scholarly journals Effects of Hydroxychloroquine on Proteinuria in IgA Nephropathy: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Jialing Zhang ◽  
Xiangxue Lu ◽  
Jianan Feng ◽  
Han Li ◽  
Shixiang Wang
Keyword(s):  
Systematic Review ◽  
Iga Nephropathy ◽  
Therapeutic Effect ◽  
Statistical Difference ◽  
Meta Analysis ◽  
Immunosuppressive Agents ◽  
Control Group ◽  
Percentage Reduction ◽  
And Control

Introduction. The present meta-analysis was to explore the efficacy of hydroxychloroquine (HCQ) in IgA nephropathy patients in terms of proteinuria. Method. We systematically searched PubMed and Embase for studies that compared HCQ and other treatments to reduce proteinuria in patients with IgA nephropathy up to June 2021. Mean ± SD of percentage change and level of proteinuria was calculated. Results. A total of 5 studies with 587 participants were included. IgA nephropathy patients who received HCQ were at a lower level of mean proteinuria at 6 months. However, there was no statistical difference between HCQ and control group considering percentage reduction in proteinuria. The long-term therapeutic effect of HCQ might be inferior to HCQ and renin-angiotensin-aldosterone system inhibition. Conclusion. HCQ might play a role in the reduction of proteinuria in IgA nephropathy patients. The addition of HCQ to other immunosuppressive agents should be clarified further.

scholarly journals The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

2021 ◽  
Vol 28 ◽  
pp. 107327482199743
Author(s):  
Ke Chen ◽  
Xiao Wang ◽  
Liu Yang ◽  
Zheling Chen
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Meta Analysis ◽  
Response Rates ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival ◽  
And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

scholarly journals The Prevalence of Adherent-Invasive Escherichia coli and Its Association With Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Razie Kamali Dolatabadi ◽  
Awat Feizi ◽  
Mehrdad Halaji ◽  
Hossein Fazeli ◽  
Peyman Adibi
Keyword(s):  
Escherichia Coli ◽  
Systematic Review ◽  
Inflammatory Bowel Diseases ◽  
Meta Analysis ◽  
Control Group ◽  
Pooled Prevalence ◽  
Bowel Diseases ◽  
Phylogenetic Grouping ◽  
Inflammatory Bowel ◽  
And Control

Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), are known as chronic gastrointestinal inflammatory disorders. The present systematic review and meta analysis was conducted to estimate the prevalence of adherent-invasive Escherichia coli (AIEC) isolates and their phylogenetic grouping among IBD patients compared with the controls. A systematic literature search was conducted among published papers by international authors until April 30, 2020 in Web of Science, Scopus, EMBASE, and PubMed databases. The pooled prevalence of AIEC isolates and their phylogenetic grouping among IBD patients as well as in controls was estimated using fixed or random effects models. Furthermore, for estimating the association of colonization by AIEC with IBD, odds ratio along with 95% confidence interval was reported. A total of 205 articles retrieved by the initial search of databases, 13 case–control studies met the eligibility criteria for inclusion in the meta analysis. There were 465 IBD cases (348 CD and 117 UC) and 307 controls. The pooled prevalence of AIEC isolates were 28% (95% CI: 18–39%), 29% (95% CI: 20–40%), 13% (95% CI: 1–30%), and 9% (95% CI: 3–19%), respectively among IBD, CD, UC, and control group, respectively. Our results revealed that the most frequent AIEC phylogroup in the IBD, CD, and control groups was B2. Fixed-effects meta analysis showed that colonization of AIEC is significantly associated with IBD (OR: 2.93; 95% CI: 1.90–4.52; P &lt; 0.001) and CD (OR: 3.07; 95% CI: 1.99–4.74; P &lt; 0.001), but not with UC (OR: 2.29; 95% CI: 0.81–6.51; P = 0.11). In summary, this meta analysis revealed that colonization by AIEC is more frequent in IBD and is associated with IBD (CD and UC). Our results suggested that the affects of IBD in patients colonized with the AIEC pathovar is not random, it is in fact a specific disease-related pathovar.

