scholarly journals The Efficacy of Ferumoxytol for Iron Deficiency Anemia: A Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 142 (3) ◽  
pp. 125-131 ◽  
Author(s):  
Yanping Shao ◽  
Wenda Luo ◽  
Haiyan Xu ◽  
Li Zhang ◽  
Qunyi Guo
Keyword(s):  
Iron Deficiency ◽  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Iron Deficiency Anemia ◽  
Meta Analysis ◽  
Mean Difference ◽  
Deficiency Anemia ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled

Introduction: This systematic review and meta-analysis aims to explore the influence of ferumoxytol versus placebo on iron deficiency anemia. Methods: We search for randomized controlled trials (RCTs) assessing the effect of ferumoxytol on iron deficiency anemia on PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases. This meta-analysis is performed using the random-effects model. Results: Four RCTs are included in the meta-analysis. Compared with the control group for iron deficiency anemia, intravenous ferumoxytol can significantly improve the proportion of patients with a ≥20 g/L hemoglobin (Hb) increase (RR = 18.43; 95% CI = 7.29–46.57; p < 0.00001), the proportion of patients with an Hb level ≥120 g/L (RR = 18.55; 95% CI = 8.66–39.72; p < 0.00001), transferrin saturation (mean difference = 11.08; 95% CI = 9.86–12.31; p < 0.00001) and FACIT-fatigue score (mean difference = 4.60; 95% CI = 3.21–6.00; p < 0.00001), but has no remarkable influence on adverse events (RR = 1.33; 95% CI = 0.84–2.10; p = 0.22), serious adverse events (RR = 1.22; 95% CI = 0.74–2.02; p = 0.44), and death (RR = 0.32; 95% CI = 0.05–1.95; p = 0.22). Conclusions: Intravenous ferumoxytol can provide the important benefits for iron deficiency anemia.

scholarly journals The effectiveness and safety of cupping therapy for stroke survivors: A systematic review and meta-analysis of randomized controlled trials

2021 ◽  
Vol 42 (4) ◽  
pp. 75-112
Author(s):  
Mikyung Kim ◽  
Chang-ho Han
Keyword(s):  
Randomized Controlled Trials ◽  
Motor Function ◽  
Upper Limb ◽  
Meta Analysis ◽  
Mean Difference ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Stroke Survivors ◽  
Randomized Controlled ◽  
Standard Mean Difference

Objectives: ncluding stroke. The aim of this study was to systematically review the clinical evidence of CT for stroke.Methods: To identify randomized controlled trials (RCTs) reporting the effectiveness and/or safety of CT, seven databases including PubMed, EMBASE, and Cochrane Library were searched for articles published from January 2000 to February 2021 without language restrictions. Meta-analysis was performed using Review Manager 5.4 software and the results were presented as mean difference (MD) or standard mean difference (SMD) for continuous variables and odds ratio (OR) for diverse variables with 95% confidence intervals (CIs). Assessment of the methodological quality of the eligible trials was conducted using the Cochrane Collaboration tool for risk of bias in RCTs.Results: Twenty-two RCTs with 1653 participants were included in the final analysis. CT provided additional benefit in improving upper limb motor function (Fugl-Meyer assessment for upper limb motor function, MD 6.91, 95% CI 4.64 to 1.67, P<0.00001) and spasticity (response rate, OR 3.28, 95% CI 1.31 to 8.22, P=0.08) in stroke survivors receiving conventional medical treatment. These findings were supported with a moderate level of evidence. CT did not significantly increase the occurrence of adverse events.Conclusions: This study demonstrated the potential of CT to be beneficial in managing a variety of complications in stroke survivors. However, to compensate for the shortcomings of the existing evidence, rigorously designed large-scale RCTs are warranted in the future.

Efficacy and Safety of Methylnaltrexone for the Treatment of Opioid-Induced Constipation: A Meta-analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Ying-Ying Zhang ◽  
Rong Zhou ◽  
Wan-Jie Gu
Keyword(s):  
Abdominal Pain ◽  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Safety Outcome ◽  
Randomized Controlled ◽  
Safety Outcomes

