Prognostic factors for adverse outcomes in patients with COVID-19: a field-wide systematic review and meta-analysis

IntroductionThe individual prognostic factors for COVID-19 are unclear. For this reason, we aimed to present a state-of-the-art systematic review and meta-analysis on the prognostic factors for adverse outcomes in COVID-19 patients.MethodsWe systematically reviewed PubMed from January 1, 2020 to July 26, 2020 to identify non-overlapping studies examining the association of any prognostic factor with any adverse outcome in patients with COVID-19. Random-effects meta-analysis was performed, and between-study heterogeneity was quantified using I2 metric. Presence of small-study effects was assessed by applying the Egger's regression test.ResultsWe identified 428 eligible articles, which were used in a total of 263 meta-analyses examining the association of 91 unique prognostic factors with 11 outcomes. Angiotensin-converting enzyme inhibitors, obstructive sleep apnea, pharyngalgia, history of venous thromboembolism, sex, coronary heart disease, cancer, chronic liver disease, chronic obstructive pulmonary disease, dementia, any immunosuppressive medication, peripheral arterial disease, rheumatological disease and smoking were associated with at least one outcome and had >1000 events, p-value <0.005, I2 <50%, 95% prediction interval excluding the null value, and absence of small-study effects in the respective meta-analysis. The risk of bias assessment using the Quality In Prognosis Studies tool indicated high risk of bias in 302 of 428 articles for study participation, 389 articles for adjustment for other prognostic factors, and 396 articles for statistical analysis and reporting.ConclusionsOur findings could be used for prognostic model building and guide patients’ selection for randomised clinical trials.

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YOGA IN CHRONIC NECK PAIN: AN EFFECTIVE COMPLEMENTARY THERAPEUTIC OPTION - A META - ANALYSIS

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.7.2/003 ◽

2018 ◽

Vol 7 (2) ◽

pp. 3-12

Author(s):

Jaza Rizvi ◽

Batool Hassan ◽

Sadia Shafaq

Keyword(s):

Neck Pain ◽

Therapeutic Option ◽

Meta Analysis ◽

Chronic Neck Pain ◽

Well Being ◽

Risk Of Bias ◽

Adverse Outcomes ◽

Cochrane Library ◽

P Value ◽

Complementary Method

BACKGROUND Neck pain is recognized as the fourth leading cause of disability worldwide. The severity of neck pain may lead to adverse outcomes related to individual’s health and well-being that augment the risk of disability and may severely interfere in activities of daily living (ADL’s) and participation in the society. AIM The aim of the quantitative analysis is to determine the effectiveness of yoga in relieving chronic neck pain and disability. METHODS Databases such as Google scholar, MEDLINE, PEDro, the Cochrane Library and Pub Med were explored from October-November for randomized controlled trials which assessed neck pain and related disability among chronic neck pain individuals. RESULTS Total six studies consisted of 298 participants with chronic neck pain. In risk of bias assessment, all six studies reported low risk of allocation and reporting bias, while one or two study disclosed high or unknown risk of bias in several domains. Moderate to large effect of -0.857 SMD at 95% CI suggest evidence in favor of the effectiveness of yoga; (Q 30.32, df 5, I2 83.51%) on a significant P-value of <0.0001. CONCLUSION The analysis of studies provided robust evidence with pool effect of -0.857 SMD at 95% CI (p<0.0001) concluded that yoga is an effectual and complementary method for the management of chronic or non-specific neck pain. KEYWORDS Yoga, Neck Pain, Cervical, Therapeutic, Prevention, Meditation

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Physical prognostic factors predicting outcome following anterior cruciate ligament reconstruction: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2019-033429 ◽

2020 ◽

Vol 10 (3) ◽

pp. e033429

Author(s):

Andrew Middlebrook ◽

Sheree Bekker ◽

Nicola Middlebrook ◽

Alison B Rushton

Keyword(s):

