scholarly journals Efficacy of Same-Day Vs. Next-Day Pegfilgrastim for the Prevention of Chemotherapy-Induced (Febrile) Neutropenia (CIN/FN): A Meta-Analysis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4764-4764
Author(s):  
Reem Diri ◽  
Ali McBride ◽  
Christopher Lee ◽  
Alaa Bagalagel ◽  
Hussain Bakhsh ◽  
...  
Keyword(s):  
Dose Reduction ◽  
Standard Error ◽  
Comparative Studies ◽  
Meta Analysis ◽  
Time Lag ◽  
Weighted Mean ◽  
Nccn Guidelines ◽  
Pubmed Search ◽  
Chemotherapy Dose ◽  
Meta Analyses

Abstract Introduction: CIN/FN is a major dose-limiting toxicity of many cancer chemotherapy (CTX) regimens. CIN/FN may require hospitalization, increase monitoring requirements and diagnostic and treatment costs, and reduce patient quality of life. Myeloid growth factors such as filgrastim or pegfilgrastim have been shown to reduce the incidence and severity of neutropenic complications. International guidelines recommend that pegfilgrastim be administered once per cycle 24-72 hours after chemotherapy, though recent NCCN guidelines mention the option of same-day administration. From the patients' perspective, the time lag is potentially cumbersome because of the need for additional visits. Several studies varying in design and outcomes have evaluated same-day administration of pegfilgrastim compared to standard (next-day) administration 24-72 hours after completion of the CTX cycle. Purpose: To conduct a meta-analysis of studies of same-day vs. next-day pegfilgrastim administration in terms of the incidence of (1) Grade 4 CIN during cycle 1 of CTX and (2) CTX dose reduction in subsequent CTX cycles. Methods: We performed a search for same-day administration of pegfilgrastim using PubMed search engines to complement investigators' familiarity with the literature. Considering heterogeneity (I2) across studies, random-effects meta-analyses were used to quantify pooled estimates of relative risk (RR), taking into account both within- (standard error) and between-study variance (τ2) using the DerSimonian and Laird method. Z-scores (weighted mean divided by the standard error of the weighted mean) and associated p-values (testing against the null hypothesis of RR = 1.0) quantified the precision of pooled RRs across studies. All analyses were performed using StataMP 14 (College Station, Texas, USA). Results: There were8 comparative studies with data on Grade 4 neutropenia that included a total of 446 patients treated the same day and 697 patients treated next day (Figure 1). Patients treated with pegfilgrastim on the same day after the first cycle of chemotherapy were equally likely to develop Grade 4 neutropenia as those treated the next day (RR = 1.13, 95% CI 0.87-1.47, p =0.371; I2 =54.1%, p=0.033). There were 8 comparative studies with data on chemotherapy dose reduction that included a total of 414 patients treated the same day and 428 patients treated next day (Figure 2). Patients treated with pegfilgrastim on the same day were equally likely to require a reduction in chemotherapy dose compared with those treated the next day (RR = 0.97, 95% CI 0.68-1.39, p =0.863; I2 =62.7%, p=0.009). Conclusion: The incidence of Grade 4 neutropenia and CTX dose reduction in patients receiving same-day pegfilgrastim were equal to those undergoing standard administration. To be confirmed through controlled studies, same-day administration of pegfilgrastim can be considered in the prophylaxis of CIN/FN in patients receiving myelotoxic CTX. Figure 1. Figure 1. Figure 2. Figure 2. Disclosures McBride: Janssen Scientific Affairs, LLC: Consultancy. Persky:Gilead Sciences, Inc: Speakers Bureau.

scholarly journals A Statistical Method for Synthesizing Meta-Analyses

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Liansheng Larry Tang ◽  
Michael Caudy ◽  
Faye Taxman
Keyword(s):  
Statistical Method ◽  
Effect Size ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Weighted Mean ◽  
Summary Effect ◽  
Different Types ◽  
Meta Analyses ◽  
Size Estimates ◽  
Similar Search

