Barrier Protection Measures for the Management of Allergic Rhinitis: A Systematic Review and Meta-analysis

2020 ◽  
Vol 34 (4) ◽  
pp. 564-572
Author(s):  
Xianzhen Chen ◽  
Chuntao Deng ◽  
Jiaoping Mi ◽  
Mo Chen ◽  
Yanfei Li ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Allergic Rhinitis ◽  
Adverse Events ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Good Choice ◽  
Protection Measures ◽  
Statistical Heterogeneity ◽  
Rhinitis Symptom

Background Pharmacotherapy for allergic rhinitis (AR) still remains unsatisfying regarding its effect and safety. Barrier protection measures may be a good choice for the patients with AR. Objective To assess the efficacy and safety of barrier protection measures in the treatment of AR. Methods We selected relevant randomized controlled trials published between January 1, 1990, and February 20, 2019, by searching Embase, PubMed, Cochrane, Web of Knowledge, and ClinicalTrials.gov. The primary outcome for this analysis was rhinitis symptom scores, overall quality of life, nasal peak inspiratory flow (NPIF), and adverse events. Differences were expressed as weighted mean difference (WMD) with 95% confidence intervals (CIs) for continuous outcomes. Statistical heterogeneity across trials was assessed with the statistic ( P < .1) and the I2 statistic. Results Fifteen RCTs (with data for 1154 participants) satisfied our inclusion criteria. The types of barrier protection measures comprised cellulose, pollen blocker cream, microemulsion, and nasal filter. To reduce the potential risk of bias and heterogeneity, we carried out subgroup analysis according to different types of barrier protection measures (cellulose: WMD = –2.18, 95% CI, –3.01 to –1.35, P < .00001; pollen blocker cream: WMD = –4.55, 95% CI, –6.10 to –3.00, P < .00001; microemulsion: WMD = –0.22, 95% CI, –0.42 to –0.03, P = .03). Findings from our meta-analysis show that, compared with placebo, barrier protection measures can yield improved symptomatic control for AR, with no increase in adverse events. Furthermore, barrier protection measures can improve the quality of life and NPIF. Conclusion Although further studies are still needed, our findings clearly lend support to barrier protection measures as a safe and efficacious option for the treatment of AR patients.

scholarly journals Effectiveness and adverse events of topical and allergen immunotherapy for atopic dermatitis: a systematic review and network meta-analysis protocol

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Luis Guillermo Gómez-Escobar ◽  
Hansel Mora-Ochoa ◽  
Andrea Vargas Villanueva ◽  
Loukia Spineli ◽  
Gloria Sanclemente ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Atopic Dermatitis ◽  
Adverse Events ◽  
Random Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Allergen Specific Immunotherapy ◽  
Statistical Heterogeneity

Abstract Background Atopic dermatitis (AD) is an inflammatory chronic condition that affects the skin of children and adults and has an important impact on the quality of life. Treatments for AD are based on environmental controls, topical and systemic therapies, and allergen-specific immunotherapy (AIT). However, it remains unclear the effectiveness and adverse events of AIT and all conventional topical treatments compared with placebo and each other for AD. Methods We will search five electronic databases [Central Cochrane register of controlled trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and LILACS] from inception until November 2019 with no language restriction, and we will include experimental studies [randomized controlled trials (RCTs), and quasi-RCTs]. The primary outcome is global and specific skin symptoms assessment. Secondary outcomes are hospital length of stay, quality of life, and adverse events. Reviewers independently will extract data from the studies that meet our inclusion criteria and will assess the risk of bias of individual primary studies. We will conduct random effects pairwise meta-analyses for the observed pairwise comparisons with at least two trials. Then, we will perform random-effects Bayesian network meta-analysis (NMA) to obtain treatment effects for all possible comparisons and to provide a hierarchy of all interventions for each outcome. Possible incoherence between direct and indirect sources of evidence will be investigated locally (if possible) and globally. To investigate sources of statistical heterogeneity, we will perform a series of meta-regression analyses based on pre-specified important effect modifiers. Two authors will appraise the certainty of the evidence for each outcome applying the GRADE’s framework for NMA. Discussion The findings of this systematic review will shed the light on the effectiveness and adverse events of all possible comparisons for treating AD and on the quality of the collated evidence for recommendations. It will also provide critical information to health care professionals to comprehend and manage this disease at different age stages, treatment type, duration, and severity of atopic dermatitis. Systematic review registration PROSPERO Protocol ID CRD42019147106

scholarly journals Acupuncture for refractory gastro-oesophageal reflux disease: a systematic review and meta-analysis protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e030713 ◽  
Author(s):  
Dacheng Li ◽  
Li Zhu ◽  
Daming Liu
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Adverse Events ◽  
Reflux Disease ◽  
Meta Analysis ◽  
Oesophageal Reflux ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Oesophageal Reflux Disease