Abstract Background: Opioid-induced constipation (OIC) is a distressing side effect during opioid analgesia and is mainly mediated by gastrointestinal μ opioid receptors. Methylnaltrexone, a peripheral μ opioid receptor antagonist with restricted ability to cross the blood-brain barrier, may alleviate OIC without reversing analgesia. We performed a meta-analysis to assess the efficacy and safety of methylnaltrexone for the treatment of OIC.Methods: We searched PubMed, Embase, and Cochrane Library for randomized controlled trials that compared methylnaltrexone with placebo for the treatment of OIC. The primary efficacy outcome was rescue-free bowel movement (RFBM) within 4 hours after the first dose. Secondary efficacy outcomes included RFBM within 24 hours after the first dose, RFBM ≥3 times per week, and need take rescue laxatives. The primary safety outcome was any adverse events. Secondary safety outcomes included abdominal pain, diarrhea, nausea, vomiting, and flatulence. Relative risks (RR) and 95% confidence interval (CI) were pooled using random-effects model with the intention-to-treat principle. We used the GRADE approach to assess the certainty of the evidence.Results: Eight trials with 2,034 participants were included. Compared with placebo, methylnaltrexone significantly increased RFBM within 4 hours after the first dose (8 trials; 1,833 participants; RR 3.74, 95% CI 3.02-4.62; I2 = 0%; high-certainty evidence), RFBM within 24 hours after the first dose (2 trials; 614 participants; RR 1.98, 95% CI 1.52-2.58; I2 = 9%; moderate-certainty evidence), and RFBM ≥3 times per week (3 trials; 1,396 participants; RR 1.33, 95% CI 1.17-1.52; I2 = 0%; moderate-certainty evidence) and decreased need to take rescue laxatives (3 trials; 807 participants; RR 0.73, 95% CI 0.63-0.85; I2 = 0%; moderate-certainty evidence). For safety outcomes, there was no difference in any adverse events between the two groups (8 trials; 2,034 participants; RR 1.11, 95% CI 0.99-1.23; I2 = 34%; moderate-certainty evidence), including diarrhea, nausea, vomiting, and flatulence; but for the most commonly reported adverse events, the abdominal pain was higher in methylnaltrexone group than that in placebo group (6 trials; 1,813 participants; RR 2.30, 95% CI 1.29-4.08; I2 = 62%; moderate-certainty evidence).Conclusions: Methylnaltrexone is an effective and safe drug for treating OIC. But the safety of abdominal pain should be considered.Trial registration: PROSPERO (CRD42020187290).

scholarly journals Hydroxychloroquine plus standard of care compared with standard of care alone in COVID-19: a meta-analysis of randomized controlled trials

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Bahman Amani ◽  
Ahmad Khanijahani ◽  
Behnam Amani
Keyword(s):  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Standard Of Care ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled ◽  
Significant Difference

AbstractThe efficacy and safety of Hydroxychloroquine (HCQ) in treating coronavirus disease (COVID-19) is disputed. This systematic review and meta-analysis aimed to examine the efficacy and safety of HCQ in addition to standard of care (SOC) in COVID-19. PubMed, the Cochrane Library, Embase, Web of sciences, and medRxiv were searched up to March 15, 2021. Clinical studies registry databases were also searched for identifying potential clinical trials. The references list of the key studies was reviewed to identify additional relevant resources. The quality of the included studies was evaluated using the Cochrane Collaboration tool and Jadad checklist. Meta-analysis was performed using RevMan software (version 5.3). Eleven randomized controlled trials with a total number of 8161 patients were identified as eligible for meta-analysis. No significant differences were observed between the two treatment groups in terms of negative rate of polymerase chain reaction (PCR) (Risk ratio [RR]: 0.99, 95% confidence interval (CI) 0.90, 1.08; P = 0.76), PCR negative conversion time (Mean difference [MD]: − 1.06, 95% CI − 3.10, 0.97; P = 0.30), all-cause mortality (RR: 1.09, 95% CI 1.00, 1.20; P = 0.06), body temperature recovery time (MD: − 0.64, 95% CI − 1.37, 0.10; P = 0.09), length of hospital stay (MD: − 0.17, 95% CI − 0.80, 0.46; P = 0.59), use of mechanical ventilation (RR: 1.12, 95% CI 0.95, 1.32; P = 0.19), and disease progression (RR = 0.82, 95% CI 0.37, 1.85; P = 0.64). However, there was a significant difference between two groups regarding adverse events (RR: 1.81, 95% CI 1.36, 2.42; P < 0.05). The findings suggest that the addition of HCQ to SOC has no benefit in the treatment of hospitalized patients with COVID-19. Additionally, it is associated with more adverse events.

scholarly journals Systematic Review and Network Meta-Analysis of Noninvasive Brain Stimulation on Dysphagia after Stroke

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Lingling Li ◽  
Hailiang Huang ◽  
Yuqi Jia ◽  
Ying Yu ◽  
Zhiyao Liu ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Brain Stimulation ◽  
Meta Analysis ◽  
Mean Difference ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Noninvasive Brain Stimulation ◽  
Randomized Controlled ◽  
Standard Mean Difference ◽  
Swallowing Dysfunction