Multiple meta-analyses may use similar search criteria and focus on the same topic of interest, but they may yield different or sometimes discordant results. The lack of statistical methods for synthesizing these findings makes it challenging to properly interpret the results from multiple meta-analyses, especially when their results are conflicting. In this paper, we first introduce a method to synthesize the meta-analytic results when multiple meta-analyses use the same type of summary effect estimates. When meta-analyses use different types of effect sizes, the meta-analysis results cannot be directly combined. We propose a two-step frequentist procedure to first convert the effect size estimates to the same metric and then summarize them with a weighted mean estimate. Our proposed method offers several advantages over existing methods by Hemming et al. (2012). First, different types of summary effect sizes are considered. Second, our method provides the same overall effect size as conducting a meta-analysis on all individual studies from multiple meta-analyses. We illustrate the application of the proposed methods in two examples and discuss their implications for the field of meta-analysis.

scholarly journals Outcomes and Complications After Primary Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis for Superior Labral Anterior-Posterior Tears or Biceps Abnormalities: A Systematic Review and Meta-analysis

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094532
Author(s):  
Zi Jun Deng ◽  
Clark Yin ◽  
Joseph Cusano ◽  
Hussein Abdul-Rassoul ◽  
Emily J. Curry ◽  
...  
Keyword(s):  
Systematic Review ◽  
Constant Score ◽  
Meta Analysis ◽  
Complication Rates ◽  
Biceps Tenodesis ◽  
Weighted Mean ◽  
Meta Analyses ◽  
Subpectoral Biceps Tenodesis ◽  
Popeye Deformity ◽  
Anterior Posterior

Background: Biceps tenodesis is a surgical treatment for both superior labral anterior-posterior (SLAP) tears and long head of the biceps tendon (LHBT) abnormalities. Biceps tenodesis can be performed either above or below the pectoralis major tendon with arthroscopic or open techniques. Purpose: To analyze the outcomes and complications comparing primary arthroscopic suprapectoral versus open subpectoral biceps tenodesis for either SLAP tears or LHBT disorders. Study Design: Systematic review; Level of evidence, 4. Methods: A search strategy based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) protocol was used to include 18 articles (471 patients) from a total of 974 articles identified. Overall exclusion criteria included the following: non–English language, non–full text, biceps tenodesis with concomitant rotator cuff repair, review articles, meta-analyses, and case reports. Data were extracted and analyzed according to procedure type and tenodesis location: arthroscopic suprapectoral biceps tenodesis (295 patients) versus open subpectoral bicepts tenodesis (176 patients). Results: For arthroscopic suprapectoral biceps tenodesis, the weighted mean American Shoulder and Elbow Surgeons (ASES) score was 90.0 (97 patients) and the weighted mean Constant score was 88.7 (108 patients); for open subpectoral biceps tenodesis, the mean ASES score was 91.1 (199 patients) and mean Constant score was 84.7 (65 patients). Among the 176 patients who underwent arthroscopic biceps tenodesis, there was an overall complication rate of 9.1%. Among the 295 patients who underwent open biceps tenodesis, there was an overall complication rate of 13.5%. Both residual pain (5.7% vs 4.7%, respectively) and Popeye deformity (1.7% vs 1.0%, respectively) rates were similar between the groups. Open subpectoral biceps tenodesis had higher reoperation (3.0% vs 0.0%, respectively), wound complication (1.0% vs 0.0%, respectively), and nerve injury (0.7% vs 0.0%, respectively) rates postoperatively. A meta-analysis of 3 studies demonstrated that both methods had similar ASES scores ( P = .36) as well as all-cause complication rates (odds ratio, 0.76 [95% CI, 0.13-4.48]; P = .26). Conclusion: Patients undergoing arthroscopic suprapectoral biceps tenodesis for either SLAP tears or LHBT abnormalities had similar outcome scores and complication rates compared with those undergoing open subpectoral biceps tenodesis. Additionally, both residual pain and Popeye deformity rates were similar between the 2 groups.