IntroductionRefractory gastro-oesophageal reflux disease (rGORD) is a common disease, affecting patients’ quality of life. Since conventional medicines have limitations, like low effective rates and adverse events, acupuncture may be a promising therapy for rGORD. While no related systematic review has been published, the present study is designed to evaluate the efficacy and safety of acupuncture for rGORD.Methods and analysisPubMed, the Cochrane Central Register of Controlled Trials and Chinese electronic databases, including China National Knowledge Infrastructure, Wan Fang database, VIP, SinoMed and the Chinese Clinical Trial Registry, will be searched from establishment of the database to 31 August 2019. There will be no limitations on language, and all articles will be screened and collected by two reviewers independently. RevMan V.5.3.5 software will be used for meta-analysis, and the conduction of study will refer to the Cochrane Handbook for Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. The efficacy and safety of acupuncture for rGORD will be evaluated based on outcomes, including global symptom improvement, oesophageal sphincter function test measured by high-resolution manometry, quality of life, recurrence rate and adverse events.Ethics and disseminationThere is no necessity for this study to acquire an ethical approval, and this review will be disseminated in a peer-reviewed journal or conference presentation.Trial registration numberCRD42018111912.

Stationary cycling exercise for knee osteoarthritis: A systematic review and meta-analysis

2020 ◽  
pp. 026921552097179
Author(s):  
Lijiang Luan ◽  
Jaquelin Bousie ◽  
Adrian Pranata ◽  
Roger Adams ◽  
Jia Han
Keyword(s):  
Quality Of Life ◽  
Knee Osteoarthritis ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Sport Performance ◽  
Cochrane Library ◽  
Cycling Exercise ◽  
Random Effects Models

Objective: To evaluate effects of stationary cycling exercise on pain, function and stiffness in individuals with knee osteoarthritis. Data sources: Systematic search conducted in seven databases (PubMed, Embase, Cochrane Library, Web of Science, EBSCO, PEDro, and CNKI) from inception to September 2020. Review methods: Included studies were randomized-controlled trials involving stationary cycling exercise conducted on individuals with knee osteoarthritis. End-trial weighted mean difference (WMD) and 95% confidence interval (CI) were analyzed, and random-effects models were used. Methodological quality and risk bias were assessed by using the Physiotherapy Evidence Database scale and Cochrane Collaboration tool, respectively. Results: Eleven studies with 724 participants were found, of which the final meta-analysis was performed with eight. Compared to a control (no exercise), stationary cycling exercise resulted in reduced pain (WMD 12.86, 95% CI 6.90–18.81) and improved sport performance (WMD 8.06, 95% CI 0.92–15.20); although most of the meta-analysis results were statistically significant, improvements in stiffness (WMD 11.47, 95% CI 4.69–18.25), function (WMD 8.28, 95% CI 2.44–14.11), symptoms (WMD 4.15, 95% CI −1.87 to 10.18), daily living (WMD 6.43, 95% CI 3.19 to 9.66) and quality of life (WMD 0.99, 95% CI −4.27 to 6.25) for individuals with knee osteoarthritis were not greater than the minimal clinically important difference values for each of these outcome measures. Conclusions: Stationary cycling exercise relieves pain and improves sport function in individuals with knee osteoarthritis, but may not be as clinically effective for improving stiffness, daily activity, and quality of life.

scholarly journals Efficacy and safety of guselkumab for the treatment of patients with moderate-to-severe plaque psoriasis: A metaanalysis of randomized clinical trials

