ID: 100: A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE RELATIVE EFFICACY AND SAFETY OF TREATMENT REGIMENS FOR HIV-ASSOCIATED CEREBRAL TOXOPLASMOSIS

2016 ◽  
Vol 64 (4) ◽  
pp. 952.3-953
Author(s):  
P Thota ◽  
V Pasupuleti ◽  
D Pellegrino ◽  
VA Benites-Zapata ◽  
A Deshpande ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Current Evidence ◽  
Drug Discontinuation ◽  
Cerebral Toxoplasmosis ◽  
Relative Efficacy ◽  
Efficacy And Safety ◽  
Random Effects Models ◽  
Treatment Regimens ◽  
Radiological Response

AimThe objective of this study was to perform a systematic review and meta-analysis of the literature to evaluate efficacy and safety of therapies for cerebral toxoplasmosis in HIV-infected adults. Pyrimethamine plus sulfadiazine (P-S) combination is considered the mainstay therapy for cerebral toxoplasmosis and pyrimethamine plus clindamycin (P-C) is the most common alternative treatment. Although, trimethoprim-sulfamethoxazole (TMP-SMX) has potential advantages, its use is infrequent.MethodsDesign: Systematic review and meta-analysis. We searched PubMed and 4 other databases to identify randomized controlled trials (RCTs) and cohort studies. Two independent reviewers searched and identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models.ResultsNine studies were included (5 RCTs, 3 retrospective cohorts, 1 prospective cohort). In comparison to P-S, treatment with P-C or TMP-SMX had similar partial or complete clinical response (P-C: RR 0.87, 95%CI 0.70–1.08; TMP-SMX: RR 0.97, 95%CI 0.78–1.21), radiological response (P-C: RR 0.92, 95%CI 0.82–1.03), skin rash (P-C: RR 0.81, 95%CI 0.56–1.17; TMP-SMX: RR 0.17, 95%CI 0.02–1.29), gastrointestinal impairment (P-C: RR 5.16, 95%CI 0.66–40.11), and drug discontinuation due to adverse events (P-C: RR 0.32, 95%CI 0.07–1.47). Liver impairment was more frequent with P-S than P-C (P-C vs P-S: RR 0.48, 95% CI 0.24–0.97).ConclusionsThe current evidence fails to identify one superior regimen in terms of relative efficacy or safety for the treatment of HIV-associated cerebral toxoplasmosis. Use of TMP-SMX as preferred treatment may be consistent with the available evidence and other real world considerations. Larger comparative studies are needed.

scholarly journals A Systematic Review of the Relative Efficacy and Toxicity of Treatment Regimens for HIV-Associated Cerebral Toxoplasmosis: Is Trimephoprim-Sulfamethaxozole a Real Option?

2015 ◽  
Vol 2 (suppl_1) ◽  
Author(s):  
Priyaleela Thota ◽  
Abhishek Deshpande ◽  
Daniela Pellegrino ◽  
Vinay Pasupuleti ◽  
Vicente Benites-Zapata ◽  
...  
Keyword(s):  
Systematic Review ◽  
Real Option ◽  
Cerebral Toxoplasmosis ◽  
Relative Efficacy ◽  
Treatment Regimens

scholarly journals Current evidence for anesthesia management during endovascular stroke therapy: updated systematic review and meta-analysis

2018 ◽  
Vol 11 (2) ◽  
pp. 107-113 ◽  
Author(s):  
Nitin Goyal ◽  
Konark Malhotra ◽  
Muhammad F Ishfaq ◽  
Georgios Tsivgoulis ◽  
Christopher Nickele ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Anesthetic Management ◽  
Functional Independence ◽  
Sensitivity Analyses ◽  
Current Evidence ◽  
Vessel Occlusion ◽  
Random Effects Models ◽  
Randomized Studies

