The efficacy and safety of pulmonary vasodilators in patients with Fontan circulation: a meta-analysis of randomized controlled trials

No previous meta-analysis has evaluated the efficacy and safety of pulmonary vasodilators in Fontan physiology. Recent relative trials have obtained conflicting results regarding improvements in peak oxygen consumption; the relatively small number of patients in each study may be a limiting factor. We aimed to evaluate the efficacy and safety of pulmonary vasodilators in Fontan patients. Relevant studies were identified by searching the PubMed, Embase, and Cochrane Library databases. Pooled outcomes were determined to assess the efficacy and safety of pulmonary vasodilators in Fontan patients. Nine randomized controlled studies involving 381 patients with Fontan circulation were included. Pulmonary vasodilator therapy led to significant improvement (mean difference = −0.39, 95% CI: [−0.72, −0.05]) in the New York Heart Association (NYHA) functional class. The 6-minute walking distance (6MWD) was significantly increased by 134 m (95% CI: [86.07, 181.94]), and the peak VO2 was also significantly improved (mean difference = 1.42 ml·(kg·min)-1, 95% CI: [0.21, 2.63]). Additionally, the mean pulmonary artery pressure (mPAP) was significantly reduced (mean difference = −2.25 mmHg, 95% CI: [−3.00, −1.50]). No significant change was found in mortality or in brain natriuretic peptide (BNP) or N-terminal pronatriuretic peptide (NT-proBNP). Four studies reported no side effects and good drug tolerance, and two studies reported mild adverse effects. The present meta-analysis indicated that pulmonary vasodilators (primarily the PDE-5 inhibitor and endothelin-1 receptor antagonist) significantly improved the hemodynamics of Fontan patients, reduced the NYHA functional class and increased the 6MWD. The peak oxygen consumption was also improved. No significant change was observed in mortality or in the BNP or NT-proBNP level. Overall, the pulmonary vasodilators were well tolerated. This finding needs to be confirmed in future studies.

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EFFECTS OF BOSENTAN ON PEAK OXYGEN CONSUMPTION, HEMODYNAMICS AND FUNCTIONAL CLASS IN FONTAN PATIENTS: A RANDOMIZED, PLACEBO CONTROLLED, DOUBLE BLIND STUDY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(14)60478-2 ◽

2014 ◽

Vol 63 (12) ◽

pp. A478 ◽

Cited By ~ 1

Author(s):

Anders Hedeboe Hebert ◽

Ulla R. Mikkelsen ◽

Ulf Thilen ◽

Lars Idorn ◽

Annette S. Jensen ◽

...

Keyword(s):

Oxygen Consumption ◽

Functional Class ◽

Blind Study ◽

Peak Oxygen Consumption ◽

Double Blind Study ◽

Double Blind ◽

Fontan Patients

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Efficacy and Safety of Adalimumab in Noninfectious Uveitis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Frontiers in Pharmacology ◽

10.3389/fphar.2021.673984 ◽

2021 ◽

Vol 12 ◽

Author(s):

Biao Li ◽

Haoran Li ◽

Li Zhang ◽

Yanlin Zheng

Keyword(s):

Systematic Review ◽

Treatment Failure ◽

Randomized Controlled Trials ◽

Primary Outcome ◽

Meta Analysis ◽

Mean Difference ◽

Controlled Trials ◽

Efficacy And Safety ◽

Randomized Controlled ◽

Risk Of Treatment

Background: Patients with noninfectious uveitis (NIU) are at risk of systemic side effects of long-term glucocorticoid therapy and uncontrolled inflammatory complications. In urgent need to identify more aggressive therapies, adalimumab (ADA) may be the right choice.Objectives: To summarize the current evidence from randomized controlled trials (RCTs) regarding the efficacy and safety of ADA in the treatment of NIU.Methods: We searched Pubmed, Embase, Web of Science, Cochrane Library databases, and Clinical Trials Registry for qualifying articles from their inception to November 19, 2020, with no language restriction. Randomized controlled trials comparing ADA with conventional routine treatment in noninfectious uveitis patients of any age, gender, or ethnicity were included. The primary outcome was the time to treatment failure (TF). The secondary outcomes were the change in best-corrected visual acuity (BCVA), change in the anterior chamber (AC) cell grade, change in vitreous haze (VH) grade, and adverse events (AEs).Main results: The six studies comprised 605 participants in all, and the sample size of each study ranged from 16 to 225. The overall pooled results of the primary outcome (HR = 0.51; 95% CI, 0.41 to –0.63) showed that ADA nearly halved the risk of treatment failure compared to placebo for NIU patients. The pooled mean difference of change in BCVA was -0.05 (95% CI, −0.07 to −0.02). The pooled mean difference of change in AC cell grade and VH grade was −0.29 (95% CI, −0.62 to −0.05) and −0.21 (95% CI, −0.32 to −0.11), respectively. The incidence of AEs in the ADA group was numerically higher than that of AEs in the placebo group (2,237 events and 9.40 events per patient-year, equivalent to 1,257 events and 7.79 events per patient-year).Conclusion: This meta-analysis of six RCTs further confirmed that ADA considerably lowered the risk of treatment failure or visual loss, and moderately reduced AC cell grades and VH grades with slightly more AEs, as compared to placebo. ADA is both effective and safe in treating NIU.Systematic Review Registration: [https://clinicaltrials.gov], identifier [CRD42020217909].

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Effects of Concurrent Training on 1RM and VO2 in Adults: Systematic Review with Meta-analysis

International Journal of Sports Medicine ◽

10.1055/a-1506-3007 ◽

2021 ◽

Author(s):

Pedro Gabriel Pito ◽

Jefferson R. Cardoso ◽

James Tufano ◽

Débora Guariglia

Keyword(s):

Systematic Review ◽

Oxygen Consumption ◽

Strength Training ◽

Aerobic Training ◽

Meta Analysis ◽

Lower Limbs ◽

Peak Oxygen Consumption ◽

Concurrent Training ◽

Strength Development ◽

Randomized Controlled

AbstractThe purpose of this systematic review was to analyze the effects of concurrent training on one repetition maximum (1RM), maximum oxygen consumption (VO2max), and peak oxygen consumption (VO2peak) in healthy adults. The review followed PRISMA recommendations using randomized controlled trials in nine databases. Twenty-one studies met the inclusion criteria, totaling a sample of 796 subjects to perform the meta-analysis. As result, concurrent training provides similar increases in 1RM as strength training for upper limbs (standardized mean difference [SMD]: 0.12; 95% IC: [−0.18; 0.41]; p=0.43) and for the lower limbs (SMD: −0.32; 95% IC: [−0.79; 0.15]; p=0.19). Similarly, no difference was found in the aerobic capacity between the concurrent training vs. aerobic training groups ([SMD – VO2max]: −0.19; 95% IC: [−0.71; 0.33]; p=0.48 and [SMD – VO2peak]: −0.24; 95% IC: [−0.57; 0.08]; p=0.14). Based on the results found, we can affirm that a) similar to strength training, concurrent training provides maximum strength development for upper and lower limbs; and b) cardiorespiratory capacity is not impaired by concurrent training in relation to aerobic training, demonstrating the compatibility of the two training sessions.

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