Systematic Review ◽

Anterior Cruciate Ligament ◽

Prognostic Factors ◽

Acl Reconstruction ◽

Cruciate Ligament ◽

Meta Analysis ◽

Risk Of Bias ◽

Predicting Outcome ◽

Anterior Cruciate

IntroductionInjuries of the anterior cruciate ligament (ACL) are a common musculoskeletal complication and can cause significant reduction in patient function and quality of life. Many undergo ACL reconstruction, with high-quality rehabilitation key to successful outcome. Knowledge of physical prognostic factors, such as quadriceps strength, is crucial to inform rehabilitation and has important implications for outcome following ACL reconstruction. However, these factors predicting outcome are poorly defined. Therefore, the aim of this systematic review is to establish physical prognostic factors predictive of outcome in adults following ACL reconstruction. Outcome will be subdivided into two groups of outcome measures, patient-reported and performance-based. Physical prognostic factors of interest will reflect a range of domains and may be modifiable/non-modifiable. Results will help decide most appropriate management and assist in planning and tailoring preoperative and postoperative rehabilitation.Methods and analysisThis systematic review protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. MEDLINE, CINAHL and EMBASE databases, key journals and grey literature will be searched from inception to July 2019. Prospective cohort studies including participants aged ≥16 years who have undergone ACL reconstruction will be included, with articles focusing on multi-ligament reconstructions and ACL repair surgery, or not published in English excluded. Two independent reviewers will conduct searches, assess study eligibility, extract data, assess risk of bias (Quality in Prognostic Studies tool) and quantify overall quality of evidence (modified Grading of Recommendations, Assessment, Development and Evaluation guidelines). If possible, a meta-analysis will be conducted, otherwise a narrative synthesis will ensue focusing on prognostic factors, risk of bias of included studies and strength of association with outcomes.Ethics and disseminationFindings will be published in a peer-reviewed journal, presented at conferences and locally to physiotherapy departments. Ethical approval is not required for this systematic review.PROSPERO registration numberCRD42019127732.

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Association between inflammatory bowel disease and chronic obstructive pulmonary disease: a systematic review and meta-analysis

BMC Pulmonary Medicine ◽

10.1186/s12890-019-0963-y ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Gonzalo Labarca ◽

Lauren Drake ◽

Gloria Horta ◽

Michael A. Jantz ◽

Hiren J. Mehta ◽

...

Keyword(s):

Systematic Review ◽

Chronic Obstructive Pulmonary Disease ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Meta Analysis ◽

Risk Of Bias ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Inflammatory Bowel ◽

New Onset

Abstract Introduction There is evidence of an association between inflammatory bowel disease (IBD) and lung conditions such as chronic obstructive pulmonary disease (COPD). This systematic review and meta-analysis explored the risk of new onset IBD in patients with COPD and new onset COPD in IBD patients. Methods We performed a systematic review of observational studies exploring the risk of both associations. Two independent reviewers explored the EMBASE, MEDLINE, LILACS and DOAJ databases, and the risk of bias was evaluated using the ROBBINS-I tool. Data from included studies was pooled in a random effect meta-analysis following a DerSimonian-Laird method. The quality of the evidence was ranked using GRADE criteria. Results Four studies including a pooled population of 1355 new cases were included. We found association between new onset IBD in COPD population. The risk of bias was low in most of them. Only one study reported tobacco exposure as a potential confounding factor. The pooled risk ratio (RR) for a new diagnosis of IBD in COPD patients was 2.02 (CI, 1.56 to 2.63), I2 = 72% (GRADE: low). The subgroup analyses for Crohn’s disease and ulcerative colitis yielded RRs of 2.29 (CI, 1.51 to 3.48; I2 = 62%), and 1.79 (CI, 1.39 to 2.29; I2 = 19%.), respectively. Discussion According to our findings, the risk of new onset IBD was higher in populations with COPD compared to the general population without this condition. Based on our analysis, we suggest a potential association between IBD and COPD; however, further research exploring the potential effect of confounding variables, especially cigarette smoking, is still needed. Review register (PROSPERO: CRD42018096624)

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Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients

EP Europace ◽

10.1093/europace/euab116.143 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

GF Romiti ◽

B Corica ◽

E Pipitone ◽

M Vitolo ◽

V Raparelli ◽

...