IntroductionDebate continues about the optimal anesthetic management for patients undergoing endovascular treatment (ET) of acute ischemic stroke due to emergent large vessel occlusion.ObjectiveTo compare, using current evidence, the clinical outcomes and procedural characteristics among patients undergoing general anesthesia (GA) and local or monitored anesthesia (non-GA).MethodsWe performed a systematic review and meta-analysis of all available studies that involved the use of stent retrievers for ET (stentriever group). Additionally, we included studies that were published in 2015 and later, and compared the clinical outcomes among the studies using stentrievers or no stentrievers (pre-stentriever group). Outcome variables included functional independence (FI; modified Rankin Scale scores of 0–2), symptomatic hemorrhage, mortality, procedure duration, and vascular and respiratory complications. We calculated pooled odds ratios and 95% CIs using random-effects models.ResultsSixteen studies (three randomized controlled clinical trials (RCTs) and 13 non-randomized studies) were identified comprising 5836 patients. Although non-GA was associated with higher odds of 3-month FI (OR=1.57; 95% CI 1.17 to 2.10; P=0.003) and lower odds of 3-month mortality (OR=0.62; 95% CI 0.47 to 0.82; P=0.0006, substantial heterogeneity was noted across included trials. Sensitivity analyses of RCTs showed that non-GA was inversely associated with FI (OR=0.55; 95% CI 0.34 to 0.89; P=0.01; I2=15%), while no association was noted with mortality (OR=1.36; 95% CI 0.79 to 2.34; P=0.27; I2=0%).ConclusionOur updated meta-analysis demonstrates favorable results with non-GA, probably owing to inclusion of non-randomized studies. Recent single-center RCTs indicate that GA is associated with higher odds of FI at 3 months, while other outcomes are similar between the two groups.

Efficacy and safety of systemic treatments for patients with recurrent/metastatic head and neck squamous cell carcinoma: A systematic review and network meta-analysis.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18001-e18001
Author(s):  
Lingbin Meng ◽  
Rui Ji ◽  
Huanhuan Wang ◽  
Xin Jiang
Keyword(s):  
Systematic Review ◽  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Meta Analysis ◽  
Neck Squamous Cell Carcinoma ◽  
Efficacy And Safety ◽  
Treatment Regimens ◽  
Significant Difference

e18001 Background: A variety of systemic chemotherapy regimens have been used for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). However, most guidelines were derived from a single clinical trial, and no studies have comprehensively compared their efficacy and safety. This study is aimed to compare the efficacy and safety of systemic chemotherapies for patients with R/M HNSCC. Methods: We conducted a systematic review of published studies in PubMed, Embase, Web of Science, and Cochrane Library databases up to July 31, 2020. Studies were included if they were randomized controlled clinical trials including treatment regimens recommended by the latest NCCN guidelines. Eligible studies should report at least one of the following outcomes: overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and ≥3 adverse events rate (AEs). Literature screening, data extraction and quality assessment were independently conducted by two researchers. Disputes were settled by a panel of other researchers. Network meta-analysis was used to compare the efficacy and safety of various treatment regimens. Heterogeneity and consistency using the Bayesian model were evaluated in the network meta-analysis. Results: Eighteen eligible trials involving 4930 patients and 15 treatment regimens were included. Cetuximab/platinum/5-FU regimen showed higher ORR values than the following agents, including cisplatin/5-FU (odds ratio 2.96, 95% credible interval 1.42 to 6.15), cisplatin (5.43, 1.90-15.54), 5-FU (8.12, 2.22-29.61), methotrexate (8.25, 2.86-23.79), cetuximab (10.16, 1.44-71.48), and afatinib (3.64, 1.00-13.32). Immunotherapy regimens pembrolizumab/platinum/5-FU and pembrolizumab alone also showed significantly higher ORR values than these agents, while nivolumab alone showed higher ORR than the single agents. However, no significant difference was observed between Cetuximab/platinum/5-FU and pembrolizumab/platinum/5-FU. Regarding ≥3 AEs, cisplatin/paclitaxel caused the highest toxicity. No significant difference was observed on OS and PFS among all these treatment regimens. Conclusions: Cetuximab/platinum/5-FU, pembrolizumab/platinum/5-FU or pembrolizumab alone displayed high ORR with low AE rate. Nivolumab also showed better efficacy than other single agents. Although it was reported that pembrolizumab/platinum/5-FU showed better efficacy than cetuximab/platinum/5-FU, we did not find a statistically significant improvement in ORR, OS or PFS when comparing the two regimens. Therefore, further prospective trials comparing these treatment regimens remain warranted.