scholarly journals IMMU-02. CH14.18 IN THE TREATMENT OF HIGH-RISK NEUROBLASTOMA: A META-ANALYSIS

2021 ◽  
Vol 23 (Supplement_1) ◽  
pp. i27-i27
Author(s):  
Sameerah Abdel-Khaleq ◽  
Lina Alim ◽  
Atholl Johnston ◽  
Khloud Adam
Keyword(s):  
High Risk ◽  
Effect Size ◽  
Standard Error ◽  
Meta Analysis ◽  
Combined Effect ◽  
Bibliographic Databases ◽  
Survival Outcomes ◽  
Weighted Mean ◽  
Term Survival ◽  
And Control

Abstract High-risk neuroblastoma (HRNB) is a rare malignancy that mainly affects young children. Long-term survival remains low despite aggressive, multimodal treatment regimens. The aim is to assess the effect of Ch14.18, a novel anti-GD2 antibody, on survival in HRNB. In this meta-analysis, Pubmed/MEDLINE, EMBASE, Cochrane CENTRAL and Clinicaltrials.gov bibliographic databases were searched from inception to 1st July 2018. Prospective or retrospective interventional clinical trials with at least two arms or observational cohort or case-control studies were eligible. Participants had to have HRNB. Ch14.18 was the intervention of choice. Any control, comparator treatments were accepted. Studies were appraised for inclusion by two independent reviewers. Data was extracted from published reports. Primary outcomes assessed were Event-Free Survival (EFS) and Overall Survival (OS) and presented as Weighted Mean EFS (%) ± Standard Error (SE) and Weighted Mean OS (%) ± Standard Error (SE), respectively. Combined effect size was elicited for EFS±SE and OS±SE. The search yielded 367 results of which 7 studies conducted on 1727 patients were eligible for inclusion. The weighted mean EFS±SE for Ch14.18 regimens (n=779) and control regimens (n=787) were 55.6±2.0% and 41.2±1.7%, respectively. The weighted mean OS±SE for Ch14.18 regimens (n=430) and control regimens (n=348) were 63.4±2.3% and 53.6±2.7%, respectively. Results of the meta analysis yielded statistical power >94%. The combined effect size of Ch14.18 regimens for EFS±SE was 0.2907±0.05 [95% CI: 0.19–0.39, p<0.001] and the combined effect size for OS±SE was 0.26±0.07 [95% CI: 0.11- 0.4, p<0.001]. Significant superior survival outcomes were achieved with the use of Ch14.18 in the treatment of HRNB. These findings support using Ch14.18 as an adjunct in maintenance therapy in high-risk neuroblastoma. This meta analysis is the first of its kind. Survival outcomes are to be interpreted with caution due to confounding bias.

scholarly journals Overall survival and adverse events after treatment with darolutamide vs. apalutamide vs. enzalutamide for high-risk non-metastatic castration-resistant prostate cancer: a systematic review and network meta-analysis

2021 ◽  
Author(s):  
Mike Wenzel ◽  
Luigi Nocera ◽  
Claudia Collà Ruvolo ◽  
Christoph Würnschimmel ◽  
Zhe Tian ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
High Risk ◽  
Meta Analysis ◽  
Castration Resistant Prostate Cancer ◽  
Castration Resistant ◽  
Pubmed Search ◽  
Grade 3 ◽  
Meta Analyses

