scholarly journals The effect of monoamine oxidase-B inhibitors on the alleviation of depressive symptoms in Parkinson’s disease: meta-analysis of randomized controlled trials

2021 ◽  
Vol 11 ◽  
pp. 204512532098599
Author(s):  
Yao Hsien Huang ◽  
Jia Hung Chen ◽  
El Wui Loh ◽  
Lung Chan ◽  
Chien Tai Hong
Keyword(s):  
Depressive Symptoms ◽  
Early Stage ◽  
Meta Analysis ◽  
Term Treatment ◽  
Monoamine Oxidase B ◽  
Controlled Trials ◽  
Short Term ◽  
Randomized Controlled ◽  
Long Term Treatment

Background: Depression is a major nonmotor symptom of Parkinson’s disease (PD). However, few treatments exist for PD depression. Monoamine oxidase-B inhibitors (MAOB-Is) provide symptomatic relief for the motor symptoms of PD and exert antidepressive effects. The present meta-analysis of randomized controlled trials (RCTs) investigated the effects of MAOB-Is on depressive symptoms in patients with PD. Methods: Articles on PD-management-related RCTs using one of three MAOB-Is approved by the US Food and Drug Administration, that is, selegiline, rasagiline, and safinamide, were identified. The primary outcomes were the benefits of MAOB-Is for depressive symptoms. Subgroup analysis included the effects of MAOB-Is on patients in the early versus middle-to-late stages of PD and the effect of short-term versus long-term treatment. Results: Overall, six studies were included, four of which were conducted on patients with early stage PD. Overall, MAOB-Is significantly reduced the severity of depressive symptoms [standardized mean difference (SMD): −0.14, 95% confidence interval (CI): −0.21 to −0.06, p < 0.001]. Subgroup analysis indicated that the positive effect of MAOB-Is was significant in patients with early stage PD (SMD: −0.20, 95% CI: −0.31 to −0.09, p < 0.001), but not in those with middle-to-late-stage PD (SMD: −0.07, 95% CI: −0.17 to 0.03, p = 0.18). The antidepressive effect was significant for short-term treatment, that is, 90–120 days (SMD: −0.23, 95% CI: −0.35 to −0.10, p < 0.001), but not long-term treatment, that is, 24 weeks to 18 months (SMD: −0.08, 95% CI: −0.18 to 0.01, p = 0.09). Conclusion: In addition to the treatment of PD motor symptoms, MAOB-Is may help reduce the severity of depressive symptoms in PD, especially in patients with early stage PD. Considering the tolerability and simultaneous benefits of MAOB-Is, further RCTs are warranted to confirm their therapeutic effects in moderate-to-severe PD depression.

Glucosamine Long-Term Treatment and the Progression of Knee Osteoarthritis: Systematic Review of Randomized Controlled Trials

2005 ◽  
Vol 39 (6) ◽  
pp. 1080-1087 ◽  
Author(s):  
Nalinee Poolsup ◽  
Chutamanee Suthisisang ◽  
Patchareeya Channark ◽  
Wararat Kittikulsuth
Keyword(s):  
Knee Osteoarthritis ◽  
Disease Progression ◽  
Term Treatment ◽  
Glucosamine Sulfate ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Knee Oa ◽  
Randomized Controlled ◽  
Long Term Treatment

OBJECTIVE: To investigate the structural and symptomatic efficacy and safety of glucosamine in knee osteoarthritis (OA). DATA SOURCES: Clinical trials of glucosamine were identified through electronic searches (MEDLINE, EMBASE, BIOSIS, EMB review, the Cochrane Library) using the key words glucosamine, osteoarthritis, degenerative joint disease, degenerative arthritis, osteoarthrosis, gonarthrosis, knee, disease progression, and clinical trial. The bibliographic databases were searched from their respective inception dates to August 2004. We also hand-searched reference lists of relevant articles. STUDY SELECTION AND DATA EXTRACTION: Studies were included if they were double-blind, randomized, controlled trials that evaluated oral glucosamine long-term treatment in knee OA; lasting at least one year; and reporting as outcome measures the symptom severity and disease progression as assessed by joint space narrowing. Two authors interpreted data independently. Disagreements were resolved through discussion. DATA SYNTHESIS: Glucosamine sulfate was more effective than placebo in delaying structural progression in knee OA. The risk of disease progression was reduced by 54% (pooled RR 0.46; 95% CI 0.28 to 0.73; p = 0.0011). The number-needed-to-treat was 9 (95% CI 6 to 20). The pooled effect sizes for pain reduction and improvement in physical function were 0.41 (95% CI 0.21 to 0.60; p < 0.0001) and 0.46 (95% CI 0.27 to 0.66; p < 0.0001), respectively, in favor of glucosamine sulfate. Glucosamine sulfate caused no more adverse effects than placebo. CONCLUSIONS: The available evidence suggests that glucosamine sulfate may be effective and safe in delaying the progression and improving the symptoms of knee OA. Due to the sparse data on structural efficacy and safety, further studies are warranted.