2020 ◽  
Vol 19 (2) ◽  
pp. 433-440
Author(s):  
Xing-Bao Tao ◽  
Yin-Qiu Huang ◽  
Yi-Hong Zhou ◽  
Lv-Lang Zhang ◽  
Yao-Kai Chen
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Adverse Events ◽  
Plaque Psoriasis ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Double Blind ◽  
Severe Plaque Psoriasis ◽  
Central Registry

Purpose: To conduct a systematic analysis on data from randomized controlled trials (RCTs) on different doses of guselkumab, and provide high-quality evidence for its use in the treatment of patients with moderate-to-severe plaque psoriasis (PsO). Methods: Related studies were searched using online search engines including MEDLINE, PubMed, and central registry of Cochrane controlled trials from January 2001 to October 2017. Only randomized, placebo-controlled, double-blind clinical trials involving guselkumab- and placebo-treated PsO subjects were included. Results: Five eligible double-blind, randomized, and placebo-controlled trials involving patients with moderate-to-severe PsO subjects treated with guselkumab were included. Compared with the placebo groups, the proportion of patients with improvements in Psoriasis Area and Severity Index (PASI) 75 (RR= 12.14; 95% CI= 9.11-16.16; p < 0.001); PASI 90 (RR= 23.26; 95% CI =14.57-37.13; p < 0.001), and PASI 100 (RR = 37.66; 95% CI = 15.81-89.69; p < 0.001) were significantly higher than those in guselkumab-treated groups. Furthermore, the guselkumab-treated groups showed significant decreases in Physician’s Global Assessment (PGA) score (RR = 10.46; 95% CI = 7.96-13.83; p < 0.001) and the Dermatology Life Quality Index (DLQI) score (SMD = -1.3; 95% CL = -1.4 to -1.19; p < 0.001), when compared with the placebo groups. However, there were no significant differences in adverse events (AEs) (RR = 1.01; 95% CL = 0.93-1.11; p > 0.05); severe adverse events (SAEs) (RR = 1.32; 95% CI =0.69-2.54; p > 0.05) and study discontinuations (RR = 0.79; 95% CI = 0.42-1.48; p > 0.05) between the two groups. Conclusion: This meta-analysis summarizes available evidence for the use of guselkumab in psoriasis. The results suggest that guselkumab is superior to placebo in moderate-to-severe psoriasis, and is welltolerated, effective, and safe in improving the severity of disease and quality of life. Keywords: Guselkumab, Effectiveness, Safety, Plaque psoriasis, Meta-analysis, Quality of life

scholarly journals Quality of Life After Coronary Artery Bypass Surgery: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 17 (22) ◽  
pp. 8439
Author(s):  
Jacqueline Schmidt-RioValle ◽  
Moath Abu Ejheisheh ◽  
María José Membrive-Jiménez ◽  
Nora Suleiman-Martos ◽  
Luis Albendín-García ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Public Health Problem ◽  
Good Choice ◽  
Physical Consequences

Coronary heart disease is a public health problem and is one of the leading causes of loss of quality of life, disability, and death worldwide. The main procedure these patients undergo is cardiac catheterisation, which helps improve their quality of life, symptoms of myocardial ischemia, and ventricular function, thus helping increase the survival rate of sufferers. It can also, however, lead to physical consequences, including kidney failure, acute myocardial infarction, and stroke. The objective of this study was to analyse how coronary artery bypass grafting (CABG) influences quality of life. A systematic review and meta-analysis were conducted using the CINAHL, PubMed, Scopus, and Cuiden databases in June 2020. A total of 7537 subjects were included, 16 in the systematic review and 3 in the meta-analysis. The studies analysing quality of life using the SF questionnaire showed improvements in the quality of physical and mental appearance, and those using the NHP questionnaire showed score improvements and, in some cases, differences in quality of life between women and men. This operation seems to be a good choice for improving the quality of life of people with coronary pathologies, once the possible existing risks have been assessed.

scholarly journals Acupuncture methods for allergic rhinitis: a systematic review and bayesian meta-analysis of randomized controlled trials

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Zihan Yin ◽  
Guoyan Geng ◽  
Guixing Xu ◽  
Ling Zhao ◽  
Fanrong Liang
Keyword(s):  
Quality Of Life ◽  
Allergic Rhinitis ◽  
Acupuncture Therapy ◽  
Conventional Medicine ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Effective Intervention ◽  
Manual Acupuncture ◽  
Nasal Symptoms