Abstract Background The most recent overall survival (OS) and adverse event (AE) data have not been compared for the three guideline-recommended high-risk non-metastatic castration-resistant prostate cancer (nmCRPC) treatment alternatives. Methods We performed a systematic review and network meta-analysis focusing on OS and AE according to the most recent apalutamide, enzalutamide, and darolutamide reports. We systematically examined and compared apalutamide vs. enzalutamide vs. darolutamide efficacy and toxicity, relative to ADT according to PRISMA. We relied on PubMed search for most recent reports addressing prospective randomized trials with proven predefined OS benefit, relative to ADT: SPARTAN, PROSPER, and ARAMIS. OS represented the primary outcome and AEs represented secondary outcomes. Results Overall, data originated from 4117 observations made within the three trials that were analyzed. Regarding OS benefit relative to ADT, darolutamide ranked first, followed by enzalutamide and apalutamide, in that order. In the subgroup of PSA-doubling time (PSA-DT) ≤ 6 months patients, enzalutamide ranked first, followed by darolutamide and apalutamide in that order. Conversely, in the subgroup of PSA-DT 6–10 months patients, darolutamide ranked first, followed by apalutamide and enzalutamide, in that order. Regarding grade 3+ AEs, darolutamide was most favorable, followed by enzalutamide and apalutamide, in that order. Conclusion The current network meta-analysis suggests the highest OS efficacy and lowest grade 3+ toxicity for darolutamide. However, in the PSA-DT ≤ 6 months subgroup, the highest efficacy was recorded for enzalutamide. It is noteworthy that study design, study population, and follow-up duration represent some of the potentially critical differences that distinguish between the three studies and remained statistically unaccounted for using the network meta-analysis methodology. Those differences should be strongly considered in the interpretation of the current and any network meta-analyses.

DERIVING TREATMENT RECOMMENDATIONS FROM EVIDENCE WITHIN RANDOMIZED TRIALS The Role and Limitation of Meta-Analysis

1999 ◽  
Vol 15 (2) ◽  
pp. 304-315 ◽  
Author(s):  
Nick Freemantle ◽  
James Mason ◽  
Martin Eccles
Keyword(s):  
Meta Analysis ◽  
Development Project ◽  
Weighted Mean ◽  
The North ◽  
Guidelines Development ◽  
Substantial Investment ◽  
Mean Differences ◽  
Meta Analyses ◽  
Robust Measures ◽  
Choice Of Therapy

Meta-analysis is commonly used in reviews of the effectiveness of medical technologies, but this approach has not been used in direct support of guidelines development groups. This paper describes the approach of the North of England Guidelines Development Project in describing the evidence using meta-analyses that were conducted explicitly to address questions on the choice of therapy raised by the guidelines development groups. Particular emphasis is placed on the context within which the contributing trials were conducted and the extent to which systematic differences between trials (heterogeneity) was observed, described, and explained. There is a trade-off between internal and external validity for different metrics when presenting the results of trials. More interpretable metrics, such as risk differences or weighted mean differences, are confounded by study design issues and strong assumptions. More robust measures such as odds ratios or standardized weighted mean differences are difficult to interpret physically. Individual patient data may prove particularly helpful in addressing pivotal questions on the magnitude of effects of interventions, though accessing and reanalyzing these data requires a substantial investment in time and other resources.

scholarly journals Cryotherapy for Prevention of Taxane-Induced Peripheral Neuropathy: A Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Junting Jia ◽  
Yimeng Guo ◽  
Raghav Sundar ◽  
Aishwarya Bandla ◽  
Zhiying Hao
Keyword(s):  
Peripheral Neuropathy ◽  
Dose Reduction ◽  
Large Scale ◽  
Meta Analysis ◽  
Gynecological Cancer ◽  
Sensory Neuropathy ◽  
Motor Neuropathy ◽  
Motor Nerves ◽  
Chemotherapy Dose