scholarly journals High-dose N-acetylcysteine for long-term, regular treatment of early-stage chronic obstructive pulmonary disease (GOLD I–II): study protocol for a multicenter, double-blinded, parallel-group, randomized controlled trial in China

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Heshen Tian ◽  
Yumin Zhou ◽  
Longhui Tang ◽  
Fan Wu ◽  
Zhishan Deng ◽  
...  
Keyword(s):  
Early Stage ◽  
Controlled Trial ◽  
Term Treatment ◽  
Chronic Obstructive ◽  
High Dose ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled ◽  
Long Term Treatment ◽  
Double Blinded

Abstract Introduction The presence of increased oxidative stress and airway inflammation has been proven in subjects with chronic obstructive pulmonary disease (COPD). Several studies have demonstrated that drugs with antioxidant and anti-inflammatory properties such as N-acetylcysteine (NAC) can reduce the rate of exacerbations in patients with COPD. However, the beneficial effects of NAC in early-stage COPD are minimally discussed. We are investigating whether high-dose NAC has therapeutic effects in Chinese patients with early-stage COPD. Method and analysis A randomized, double-blinded, placebo-controlled, parallel-group, multicenter clinical trial is evaluating the efficacy and safety of NAC for the long-term treatment of patients with early-stage COPD at 24 centers in China. Subjects aged 40–80 years and recruited by physicians or researchers with special training will be randomized to either NAC 600 mg twice daily group or matching placebo group for 2 years. Measurements will include forced expiratory volume in 1 s (FEV1), the number of COPD exacerbations, health-related quality, and pharmacoeconomic analysis. Discussion Currently, there are no randomized controlled trials with high-dose N-acetylcysteine (600 mg twice daily) for patients with mild-to-moderate COPD (GOLD I–II). We designed this multicenter randomized controlled trial (RCT) to assess the effectiveness, safety, and cost-effectiveness of long-term treatment with high-dose N-acetylcysteine. The results of this trial may guide clinical practice and change the standard of early COPD management. Trial registration Chinese Clinical Trial Registry ChiCTR-IIR-17012604. Registered on 07 September 2017.

scholarly journals POS1099 EFFICACY OF INTRA-ARTICULAR CORTICOSTEROID INJECTIONS IN KNEE OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 829.2-830
Author(s):  
A. Najm ◽  
A. Alunno ◽  
C. Weill ◽  
J. Gwinnutt ◽  
F. Berenbaum
Keyword(s):  
Knee Osteoarthritis ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Medium Term ◽  
Short Term ◽  
Knee Oa ◽  
Randomized Controlled ◽  
And Function

Background:Knee osteoarthritis (OA) is a frequent degenerative disease representing an important health and economic burden. Symptomatic medical treatments available include intra-articular (IA) injections of corticosteroids (GC) but their efficacy is debated. In addition, safety signals regarding cartilage damage with IA GC have been highlighted in a few studies.Objectives:To perform a meta-analysis of studies assessing IA GC efficacy and safety in knee OA.Methods:A systematic literature review and a meta-analysis of randomized controlled trials (RCTs) assessing the effect of GC IA injections versus other interventions (IA Hyaluronic Acid, IA placebo, IA NSAID, oral NSAID or physiotherapy) in knee OA was performed. The effect of the interventions on pain and function were extracted from the single studies and pooled and are presented as short term (<6weeks), medium term (6-24 weeks) and long term (>24 weeks) follow-up period. Standardized mean differences (SMD) are reported.Results:Of 520 studies screened, 23 were included in the SLR and 14 subsequently included in the MA. While IA GC showed a superior effect compared to control on both pain (SMD -0.61 (95% CI -1,25, 0.03)) and function (SMD -1.02 (95% CI -2.14, 0.10)) in short term follow-up; long term follow-up analysis favored controls (IA HA, IA NSAID, physiotherapy) for both pain (SMD 0.68 (95% CI -0.11, 1.47)) and function (SMD 0.88 (95% CI -0.36, 2.12) outcomes (Figure 1). No difference was found between interventions in the medium term. Safety data were reported in 18/23 studies (n= 1936/2314 patients); and side effects were reported as follows: arthralgia (69 IA GC patients, 146 IA HA patients, and 20 saline patients); site injection pain (7 in the IA GC group, 2 in the IA saline group, 14 in the IA HA group); 16 post injection knee swelling without signs of septic arthritis in the IA GC group and 24 in the IA HA group. In one study assessing cartilage effects of GCs, the rate of cartilage loss was greater in the GC group with a reduction of cartilage thickness at 2 year compared to placebo group. No difference was observed in the progression of cartilage denudation or bone marrow lesion. On the contrary, another study showed no effect of injections on the cartilage structure.Conclusion:We demonstrate in this work that IA GC injections reduce pain and improve function in the early phase (≤6 weeks) of treatment. In the long term (≥24 weeks), other intervention such as IA HA injections or physiotherapy seem to be more efficient, but this effect was largely driven by single studies with large effect sizes and the comparators were heterogeneous.Figure 1.Knee pain outcome at short term (≤6weeks) (A), medium term (>6 & <24 weeks) (B), and long term (≥24 weeks) (C) follow up.Disclosure of Interests:None declared.