Abstract Background Allergic rhinitis (AR) is a common symptomatic, inflammatory, and immunological disorder of nasal mucosa. Multiple clinical trials and systematic reviews have implicated acupuncture methods as potentially effective treatment strategies for AR, however, considering the great burden of AR, it is crucial to explore the most recent clinical evidence supporting acupuncture in AR. Besides, the methodologies reported in previous studies as well as those commonly applied during clinical practices greatly vary. Herein, we conducted network meta-analysis to compare the effectiveness of diverse acupuncture methods for AR treatment. Methods We conducted a literature search for relevant reports published from inception to 1 July 2020 in several scientific databases, including PubMed, Embase, Cochrane library, Web of Science, CNKI, WF, VIP, CBM, AMED as well as related registration platforms. Primary outcomes as reported in the identified studies were assessed using nasal symptoms. All Meta-analyses were performed with RevMan, ADDIS, and STATA software. To ensure consistency among our reviewers, the intra-class correlation coefficient was used. Results Exactly 39 studies with 3433 participants were covered in this meta-analysis. The meta-analysis demonstrated that all acupuncture types were superior to sham acupuncture in terms of total nasal symptom score and rhinoconjunctivitis quality of life questionnaire. Moxibustion was recommended as the most effective intervention as it reduced nasal symptoms in 6 treatments. On the other hand, manual acupuncture plus conventional medicine was recommended as the most effective intervention in improving the quality of life in 9 treatments. Notably, moxibustion was recommended as the most effective intervention that changed the content of IgE in 9 treatments. Moreover, adverse events of these interventions were acceptable. Conclusion Our findings revealed that all acupuncture methods are effective and safe for AR. Moreover, either moxibustion or manual acupuncture plus conventional medicine are potentially the most effective treatment strategies for AR. Based on these findings, it is evident that acupuncture therapy is not inferior to pharmacologic therapy. Therefore, for AR patients who are either unresponsive to conventional medicine or are intolerant to adverse events, acupuncture therapy should be administered. However, the quality of these included trials was mainly ranked as moderate quality, we recommend additional well-designed RCTs with larger sample sizes to validate these findings.

scholarly journals Clinical effectiveness of house dust mite immunotherapy in mono- versus poly-sensitised patients with allergic rhinitis: a systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
J.Y. Kim ◽  
D. Hwang ◽  
M. Jang ◽  
C.S. Rhee ◽  
D.H. Han
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Allergic Rhinitis ◽  
House Dust ◽  
House Dust Mite ◽  
Meta Analysis ◽  
Clinical Effectiveness ◽  
Nasal Symptom ◽  
Dust Mite

Selecting an appropriate allergen-specific immunotherapy (AIT) regimen for polysensitised allergic rhinitis (AR) patients is challenging for clinicians. Although previous studies showed comparable effectiveness of single-allergen AIT with house dust mite (HDM) extract between monosensitised and polysensitised AR patients, there is no systematic review and meta-analysis demonstrating the comparable effectiveness of HDM AIT. In this meta-analysis, we analysed nine studies to compare the clinical effectiveness of HDM AIT. The primary outcome was nasal symptom score and secondary outcomes were medication and quality of life scores. The changes in nasal symptom score after HDM AIT did not significantly differ between monosensitised and polysensitised patients. The clinical effectiveness of HDM AIT regarding medication and quality of life score was not significantly different between monosensitised and polysensitised patients). In conclusion, single-allergen AIT with HDM extract showed comparable clinical effectiveness between polysensitised and monosensitised patients with AR.

scholarly journals Omalizumab for the treatment of allergic rhinitis: a systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
S. Tsabouri ◽  
G. Ntritsos ◽  
F. Koskeridis ◽  
E. Evangelou ◽  
P. Olsson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Allergic Rhinitis ◽  
Symptom Severity ◽  
Meta Analysis ◽  
Mean Difference ◽  
Efficacy And Safety ◽  
Symptom Severity Score ◽  
Large Heterogeneity ◽  
Standardized Mean Difference