scholarly journals Comparative safety of the sodium glucose co-transporter 2 (SGLT2) inhibitors: a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022577 ◽  
Author(s):  
Jennifer R Donnan ◽  
Catherine A Grandy ◽  
Eugene Chibrikov ◽  
Carlo A Marra ◽  
Kris Aubrey-Bassler ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bone Fractures ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Sglt2 Inhibitors ◽  
Current Evidence ◽  
Random Effects Models ◽  
Relative Risks ◽  
Increased Risk ◽  
Tract Infections

ObjectiveTo estimate the association between the use of sodium glucose co-transporter-2 (SGLT2) inhibitors and postmarket harms as identified by drug regulatory agencies.DesignWe conducted a systematic review and meta-analysis of randomised controlled trials (RCT). Six large databases were searched from inception to May 2018. Random effects models were used to estimate pooled relative risks (RRs).InterventionSGLT2 inhibitors, compared with placebo or active comparators.Primary outcomesAcute kidney injury (AKI), diabetic ketoacidosis (DKA), urinary tract infections (UTI), bone fractures and lower limb amputations.ResultsWe screened 2418 citations of which 109 were included. Most studies included one of four SGLT2 inhibitors, dapagliflozin, canagliflozin, empagliflozin and ipragliflozin. When compared with placebo, SGLT2 inhibitors were found to be significantly protective against AKI (RR=0.59; 95% CI 0.39 to 0.89; I2=0.0%), while no difference was found for DKA (RR 0.66; 95% CI 0.30 to 1.45, I2=0.0%), UTI (RR 1.02; 95% CI 0.95 to 1.09, I2=0.0%) or bone fracture (RR 0.87; 95% CI 0.69 to 1.09, I2=1.3%). Three studies reported on amputation, with one finding a significant increase risk. No increased risk for either outcome was found when compared with active controls. Subgroup analysis did show an increased risk of UTI with dapagliflozin only (RR 1.21; 95% CI 1.02 to 1.43, I2=0.0%), but no other analysis supported an increased risk of AKI, DKA, UTI or fracture.ConclusionsCurrent evidence from RCTs does not suggest an increased risk of harm with SGLT2 inhibitors as a class over placebo or active comparators with respect to AKI, DKA, UTI or fracture. However, wide CIs for many comparisons suggest limited precision, and therefore clinically important adverse events cannot be ruled out. Dapagliflozin, appears to independently increase the risk of UTI, although the mechanism for this intraclass variation in risk is unclear.PROSPERO registration numberCRD42016038715.

scholarly journals Efficacy and Safety of Moxibustion for Postherpetic Neuralgia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Qiqi Wu ◽  
Hantong Hu ◽  
Dexiong Han ◽  
Hong Gao
Keyword(s):  
Systematic Review ◽  
Herbal Medicine ◽  
Adverse Events ◽  
Postherpetic Neuralgia ◽  
Outcome Measure ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Efficacy Rate ◽  
Efficacy And Safety

Background: Postherpetic neuralgia (PHN) is one of the most common complications of herpes zoster (HZ), and there is still a lack of effective therapies. An increasing number of studies have found that compared to traditional therapy, moxibustion treatment is beneficial for the treatment of PHN, although current evidence remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of moxibustion for PHN.Methods: We conducted a broad literature review of a range of databases from inception to December 2020, including the Cochrane Library, PubMed, EMBASE, Web of Science, Clinical Trails, China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP), China Biomedical Network Information, and Wanfang databases. We included RCTs that compared moxibustion to pharmacological therapies, herbal medicine, or no treatment for treating PHN. The main outcome measure was efficacy rate and Visual Analog Scale (VAS); the secondary outcome measure was adverse events. Data accumulation and synthesis included meta-analysis, publication bias, sensitivity analysis, risk-of-bias assessment, and adverse events.Results: We included 13 RCTs involving 798 patients. Compared with the controls (pharmacological therapies, herbal medicine, or no treatment), moxibustion achieved a significantly higher efficacy rate (odds ratio [OR]: 3.65; 95% [confidence interval]: [2.32, 5.72]; P < 0.00001). Subgroup analysis of the distinct moxibustion modalities showed that both Zhuang medicine medicated thread and thunder-fire moxibustions obtained higher clinical efficacy than the control group. Compared with the controls, moxibustion resulted in significantly lower scores on the VAS (Weighted Mean Difference (MD) = −1.79; 95% CI: [−2.26, −1.33]; P < 0.00001). However, there was no significant difference in terms of safety between moxibustion and the controls (OR = 0.33; 95% CI [0.06, 1.77]; P = 0.19).Conclusion: Due to the lack of methodological quality as well as the significant heterogeneity of the included studies, it remains difficult to draw a firm conclusion on the efficacy and safety of moxibustion for the treatment of PHN. Future high-quality studies are urgently needed.