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Major Bleeding ◽

Meta Analysis ◽

Cardiovascular Death ◽

Adverse Outcomes ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf AF-COMET Collaborative Group Background Multimorbidity is a major concern in patients with atrial fibrillation (AF). Among other diseases, the prevalence of chronic obstructive pulmonary disease (COPD) in these patients is unclear, and its association with adverse outcomes is often overlooked. Moreover, uncertainties on the treatment of patients with both AF and COPD still exist, and may lead to undertreatment. Purpose The aim of this study is to estimate the prevalence of COPD, and its impact on management and outcomes in patients with AF. Methods A systematic review and meta-analysis was conducted according to PRISMA guidelines. All studies reporting the prevalence of COPD in AF patients were included and pooled. Data on comorbidities, beta-blockers (BBs) and oral anticoagulant (OAC) prescription, and outcomes (all-cause death, cardiovascular death, ischemic stroke, major bleeding) were pooled and compared according to COPD status; the impact of BBs on outcomes in patients with COPD was also investigated. All analyses were performed using random-effect models; subgroup analysis and meta-regressions were also performed to account for heterogeneity. Results Among 46 studies, the pooled prevalence of COPD was 13% (95% Confidence Intervals (CI): 10-16%), with high heterogeneity between studies; significant differences were found according to geographical locations and definition of COPD. A multivariable meta-regression model which included age, female sex, history of hypertension, diabetes and chronic heart failure (CHF) was able to explain a significant proportion of the heterogeneity (R2 = 69.8%). COPD was associated with a higher prevalence of diabetes, coronary artery disease, CHF and stroke (Fig. 1, panel A), as well as higher CHA2DS2-VASc scores and age (Fig. 1, panel B), and lower probability of BB prescription (Odds Ratio (OR): 0.77, 95%CI: 0.61-0.98). Patients with COPD showed higher risk of all-cause death (OR: 2.22, 95%CI: 1.93-2.55), cardiovascular death (OR: 1.84, 95%CI: 1.39-2.43) and major bleeding (OR: 1.45, 95%CI: 1.17-1.80) (Fig.1, Panel C); no significant differences in outcomes were observed according to BBs use in AF patients with COPD (Fig. 1, panel D). Conclusion COPD is common in AF, being found in 1 every 8 patients, and is associated with an increased burden of comorbidities, differential management and worse outcomes, with more than two-fold higher risk of all-cause death and increased risk of CV death and major bleeding. Therapy with BBs does not increase the risk of adverse outcomes in these patients. Abstract Figure.

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Systematic review and meta-analysis of the prognosis and prognostic factors of interstitial pneumonia with autoimmune features

BMJ Open ◽

10.1136/bmjopen-2019-031444 ◽

2019 ◽

Vol 9 (12) ◽

pp. e031444 ◽

Cited By ~ 1

Author(s):

Hiroyuki Kamiya ◽

Ogee Mer Panlaqui

Keyword(s):

Systematic Review ◽

Prognostic Factors ◽

Interstitial Pneumonia ◽

Evaluation System ◽

Meta Analysis ◽

Usual Interstitial Pneumonia ◽

Risk Of Bias ◽

Significant Difference ◽

All Cause Mortality

ObjectiveTo clarify the prognosis and prognostic factors of interstitial pneumonia with autoimmune features (IPAF) in comparison to idiopathic pulmonary fibrosis (IPF), the most common idiopathic interstitial pneumonia, and connective tissue disease-associated interstitial pneumonia (CTD-IP).DesignA systematic review and meta-analysis.Data sourcesElectronic databases such as Medline and Embase were searched from 2015 through 6 September 2019.Eligibility criteria for selecting studiesPrimary studies that comparatively investigated the prognosis or prognostic factors of IPAF were eligible.Data extraction and analysisTwo reviewers extracted relevant data and assessed the risk of bias independently. A meta-analysis was conducted using a random-effects model. The quality of presented evidence was assessed by the Grades of Recommendation, Assessment, Development, and Evaluation system.ResultsOut of a total of 656 records retrieved, 12 studies were reviewed. The clinical features of IPAF were diverse between studies, which included a radiological and/or pathological usual interstitial pneumonia (UIP) pattern of between 0% and 73.8%. All studies contained some risk of bias. There was no significant difference of all-cause mortality between IPAF-UIP and IPF in all studies, although the prognosis of IPAF in contrast to IPF or CTD-IP varied between studies depending on the proportion of UIP pattern. Among the potential prognostic factors identified, age was significantly associated with all-cause mortality of IPAF by a pooled analysis of univariate results with a hazard ratio (HR) of 1.06 (95% confidence interval (CI) 1.04 to 1.07). The adjusted effect of age was also significant in all studies. The quality of presented evidence was deemed as very low.ConclusionThere was no significant difference of all-cause mortality between IPAF-UIP and IPF. Age was deemed as a prognostic factor for all-cause mortality of IPAF. The findings should be interpreted cautiously due to the low quality of the presented evidence.PROSPERO registration numberCRD42018115870.