Background: Allergic rhinitis (AR), an IgE mediated inflammatory disease, significantly impacts quality of life of a considerable proportion of the general population. Omalizumab, a humanized monoclonal antibody against IgE, has been evaluated for both seasonal and perennial AR. We aimed to assess the efficacy and safety of omalizumab in randomized controlled trials (RCTs) in inadequately controlled AR. Methods: We conducted a systematic literature search of RCTs evaluating the safety and efficacy of omalizumab in AR. We synthesized evidence for clinical improvement of AR symptoms, quality of life, reduction of the use of rescue medication, and adverse events. Results: The systematic search returned 289 articles, of which 12 RCTs were eligible for data extraction and meta-analysis. Omalizumab reduced the Daily Nasal Symptom Severity Score (DNSSS) by a summary standardized mean difference of -0.41 points with large heterogeneity; omalizumab significantly reduced the DNSSS both in the 3 cedar pollen-induced AR trials by -0.97 points and to a lower extent in the remaining five non-cedar trials by -0.19 points. Omalizumab also improved the Daily Ocular Symptom Severity Score (DOSSS) by a summary standardized mean difference of -0.30 points with large heterogeneity; the Rhino-conjunctivitis Quality of Life Questionnaire by a summary standardized mean difference of -0.45 points with no heterogeneity and the mean daily consumption of rescue antihistamines by a summary standardized mean difference of -0.21 with large heterogeneity. No statistically significant difference in the occurrence of adverse events was observed between omalizumab and placebo. Conclusion: Our findings further support the efficacy and safety of omalizumab in the management of patients with allergic rhinitis inadequately controlled with a conventional treatment.

Leukotriene Receptor Antagonist Addition to H1-Antihistamine Is Effective for Treating Allergic Rhinitis: A Systematic Review and Meta-analysis

2019 ◽  
Vol 33 (5) ◽  
pp. 591-600 ◽  
Author(s):  
Kachorn Seresirikachorn ◽  
Wirach Chitsuthipakorn ◽  
Dichapong Kanjanawasee ◽  
Likhit Khattiyawittayakun ◽  
Kornkiat Snidvongs
Keyword(s):  
Quality Of Life ◽  
Allergic Rhinitis ◽  
Receptor Antagonist ◽  
Meta Analysis ◽  
Leukotriene Receptor Antagonist ◽  
Ocular Symptoms ◽  
Nasal Symptoms ◽  
Subgroup Analyses ◽  
Leukotriene Receptor

Background Histamine and leukotriene are released after being triggered by allergen exposure. The combination of leukotriene receptor antagonist (LTRA) and H1-antihistamine (AH) is utilized to control the allergic rhinitis (AR) symptoms after the failure of either AH or LTRA. Objective This study aimed to investigate the effects of the combination of H1-antihistamine and leukotriene receptor antagonist (AH-LTRA) in patients with AR. Methods Randomized controlled trials studying the effects of AH-LTRA versus AH alone on rhinoconjuncitivits symptoms in patients with AR were included. Data were pooled for meta-analysis. The outcomes were nasal symptoms, ocular symptoms, disease-specific quality of life, and adverse events. Meta-analyses were performed to compare the outcomes between AH-LTRA and AH. Subgroup analyses by AR subtype, asthma, and pediatric patients were performed. Results Fourteen studies (3271 participants) met the inclusion criteria. The results favored the effects of AH-LTRA on (1) composite nasal symptom score (standardized mean difference [SMD]: −0.20; 95% confidence interval [CI]: −0.36, −0.03), (2) rhinorrhea (SMD: −0.14; 95% CI: −0.27, −0.02), and (3) sneezing (SMD: −0.15; 95% CI: −0.27, −0.02). Subgroup analyses revealed that results favored the effects of AH-LTRA for perennial AR (SMD: −0.57; 95% CI: −0.87, −0.26) but not in the seasonal AR subgroup (SMD: −0.09; 95% CI: −0.21, 0.04), P = .004. There were no differences between AH-LTRA and AH on nasal obstruction, itching, ocular symptoms, Rhinoconjunctivitis Quality of life Questionnaire and adverse events. Due to limited number of included studies, effects on asthma and pediatric subgroups could not be assessed. Conclusion For controlling rhinoconjunctivitis symptoms in patients with AR, AH-LTRA provided greater beneficial effects on composite nasal symptoms, rhinorrhea, and sneezing compared to AH alone. These effects were shown in patients with perennial AR.

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