Effectiveness of Aerobic Exercise on Smoking Cessation in Adults: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 18 (2) ◽  
pp. 230-242
Author(s):  
Caroline Pereira Santos ◽  
Mahara Proença ◽  
Tamara dos Santos Gouveia ◽  
Crystian Bitencourt Soares de Oliveira ◽  
Guilherme Yassuki Tacao ◽  
...  
Keyword(s):  
Systematic Review ◽  
Smoking Cessation ◽  
Aerobic Exercise ◽  
Usual Care ◽  
Meta Analysis ◽  
Control Group ◽  
Short Term ◽  
Continuous Abstinence ◽  
Different Characteristics

Background: The specific benefits of aerobic exercises in smoking cessation are unclear, as they have different characteristics, intensities, and durations. The purpose of this systematic review with meta-analysis was to evaluate the effects of aerobic exercise, with or without co-interventions, compared with a control group of cognitive behavior treatment on smoking cessation. Methods: This review was prospectively registered on PROSPERO, and the searches were performed from 2016 to 2018. Randomized controlled trials evaluating the effects of aerobic exercise, with or without nicotine therapy replacement, compared with usual care were included. The primary outcome was smoking cessation defined as the prevalence of those who quit or continuous abstinence. Meta-analysis was calculated using random effects model in the comprehensive meta-analysis software. Results: The authors identified 18 trials reporting data for a total of 2815 participants. There was moderate-quality evidence that aerobic exercise was better than usual care in promoting smoking cessation at short term (11 trials, risk ratio 0.79; 95% confidence interval, 0.66–0.94). However, there were no differences between aerobic exercises and usual care at medium- or long-term follow-ups. Conclusions: According to review, aerobic exercise may be effective in promoting smoking cessation at short-term, but not at medium- and long-term follow-ups.

scholarly journals Association between perioperative fluid administration and postoperative outcomes: a 20-year systematic review and a meta-analysis of randomized goal-directed trials in major visceral/noncardiac surgery

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Antonio Messina ◽  
Chiara Robba ◽  
Lorenzo Calabrò ◽  
Daniel Zambelli ◽  
Francesca Iannuzzi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Fluid Management ◽  
Risk Difference ◽  
Control Group ◽  
Perioperative Mortality ◽  
Perioperative Fluid Management ◽  
The Individual ◽  
And Control

Abstract Background Appropriate perioperative fluid management is of pivotal importance to reduce postoperative complications, which impact on early and long-term patient outcome. The so-called perioperative goal-directed therapy (GDT) approach aims at customizing perioperative fluid management on the individual patients’ hemodynamic response. Whether or not the overall amount of perioperative volume infused in the context of GDT could influence postoperative surgical outcomes is unclear. Methods We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing the efficacy of GDT approach between study population and control group in reducing postoperative complications and perioperative mortality, using MEDLINE, EMBASE and the Cochrane Controlled Clinical trials register. The enrolled studies were grouped considering the amount infused intraoperatively and during the first 24 h after the admission in the critical care unit (perioperative fluid). Results The metanalysis included 21 RCTs enrolling 2729 patients with a median amount of perioperative fluid infusion of 4500 ml. In the studies reporting an overall amount below or above this threshold, the differences in postoperative complications were not statically significant between controls and GDT subgroup [43.4% vs. 34.2%, p value = 0.23 and 54.8% vs. 39.8%; p value = 0.09, respectively]. Overall, GDT reduced the overall rate of postoperative complications, as compared to controls [pooled risk difference (95% CI) = − 0.10 (− 0.14, − 0.07); Chi2 = 30.97; p value < 0.0001], but not to a reduction of perioperative mortality [pooled risk difference (95%CI) = − 0.016 (− 0.0334; 0.0014); p value = 0.07]. Considering the rate of organ-related postoperative events, GDT did not reduce neither renal (p value = 0.52) nor cardiovascular (p value = 0.86) or pulmonary (p value = 0.14) or neurological (p value = 0.44) or infective (p value = 0.12) complications. Conclusions Irrespectively to the amount of perioperative fluid administered, GDT strategy reduces postoperative complications, but not perioperative mortality. Trial Registration CRD42020168866; Registration: February 2020 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=168866

scholarly journals Systematic review and meta analysis of differential attrition between active and control arms in randomized controlled trials of lifestyle interventions in chronic disease

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bevens W ◽  
Shoushtari A ◽  
Jelinek P ◽  
Jelinek GA ◽  
Weiland TJ
Keyword(s):  
Systematic Review ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Lifestyle Intervention ◽  
Meta Analysis ◽  
Research Question ◽  
Lifestyle Interventions ◽  
And Control