Background. Dysphagia is a common sequelae after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve dysphagia. Objective. To systematically evaluate the effect of NIBS on dysphagia after stroke and compare the effects of two different NIBS. Methods. Randomized controlled trials about the effect of NIBS on dysphagia after stroke were retrieved from databases of PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP, and CBM, from inception to June 2021. The quality of the trials was assessed, and the data were extracted according to the Cochrane Handbook for Systematic Reviews of Interventions. A statistical analysis was carried out using RevMan 5.3 and ADDIS 1.16.8. The effect size was evaluated by using the standardized mean difference (SMD) and a 95% confidence interval (CI). Results. Ultimately, 18 studies involving 738 patients were included. Meta-analysis showed that NIBS could improve the dysphagia outcome and severity scale (DOSS) score (standard mean difference SMD = 1.44 , 95% CI 0.80 to 2.08, P < 0.05 ) and the water swallow test score ( SMD = 6.23 , 95% CI 5.44 to 7.03, P < 0.05 ). NIBS could reduce the standardized swallowing assessment (SSA) score ( SMD = − 1.04 , 95% CI -1.50 to -0.58, P < 0.05 ), the penetration-aspiration scale (PAS) score ( SMD = − 0.85 , 95% CI -1.33 to -0.36, P < 0.05 ), and the functional dysphagia scale score ( SMD = − 1.05 , 95% CI -1.48 to -0.62, P < 0.05 ). Network meta-analysis showed that the best probabilistic ranking of the effects of two different NIBS on the DOSS score is rTMS   P = 0.52 > tDCS   P = 0.48 , the best probabilistic ranking of the SSA score is rTMS   P = 0.72 > tDCS   P = 0.28 , and the best probabilistic ranking of the PAS score is rTMS   P = 0.68 > tDCS   P = 0.32 . Conclusion. Existing evidence showed that NIBS could improve swallowing dysfunction and reduce the occurrence of aspiration after stroke, and that rTMS is better than tDCS. Limited by the number of included studies, more large-sample, multicenter, double-blind, high-quality clinical randomized controlled trials are still needed in the future to further confirm the results of this research.

scholarly journals Clinical Efficacy and Safety of Tranexamic Acid in Aneurysmal Subarachnoid Hemorrhage: a Meta-analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Tao Liu ◽  
Lingqin Wu ◽  
Renmin Xue ◽  
Huiru Ding
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Adverse Events ◽  
Tranexamic Acid ◽  
Randomized Controlled Trials ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Meta Analysis ◽  
Delayed Cerebral Ischemia ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Randomized Controlled

Abstract Background: Tranexamic acid, as a traditional hemostatic agent, is commonly applied in the treatment or prevention of excessive blood loss. However, the role of tranexamic acid in promoting good clinical outcomes, reducing mortality, and the risk of experiencing adverse events during the therapeutic process of aneurysmal subarachnoid hemorrhage remains unclear.Methods: In strict accordance with the inclusion and exclusion criteria, the Cochrane Library, Embase, Web of Science, and PubMed were retrieved for randomized-controlled trials (from 1980 to 2021). Statistical analysis was performed using STATA 16.0 and RevMan 5.3. In addition, the fixed-effect model (M-H method) and effect size RR (95% CI) were used as a pooled measure to combine the heterogeneous data. We also performed post hoc sensitivity analysis and subgroup analysis to evaluate each outcome with low heterogeneity.Results: Meta-analysis revealed that although tranexamic acid was related to less rebleeding (RR = 0.72; 95% CI 0.59-0.87; P = 0.0008), it might have no effect on good clinical outcome or mortality (RR = 0.98; 95% CI 0.92-1.04; P = 0.51; RR = 1.01; 95% CI 0.88-1.15; P = 0.91). Tranexamic acid was associated with increased hydrocephalus (RR = 1.13; 95% CI 1.02-1.24; P = 0.02), delayed cerebral ischemia (RR = 1.70; 95% CI 1.34-2.16; P < 0.0001) and seizure (RR = 1.46; 95% CI 1.00-2.14; P = 0.05). The incidence of thromboembolic complications was identical in both groups (RR = 0.91; 95% CI 0.63-1.31; P = 0.62), and there were significant drug-related overall adverse events (RR = 1.21; 95% CI 1.11- 1.32; P < 0.0001).Conclusions: These findings indicate that the routine use of TXA is not suggested for patients with aneurysmal subarachnoid hemorrhage.

scholarly journals Acupuncture for Essential Hypertension: A Meta-Analysis of Randomized Sham-Controlled Clinical Trials

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Dong-Ze Li ◽  
Yu Zhou ◽  
Yi-Ning Yang ◽  
Yi-Tong Ma ◽  
Xiao-Mei Li ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Sham Acupuncture ◽  
Mean Difference ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Antihypertensive Medications ◽  
Randomized Controlled

Background. Acupuncture is frequently advocated as an adjunct treatment for essential hypertension. The aim of this review was to assess its adjunct effectiveness in treating hypertension.Methods. We searched PubMed, the Cochrane Library, EMBASE, and the Chinese databases Sino-Med, CNKI, WanFang, and VIP through November, 2012, for eligible randomized controlled trials that compared acupuncture with sham acupuncture. Outcome measures were changes in diastolic (DBP) and systolic blood pressure (SBP).Results. A total of 4 randomized controlled trials were included. We found no evidence of an improvement with the fact that acupuncture relative to sham acupuncture in SBP change (n=386; mean difference = −3.80 mmHg, 95% CI = −10.03–2.44 mmHg;I2=99%), and an insignificant improvement in DBP change (n=386; mean difference = −2.82 mmHg, 95% CI = −5.22–(−0.43) mmHg;I2=97%). In subgroup analyses, acupuncture significantly improved both SBP and DBP in patients taking antihypertensive medications. Only minor acupuncture-related adverse events were reported.Conclusions. Our results are consistent with acupuncture significantly lowers blood pressure in patients taking antihypertensive medications. We did not find that acupuncture without antihypertensive medications significantly improves blood pressure in those hypertensive patients.

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