scholarly journals Efficacy and safety of bupropion for smoking cessation and reduction in schizophrenia: systematic review and meta-analysis

2010 ◽  
Vol 196 (5) ◽  
pp. 346-353 ◽  
Author(s):  
Daniel Tai-yin Tsoi ◽  
Mamta Porwal ◽  
Angela Claire Webster
Keyword(s):  
Systematic Review ◽  
Smoking Cessation ◽  
Negative Symptoms ◽  
Meta Analysis ◽  
Current Evidence ◽  
Smoking Abstinence ◽  
Efficacy And Safety ◽  
End Of Treatment ◽  
Significant Difference ◽  
Randomised Controlled

BackgroundThe benefits and harms of bupropion as an aid for smoking cessation in schizophrenia remain uncertain.AimsTo summarise the current evidence for efficacy and safety of bupropion as treatment for nicotine dependence in schizophrenia.MethodSystematic review and random-effects meta-analysis of randomised controlled trials (RCTs) comparing bupropion with placebo or alternative therapeutic control in adult smokers with schizophrenia.ResultsTwenty-one reports from seven RCTs were included. Biochemically verified self-reported smoking cessation rates after bupropion were significantly higher than placebo at the end of treatment (risk ratio (RR) = 2.57, P = 0.004) and at 6 months (RR = 2.78, P = 0.05). Expired carbon monoxide level was significantly lower with bupropion at the end of therapy (P = 0.002) but not at 6 months (P = 0.37). There was no significant difference in positive (P = 0.28) or negative symptoms (P = 0.49) between the bupropion and the placebo group.ConclusionsBupropion increases the rates of smoking abstinence in smokers with schizophrenia, without jeopardising their mental state.

scholarly journals Efficacy and Safety of Eculizumab in the Treatment of Transplant-Associated Thrombotic Microangiopathy: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Rui Zhang ◽  
Meng Zhou ◽  
Jiaqian Qi ◽  
Wenjing Miao ◽  
Ziyan Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Thrombotic Microangiopathy ◽  
Response Rate ◽  
Meta Analysis ◽  
Complete Response ◽  
Current Evidence ◽  
Efficacy And Safety ◽  
Impaired Liver Function ◽  
Hematopoietic Stem ◽  
Impaired Liver

BackgroundTransplant-associated thrombotic microangiopathy (TA-TMA) is a dangerous and life-threatening complication in patients undergoing hematopoietic stem cell transplantation (HSCT). Eculizumab has been used in the treatment of TA-TMA, and several studies have confirmed the benefit of Eculizumab in patients with TA-TMA. However, the results remain controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of Eculizumab for TA-TMA.Materials and MethodsWe searched PubMed and Embase for studies on the efficacy and safety of Eculizumab in TA-TMA patients. Efficacy outcomes consisted of overall response rate (ORR), complete response rate (CRR), and survival rate at the last follow-up (SR). Safety outcomes were adverse events (AEs), including infection, sepsis, impaired liver function, infusion reactions, and death.ResultsA total of 116 patients from six studies were subjected to meta-analysis. The pooled estimates of ORR, CRR, and SR for TA-TMA patients were 71% (95% CI: 58–82%), 32% (95% CI: 11–56%), and 52% (95% CI: 40–65%), respectively. Only one patient presented with a severe rash, and infection was the most common AEs. The main causes of death were infection and GvHD.ConclusionCurrent evidence suggests that Eculizumab improves SR and ORR in patients with TA-TMA and that Eculizumab is well tolerated. However, the number of studies is limited, and the findings are based mainly on data from observational studies. Higher quality randomized controlled trials and more extensive prospective cohort studies are needed.

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