Abstract Background Attrition is a major obstacle for lifestyle interventions sustained for the medium-to-long term and can have significant consequences on the internal validity of a trial. When the degree of attrition differs between active and control arms this is termed differential attrition and is an important consideration during initial stages of trial planning. Objectives The primary research question of this study was: what is the differential attrition between treatment arms in lifestyle interventions for prevalent chronic diseases? Methods We performed a systematic review and meta-analysis of 23 studies involving a lifestyle intervention component in cohorts with chronic diseases. The search accessed three databases: Scopus, Medline Ovid and Web of Science. Attrition between treatment arms was analysed using a random-effects model and examined the relationship between the relative attrition and potential moderators, such as time to final follow-up, time to first follow-up, type of disease, type of control, type of intervention and length of treatment. Results The pooled risk ratio was 1.00 (95% CI 0.97 – 1.03) and only one study fell outside this range. A univariable association was described between the pooled risk ration and length (years) to final follow-up, which did not remain in the multivariable model. Conclusions Ultimately, we found no evidence of differential attrition in medium-to-long term lifestyle intervention studies for chronic disease, increasing confidence in conducting such studies with minimal potential of attrition bias. Trial registration PROSPERO registration number CRD42018084495.

scholarly journals Efficacy and Safety of Immunosuppressive Monotherapy Agents for IgA Nephropathy: A Network Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Shisheng Han ◽  
Tianwen Yao ◽  
Yan Lu ◽  
Min Chen ◽  
Yanqiu Xu ◽  
...  
Keyword(s):  
Serum Creatinine ◽  
Clinical Remission ◽  
Meta Analysis ◽  
Immunosuppressive Agents ◽  
Cochrane Library ◽  
Control Group ◽  
Efficacy And Safety ◽  
Long Term Effects

Background: The efficacy and safety of immunosuppressive monotherapy agents were evaluated for immunoglobulin A nephropathy (IgAN) using a network meta-analysis approach.Methods: Randomized controlled trials (RCTs) published prior to October 1, 2019, using immunosuppressive agents for treating IgAN, were systematically searched in PubMed, Embase, Cochrane Library, and Web of Science databases. Relative risks (RRs) or standard mean differences with 95% confidence intervals (CIs) were estimated using the random-effects model. The primary outcomes were clinical remission, end-stage renal disease (ESRD), and serious adverse events (SAEs). The secondary outcomes were urinary protein excretion and serum creatinine.Results: Twenty-five RCTs with 2,005 participants were deemed eligible. Six medications were evaluated: corticosteroids, mycophenolate mofetil (MMF), tacrolimus (TAC), cyclosporine, leflunomide, and hydroxychloroquine (HCQ). Steroids (RR 1.50, 95% CI 1.17–1.93), MMF (RR 2.05, 95% CI 1.15–3.65), TAC (RR 3.67, 95% CI 1.06–12.63), and HCQ (RR 3.25, 95% CI 1.05–10.09) significantly improved clinical remission rates compared to supportive care alone. Only steroids reduced the risk of ESRD (RR 0.35, 95% CI 0.12–0.98); however, there were significantly more SAEs than in the control group (RR 2.90, 95% CI 1.37–6.13). No significantly different effects in serum creatinine levels were found among the therapies. MMF showed no significant improvement in remission when excluding studies with a follow-up of fewer than 2 years in the sensitivity analysis (RR 1.41, 95% CI 0.40–4.92). The effect of TAC in the decrease of proteinuria was reversed after discontinuing medication for 3 months; the long-term effects of HCQ could not be evaluated due to the short follow-up duration.Conclusion: Corticosteroids might induce remission and increase renal survival in IgAN; however, adverse reactions should be taken into consideration. MMF, TAC, and HCQ might improve the remission of proteinuria when treating IgAN, but showed no superiority compared to steroids, and the long-term effects require further study.

scholarly journals Efficacy and Safety of Immunosuppressive Treatment in IgA Nephropathy: A Meta-analysis of Randomized Controlled Trials

2019 ◽  
Author(s):  
Zheng Zhang ◽  
Yue Yang ◽  
Shi-min Jiang ◽  
Wen-ge Li
Keyword(s):  
Randomized Controlled Trials ◽  
Immunosuppressive Therapy ◽  
Iga Nephropathy ◽  
Meta Analysis ◽  
Immunosuppressive Agents ◽  
Cochrane Library ◽  
Control Group ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled

AbstractBackgroundThere is some controversy regarding the efficacy and safety of immunosuppressive agents for the treatment of kidney diseases. The recent STOP-IgAN and TESTING studies have focused attention on the application of immunosuppressive agents in IgA nephropathy (IgAN). This study investigated the benefits and risks of immunosuppressive agents in IgAN.MethodsMEDLINE, EMBASE, the Cochrane Library, and article reference lists were searched for randomized controlled trials (RCTs) comparing immunosuppressive agents with any other non-immunosuppressive agents for treating IgAN. A meta-analysis was performed on the outcomes of proteinuria, creatinine (Cr), estimated glomerular filtration rate (eGFR), and adverse events in patients with IgAN, and trial sequential analyses were also performed for outcomes.ResultsTwenty-nine RCTs (1957 patients) that met our inclusion criteria were identified. Steroids (weighted mean difference [WMD] −0.70, 95% confidence interval [CI] −1.2 to −0.20), non-steroidal immunosuppressive agents (NSI) (WMD −0. 43, 95% CI −0.55 to −0.31), and combined steroidal and non-steroidal immunosuppressive agents (S&NSI) (WMD −1.46, 95% CI −2.13 to −0.79) therapy significantly reduced proteinuria levels in patients with IgAN. Steroid treatment significantly reduced the risk for end-stage renal disease (ESRD) (relative risk [RR] 0.39, CI 0.19 to 0.79). The immunosuppressive therapy group showed significant increases in gastrointestinal, hematological, dermatological, and genitourinary side effects, as well as impaired glucose tolerance or diabetes. Hyperkalemia was more common in the control group.ConclusionImmunosuppressive therapy can significantly reduce proteinuria and ESRD risk in patients with IgAN, but with a concomitant increase in adverse reactions. Therefore, care is required in the application of immunosuppressive agents in IgAN.

scholarly journals Does gamification improve physical activity? A systematic review and meta-analysis

2020 ◽  
Author(s):  
Alexandre Mazéas ◽  
Martine Duclos ◽  
Bruno Pereira ◽  
Aïna Chalabaev
Keyword(s):  
Physical Activity ◽  
Systematic Review ◽  
Chronic Diseases ◽  
Video Game ◽  
Meta Analysis ◽  
Term Effect ◽  
Sensitivity Analyses ◽  
Control Group ◽  
Long Term Effect

Background. The use of gamification to change behaviors and promote physical activity is a promising avenue to tackle the global physical inactivity pandemic and the current prevalence of chronic diseases. However, we do not have yet evidence of the effectiveness of gamified interventions with the existence of mixed results in the literature.Objective. This systematic review and meta-analysis aimed to evaluate the effectiveness of gamified interventions and their healthcare potential by testing the scalability and sustainability of their influence on physical activity (PA) and sedentary behaviors (SB).Methods. Five electronic databases (Pubmed, EMBASE, Scopus, Web of Science and CENTRAL) were searched for randomized controlled trials (RCTs) published since 2010. Eligibility criteria were based on components of PICO (participants, interventions, comparators, and outcomes). Studies were included when they used gamified interventions in daily life with an active or inactive control group, and when they assessed a PA or SB outcome. Studies were excluded when the intervention was based on an active video game using a gaming console. We conducted meta-analyses using a random effects model approach. Sensitivity analyses, influence analyses and publication bias analyses were performed to examine the robustness of our results.Results. The main meta-analysis performed on 16 studies and 2407 participants, revealed a small to medium summary effect of gamified interventions on PA behavior (g = 0.42 (95%CI [0.14, 0.69]). No statistical difference was found between different subgroups (adults vs adolescents, healthy participants vs adults with chronic diseases) and no interaction effects with moderators like age, gender or BMI, suggesting good scalability of gamified interventions. Moreover, the effect appears better on the step count (MD = +1609.56 steps per day (95%CI [372.39, 2846.73]) than on moderate-to-vigorous PA (g = 0.31 (95%CI [-0.19, 0.80]). The long-term effect (measured with follow-up averaging 14 weeks after the end of the intervention) is more volatile with a very small to small effect (g = 0.15, [0.07, 0.23]). Conclusions. This meta-analysis confirms that gamified interventions are promising to promote PA in various publics. However, if the effect persists after the end of the program, suggesting that it is not just a novelty effect due to the playful nature of gamification, it seems volatile with a small long-term effect. The integration of gamification in more global healthcare interventions could be a way to address this low sustainability. Future rigorous trials are needed to explore these perspectives.

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