scholarly journals Intravitreal corticosteroids for diabetic macular edema: a network meta-analysis of randomized controlled trials

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lu Gao ◽  
Xu Zhao ◽  
Lei Jiao ◽  
Luosheng Tang
Keyword(s):  
Confidence Interval ◽  
Randomized Controlled Trials ◽  
Macular Edema ◽  
Diabetic Macular Edema ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Short Term ◽  
Randomized Controlled

Abstract Background To evaluate the efficacy and safety of different intravitreal corticosteroids for treating diabetic macular edema (DME). Methods Four databases were systematically searched for randomized controlled trials comparing different intravitreal corticosteroids for treating DME. The primary outcome was the change in best-corrected visual acuity (BCVA) within 6 months after the first injection (short-term BCVA). Secondary outcomes were the change in BCVA over 1 year (long-term BCVA) and changes in central macular thickness (CMT) and intraocular pressure (IOP) within 6 months after the first injection. Network meta-analysis was performed to aggregate the results from the individual studies. Results Nineteen trials involving 2839 eyes were included. Intravitreal triamcinolone acetonide (TA) injections (≥ 8 mg and 4–8 mg), fluocinolone acetonide (FA) implants (0.5 µg/day) and dexamethasone (DEX) implants (700 µg) improved short-term BCVA (mean changes in logMAR [95% confidence interval] − 0.27 [− 0.40, − 0.15]; − 0.12 [− 0.18, − 0.06]; − 0.10 [− 0.21, − 0.01]; and − 0.06 [− 0.11, − 0.01]). Intravitreal TA injections (4 mg, multiple times), FA implants (0.5 µg/day and 0.2 µg/day), and DEX implants (350 µg) improved long-term BCVA (mean changes in logMAR [95% confidence interval] − 0.11 [− 0.21, − 0.02]; − 0.09 [− 0.15, − 0.03]; − 0.09 [− 0.14, − 0.02]; and − 0.04 [− 0.07, − 0.01]). All intravitreal corticosteroids reduced CMT, and different dosages of TA did not show significant differences in increasing IOP. Conclusions Intravitreal corticosteroids effectively improved BCVA in DME patients, with higher dosages showing greater efficacies. TA was not inferior to FA or DEX and may be considered a low-cost alternative choice for DME patients. The long-term efficacy and safety of different corticosteroids deserve further investigation. Trial registration Prospectively registered: PROSPERO, CRD42020219870

scholarly journals Metabolic side effects of antipsychotic drugs in individuals with schizophrenia during medium- to long-term treatment: protocol for a systematic review and network meta-analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Johannes Schneider-Thoma ◽  
Angelika Kapfhammer ◽  
Dongfang Wang ◽  
Irene Bighelli ◽  
Spyridon Siafis ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Antipsychotic Drugs ◽  
Meta Analysis ◽  
Density Lipoprotein ◽  
Term Treatment ◽  
Controlled Trials ◽  
Metabolic Side Effects ◽  
Long Term Treatment

Abstract Background Antipsychotic drugs and especially the newer compounds are known to cause metabolic side effects. However, a comprehensive comparison of the different substances regarding their propensity to cause metabolic side effects in medium- to long-term treatment of schizophrenia is lacking. Methods We will conduct a systematic review and network meta-analysis (NMA). We will include randomized controlled trials (RCTs) in which participants received either placebo or an antipsychotic (i.e. placebo-controlled trials and head-to-head comparisons of drugs). We will include studies in individuals with schizophrenia or related disorders (such as schizophreniform or schizoaffective disorders) at any stage of the disease (acute episode; maintenance phase). We will include studies with a duration of more than 3 months (medium- to long-term treatment). The primary outcome will be the change in body weight. Secondary outcomes will be the further metabolic parameters: fastening glucose, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides. We will search for eligible studies (independent of the publication status) in Cochrane Schizophrenia Group’s Study-Based Register of Trials, which is compiled by regular searches in trial registries and multiple electronic databases from their inception onwards including MEDLINE, EMBASE and PsycINFO. Additionally, we will search previously published systematic reviews and websites of pharmaceutical companies for eligible studies. At least two reviewers will independently conduct the process of study selection and data extraction. We will use the Cochrane Risk of Bias 2 tool to evaluate the risk of bias in studies. We will conduct random-effects NMA within a Bayesian framework to synthesize all evidence for each outcome. We will conduct sensitivity and subgroup analyses to assess the robustness of the findings and to explore heterogeneity. The confidence in the results will be evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework. Discussion This systematic review and network meta-analysis will provide a synthesis of the existing evidence from RCTs how antipsychotic drugs differ in terms of metabolic side effects during medium- to long-term treatment. The findings have the potential to influence the choice of antipsychotic medication made by individuals with schizophrenia and their physicians. Systematic review registration PROSPERO CRD42020175414

