041 Change in Battery voltage >0.04V 7132 42 0.0061 0.0009 0.0043 0.0079 Sensing decrease >50%-A/V 5087/5834 17/9 0.0033/0.0015 0.0008/0.0005 0.0020/0.0008 0.0052/0.0028 Impedance changes >50ohms/>50% 5810 22 0.0038 0.0008 0.0024 0.0057 Rise in cardiac enzymes 1703 26 0.0152 0.0030 0.0102 0.0219 A, atrial; V, ventricular; SE, standard Error; LL, lower limit; UL, upper limit; CI, Confidence intervals. Conclusions MRI in patients with non-conditional CIEDs can be performed with high degree of safety and low rate of clinical events when performed under standardized protocols Acknowledgement/Funding None

scholarly journals Second-generation antipsychotic drugs and short-term somatic serious adverse events: a systematic review and meta-analysis

2019 ◽  
Vol 6 (9) ◽  
pp. 753-765 ◽  
Author(s):  
Johannes Schneider-Thoma ◽  
Orestis Efthimiou ◽  
Irene Bighelli ◽  
Carola Dörries ◽  
Maximilian Huhn ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Events ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Meta Analysis ◽  
Short Term ◽  
Serious Adverse Events ◽  
Second Generation Antipsychotic

Adjuvant interventions with opioids for vaso-occlusive crisis in sickle cell disease: A mixed treatment network meta-analysis of randomized controlled clinical trials

2020 ◽  
Vol 16 (4) ◽  
pp. 267-275
Author(s):  
Kannan Sridharan, MD, DM ◽  
Gowri Sivaramakrishnan, MDS
Keyword(s):  
Nitric Oxide ◽  
Sickle Cell Disease ◽  
Adverse Events ◽  
Magnesium Sulfate ◽  
Sickle Cell ◽  
Meta Analysis ◽  
Favorable Effect ◽  
Secondary Outcome ◽  
Cell Disease ◽  
Number Of Patients

Objective: Vaso-occlusive crisis is the most common clinical feature requiring opioid analgesics in patients with sickle cell disease. We conducted a network meta-analysis to compare the drugs that can be used as add-on with opioids for vaso-occlusive crisis.Design: Network meta-analysis of randomized clinical trials.Patients: Sickle cell disease patients with vaso-occlusive crisis receiving adjuvants to opioids for pain management.Main outcome measures: A number of patients with complete pain relief and pain scores assessed either by visual analog or by a numerical rating scale were the primary outcomes. Adverse events and dose of opioids (in morphine equivalents) for pain alleviation between the treatment arms were the secondary outcome measures.Results: Eleven studies evaluating the addition of ketorolac, magnesium sulfate, ketoprofen, ibuprofen, methadone, inhalational nitric oxide, methylprednisolone, and arginine with morphine were obtained. The pooled analysis showed a favorable effect in the pain reduction for the additions of arginine {–2 [–3.39, –0.61]} and ibuprofen {–1.7 [–3.26, –0.14]} with morphine. Arginine has high probability of being the “best” in the pool followed by ibuprofen. No significant differences were observed in the risk of adverse events {ketoprofen—0.84 [0.42, 1.65]; magnesium sulfate—1.81 [0.64, 5.81]; and arginine—2.08 [0.18, 24.31]}. A significant lower dose of opioid was required when given adjunctive to arginine, inhalational nitric oxide, and methylprednisolone.Conclusion: We observed that arginine and ibuprofen could produce additional analgesic effects when combined with morphine in vaso-occlusive crisis.

Drug Treatment of Depression

1990 ◽  
Vol 3 (4) ◽  
pp. 252-261
Author(s):  
Candace S. Brown ◽  
Stephen G. Bryant
Keyword(s):  
Side Effects ◽  
Major Depression ◽  
Drug Treatment ◽  
Depressed Patient ◽  
First Generation ◽  
Second Generation ◽  
Treatment Of Depression ◽  
New Generation

The major advantage of the new generation of antidepressants lies in their enhanced ability to avoid unwanted side effects, such as anticholinergic or cardiovascular toxicities, and in many cases, to reduce fatalities after overdose. Second-generation antidepressants are as effective as the first generation agents, but are more selective, enabling precise targeting of symptoms. Caution in recommending the newer antidepressants must be applied, however, because these agents possess differing side effects, and unforeseen toxicities may not appear until after several years of use. Conventional tricyclics should not be overlooked in managing the depressed patient. This article discusses the symptoms of major depression, followed by the latest information on second-generation antidepressants. It concludes by providing the pharmacist with guidelines for when to select a newer over an older agent.

scholarly journals Differential Effects of Acute Treatment With Antipsychotic Drugs on Peripheral Catecholamines

2020 ◽  
Vol 11 ◽  
Author(s):  
Heidi N. Boyda ◽  
Amanzo A. Ho ◽  
Lurdes Tse ◽  
Ric M. Procyshyn ◽  
Jessica W. Y. Yuen ◽  
...  
Keyword(s):  
Side Effects ◽  
Acute Treatment ◽  
First Generation ◽  
Antipsychotic Drugs ◽  
Second Generation ◽  
Psychotic Disorders ◽  
Female Rats ◽  
Maximum Increase ◽  
Sympathetic Nervous ◽  
Dose Dependent

Antipsychotic drugs represent the most effective treatment for chronic psychotic disorders. The newer second generation drugs offer the advantage of fewer neurological side-effects compared to prior drugs, but many cause serious metabolic side-effects. The underlying physiology of these side-effects is not well-understood, but evidence exists to indicate that the sympathetic nervous system may play an important role. In order to examine this possibility further, we treated separate groups of adult female rats acutely with either the first generation antipsychotic drug haloperidol (0.1 or 1 mg/kg) or the second generation drugs risperidone (0.25 or 2.5 mg/kg), clozapine (2 or 20 mg/kg), olanzapine (3 or 15 mg/kg) or vehicle by intraperitoneal injection. Blood samples were collected prior to drug and then 30, 60, 120, and 180 mins after treatment. Plasma samples were assayed by HPLC-ED for levels of norepinephrine, epinephrine, and dopamine. Results confirmed that all antipsychotics increased peripheral catecholamines, although this was drug and dose dependent. For norepinephrine, haloperidol caused the smallest maximum increase (+158%], followed by risperidone (+793%), olanzapine (+952%) and clozapine (+1,684%). A similar pattern was observed for increases in epinephrine levels by haloperidol (+143%], olanzapine (+529%), risperidone (+617%) then clozapine (+806%). Dopamine levels increased moderately with olanzapine [+174%], risperidone [+271%], and clozapine [+430%]. Interestingly, levels of the catecholamines did not correlate strongly with each other prior to treatment at baseline, but were increasingly correlated after treatment as time proceeded. The results demonstrate antipsychotics can potently regulate peripheral catecholamines, in a manner consistent with their metabolic liability.

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