PurposeTaxanes are widely used in gynecological cancer therapy, however, taxane-induced peripheral neuropathy (TIPN) limits chemotherapy dose and reduces patients’ quality of life. As a safe and convenient intervention, cryotherapy has been recommended as a promising intervention in the recent clinical guidelines for the prevention of TIPN. Although there are a considerable number of studies which explored the use of cryotherapy in preventing chemotherapy-induced peripheral neuropathy (CIPN), there is insufficient large-scale clinical evidence. We performed a meta-analysis on the current available evidence to examine whether cryotherapy can prevent TIPN in cancer patients receiving taxanes.MethodsWe searched databases including PubMed, Embase, and Cochrane from inception to August 3, 2021 for eligible trials. Clinical trials that examined the efficacy of cryotherapy for prevention of TIPN were included. The primary outcome was the incidence of TIPN, and secondary outcomes were incidence of taxane dose reduction and changes in nerve conduction studies. The meta-analysis software (RevMan 5.3) was used to analyze the data.ResultsWe analyzed 2250 patients from 9 trials. Assessments using the Common Terminology Criteria for Adverse Events (CTCAE) score showed that cryotherapy could significantly reduce the incidence of motor and sensory neuropathy of grade≥2 (sensory: RR 0.65, 95%CI 0.56 to 0.75, p<0.00001; motor: RR 0.18, 95% CI [0.03, 0.94], p=0.04). When evaluated using the Patient Neuropathy Questionnaire (PNQ), cryotherapy demonstrated significant reduction in the incidence of sensory neuropathy (RR 0.11, 95% CI 0.04 to 0.31], p<0.0001), but did not show significant reduction in the incidence of motor neuropathy (RR 0.46, 95% CI 0.11 to 1.88, p=0.28). Cryotherapy was associated with reduced incidences of taxane dose reduction due to TIPN (RR 0.48, 95% CI [0.24, 0.95], p=0.04) and had potential to preserve motor nerves.ConclusionsCryotherapy is likely to prevent TIPN in patients receiving taxanes. High quality and sufficient amount of evidence is warranted.

Exploring the Relationships Between Problem Gambling and ADHD: A Meta-Analysis

2016 ◽  
Vol 23 (12) ◽  
pp. 1427-1437 ◽  
Author(s):  
Jennifer Theule ◽  
Kylee E. Hurl ◽  
Kristene Cheung ◽  
Michelle Ward ◽  
Brenna Henrikson
Keyword(s):  
Confidence Interval ◽  
Problem Gambling ◽  
Random Effects ◽  
Meta Analysis ◽  
Random Effects Model ◽  
Adhd Symptoms ◽  
Weighted Mean ◽  
Problem Gamblers ◽  
Gambling Severity ◽  
Meta Analyses

Objective: At present, there are inconsistencies in the literature pertaining to the association between ADHD and problem gambling. This study utilized meta-analytic techniques to clarify the association between symptoms of problem gambling and symptoms of ADHD. Method: Several meta-analyses were conducted using a random effects model. PsycINFO, PubMed, ProQuest Dissertations & Theses, and Google Scholar were searched for relevant studies. Results: The weighted mean correlation between ADHD symptomology and gambling severity was r = .17, 95% confidence interval (CI) = [0.12, 0.22], p < .001. Mean age of the sample was the only moderator to approach significance, with greater age being linked to a stronger relationship between symptoms of ADHD and gambling severity. Conclusion: Clinicians needs to be cognizant of the greater risk of ADHD symptoms when working with problem gamblers and vice versa.

scholarly journals Periodontitis is associated with hypertension: a systematic review and meta-analysis

2019 ◽  
Vol 116 (1) ◽  
pp. 28-39 ◽  
Author(s):  
Eva Muñoz Aguilera ◽  
Jean Suvan ◽  
Jacopo Buti ◽  
Marta Czesnikiewicz-Guzik ◽  
Aline Barbosa Ribeiro ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Primary Outcome ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Health Assessment ◽  
Periodontal Therapy ◽  
Mean Difference ◽  
Weighted Mean ◽  
Meta Analyses