scholarly journals The therapeutic potential of etoricoxib in clinical practice

2020 ◽  
Vol 14 (1) ◽  
pp. 108-117 ◽  
Author(s):  
A. E. Karateev
Keyword(s):  
Large Scale ◽  
Therapeutic Potential ◽  
Meta Analysis ◽  
Gouty Arthritis ◽  
Term Treatment ◽  
Gastrointestinal Complications ◽  
Randomized Controlled ◽  
Long Term Treatment ◽  
Inflammatory Drugs

Etoricoxib is one of the most popular representatives of a group of nonsteroidal anti-inflammatory drugs (NSAIDs), which is widely used in Russia and other countries of the world. It is a highly selective cyclooxygenase 2 inhibitor that has a rapid and pronounced analgesic effect, a high antiinflammatory potential, and an ability to affect the development of central sensitization, one of the central mechanisms for chronic pain. The therapeutic potential and safety of etoricoxib have been extensively tested in numerous large-scale randomized controlled trials (RCTs). It has proven to be an effective agent for relief of acute pain (including that in dental practice) and acute gouty arthritis, for long-term treatment of rheumatoid arthritis, ankylosing spondylitis (AS), and osteoarthritis (OA). A meta-analysis of a series of RCTs suggests that etoricoxib may be a more effective analgesic drug for AS and OA than other NSAIDs. Etoricoxib significantly less frequently cause gastrointestinal complications than non-selective NSAIDs. The cardiovascular risk associated with etoricoxib is not higher than that with non-selective NSAIDs such as diclofenac.

The effects of counterforce brace on pain in subjects with lateral elbow tendinopathy: A systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 44 (5) ◽  
pp. 341-354
Author(s):  
Saeed Shahabi ◽  
Kamran Bagheri Lankarani ◽  
Seyed Taghi Heydari ◽  
Maryam Jalali ◽  
Sulmaz Ghahramani ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Meta Analysis ◽  
Mean Difference ◽  
Controlled Trials ◽  
Short Term ◽  
Randomized Controlled ◽  
Lateral Elbow ◽  
Standardized Mean Difference ◽  
Lateral Elbow Tendinopathy

Background: Lateral elbow tendinopathy, also known as “tennis elbow” or “lateral epicondylitis,” is a common disease leading to pain in the lateral side of the elbow and disability during hand gripping. A counterforce brace is one of the most conventional treatments. However, its effects on outcomes remain inconclusive. Objectives: To investigate the effects of counterforce braces on pain in subjects with lateral elbow tendinopathy. Grip strength was reviewed as a secondary outcome. Study design: Systematic review and meta-analysis of randomized controlled trials. Methods: PubMed, Embase, Scopus, Web of Science, CENTRAL, PEDro, ProQuest, RECAL, and RehabData were searched from January 1, 1995, through June 15, 2019. Results: Seventeen studies were included with a total of 1145 participants. A small improvement in pain over the short term (standardized mean difference −0.02; 95% confidence interval: −0.85 to 0.80) and a moderate-to-large improvement in pain in subjects 45 years or younger (standardized mean difference −0.86; 95% confidence interval: −2.45 to 0.72) in favor of the brace versus physiotherapy interventions were found. In contrast, over the long-term physiotherapy interventions (standardized mean difference 1.17; 95% confidence interval: −0.00 to 2.34), wrist splint (standardized mean difference 0.35; 95% confidence interval: −0.07 to 0.76), and laser therapy (standardized mean difference 0.58; 95% confidence interval: −0.44 to 1.59) had better effects on pain improvement versus the brace. Conclusion: The results indicated that physiotherapy interventions compared to counterforce braces have better effects, especially over the long-term. However, counterforce braces may have better effects on pain in younger people (<45 years old) over the short term (<6 weeks). Clinical relevance The results suggest that counterforce bracing is a reasonable strategy to alleviate pain over the short term. However, the subgroup analysis suggests that factors such as age may have a role in their effectiveness.

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