Abstract Recent evidence suggests a link between periodontitis (PD) and hypertension, but the nature of this association remains unclear. The overall aim of this review was to critically appraise the evidence linking these two common disorders. Systematic search was conducted for studies published up to December 2018. Prevalence of hypertension in patients with PD (moderate/severe groups) vs. those without PD (non-PD) was the primary outcome. Additional outcomes included adjusted mean difference in systolic (SBP) and diastolic (DBP) blood pressure (BP) levels in PD vs. non-PD, assessment of biomarkers in PD and hypertension, and BP changes after periodontal therapy. From 81 studies selected, 40 were included in quantitative meta-analyses. Diagnoses of moderate-severe PD [odds ratio (OR) = 1.22; 95% confidence interval (CI): 1.10–1.35] and severe PD (OR = 1.49; 95% CI: 1.09–2.05) were associated with hypertension. Prospective studies confirmed PD diagnosis increased likelihood of hypertension occurrence (OR = 1.68; 95% CI: 0.85–3.35). Patients with PD exhibited higher mean SBP [weighted mean difference (WMD) of 4.49 mmHg; 95% CI: 2.88–6.11] and DBP (2.03 mmHg; 95% CI: 1.25–2.81) when compared with non-PD. Lastly, only 5 out of 12 interventional studies confirmed a reduction in BP following periodontal therapy, ranging from 3 to 12.5 mmHg of SBP and from 0 to 10 mmHg of DBP. PD is associated with increased odds of hypertension (SORT C) and higher SBP/DBP levels. The evidence suggesting that PD therapy could reduce BP is inconclusive. Although additional research is warranted on this association, these results suggest that oral health assessment and management of PD could not only improve oral/overall health and quality of life but also be of relevance in the management of patients with hypertension.

An updated meta-analysis on the effect of peer tutoring on tutors’ achievement

2018 ◽  
Vol 40 (2) ◽  
pp. 200-214 ◽  
Author(s):  
Kim Chau Leung
Keyword(s):  
Best Practices ◽  
Secondary School ◽  
Peer Tutoring ◽  
Role Theory ◽  
Meta Analysis ◽  
Tutor Training ◽  
Weighted Mean ◽  
Training Time ◽  
Reciprocal Peer Tutoring ◽  
Meta Analyses

Meta-analyses on the effect of peer tutoring have rarely examined the effect of peer tutoring on tutors’ academic gain. Some previous analyses are dated and have methodological or theoretical limitations. Hence, there is a compelling need to fill this gap by conducting an updated and comprehensive meta-analysis for identifying certain determinants of best practices for peer tutoring on tutors’ academic achievement in the present study. Additionally, role theory and equity theory in peer tutoring were tested. The present meta-analytic study examined 16 articles using The comprehensive meta-analysis software programme and SPSS macro for analyses. It was found that the weighted mean effect size was 0.43 ( p < 0.001). Moreover, the crucial parameters for optimizing the effectiveness of peer tutoring interventions are identified as follows: Tutees with low academic ability; tutors coming from secondary school; fewer tutor training sessions per week; shorter tutor training time per session; choosing mathematics as subject content; random assignment of tutees and tutors; structured peer tutoring; same-age non-reciprocal peer tutoring; same-sex dyad grouping; and more weekly tutoring sessions but longer tutoring time for each session.

A Meta-Analytic Investigation of the Association Between Working Alliance and Outcomes of Individual Career Counseling

2020 ◽  
pp. 106907272098503
Author(s):  
Francis Milot-Lapointe ◽  
Yann Le Corff ◽  
Nicole Arifoulline
Keyword(s):  
Working Alliance ◽  
Career Counseling ◽  
Effect Size ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Weighted Mean ◽  
Analytic Investigation ◽  
Unpublished Studies ◽  
Meta Analyses

This article reports on the results of the first meta-analysis of the association between working alliance and outcomes of individual career counseling. This random-effects meta-analysis included 18 published and unpublished studies that produced a weighted mean effect size of r = .42. This effect size was heterogeneous across studies. Separate meta-analyses were conducted for several types of outcomes: Career outcomes, mental health outcomes, and client-perceived quality of the intervention. Average effect sizes for the association between working alliance and types of outcomes were .28, .18 and .62, respectively. Moderator analyses indicated that the overall mean effect size ( r =.42) varied in a large proportion as a function of the type of outcomes and the time of assessment of working alliance (first session, mid or at termination of the counseling service). Our results confirm that working alliance is associated to career counseling effectiveness and suggest that career counselors should emphasize on the working alliance during the career counseling process. In conclusion, this article provides suggestions for practice in individual career counseling and avenues of research on working alliance in this context.

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