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0599 The Association Between Obstructive Sleep Apnea and Cancer Incidence and Mortality: A Systematic Review and Meta-Analysis

SLEEP ◽

10.1093/sleep/zsaa056.596 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A229-A229

Author(s):

R Sutherland ◽

J Platt

Keyword(s):

Sleep Apnea ◽

Cancer Incidence ◽

Cancer Mortality ◽

Meta Analysis ◽

Risk Of Bias ◽

P Value ◽

Hazard Ratios ◽

Obstructive Sleep ◽

Incidence And Mortality ◽

Risk Of Cancer

Abstract Introduction Sleep related breathing disorders (SRBD) are common (20% prevalence) in the general population and can have multiple health consequences. There is growing evidence that chronic hypoxia - a key consequence of sleep apnea - is a common feature in solid tumour tissue, therapeutic resistance, tumour progression, and metastasis. However, there is conflicting evidence regarding the association between sleep apnea, cancer incidence, or mortality. A review of all available literature and subsequent meta-analysis was done to clarify these relationships. Methods A thorough literature search was completed using Medline, EMBASE and Web of Science databases. The search resulted in 7222 studies, 1551 duplicates were removed, 5552 studies were removed after abstract screening, and full text review was done on 119 studies, yielding 12 full retrospective cohort studies. The risk of bias was assessed using the Newcastle-Ottawa Scale. Review and data extraction were done in duplicate. Results In the pooled analysis, 9 studies totalling 2,358405 subjects with OSA and 3.97% cancer incidence and 2,442794 subjects without OSA and 3.35% cancer incidence. A random effects model with inverse-variance weighting analysis yielded an unadjusted OR = 1.32 (95% CI: 0.76 - 2.30). After 2 studies with a moderate risk of bias were removed the pooling yielded an OR = 1.89 (95% CI: 0.99 - 3.50). Heterogeneity was high at 99.9% p-value less than 0.01. Meta-regression was then done to assess for the cause(s) of heterogeneity sex, age, or BMI were not significant contributors. A review of 3 studies, which included cancer mortality, was done. Hazard ratios in 2 studies suggested OSA increased the risk of cancer mortality. Hazard ratios also increased with increasing OSA severity. Conclusion Sleep apnea significantly increases cancer mortality and is positively associated with increasing severity. Meta-analysis demonstrated an 86% increase in the unadjusted odds of cancer in those with sleep apnea. However, this result was borderline non-significant with high heterogeneity. Further studies may be helpful in determining the true associations between sleep apnea and cancer. Support None.

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Comparative Analysis of Azacitidine and Decitabine in Myelodysplastic Syndromes: A Systematic Review and Network Meta-Analysis

Blood ◽

10.1182/blood.v126.23.1692.1692 ◽

2015 ◽

Vol 126 (23) ◽

pp. 1692-1692 ◽

Cited By ~ 2

Author(s):

Jehad Almasri ◽

Hassan B Alkhateeb ◽

Moussab Damlaj ◽

Zhen Wang ◽

M. Hassan Murad ◽

...

Keyword(s):

Systematic Review ◽

High Risk ◽

Myelodysplastic Syndromes ◽

Meta Analysis ◽

Complete Response ◽

Risk Of Bias ◽

P Value ◽

Hypomethylating Agents ◽

Two Agents ◽

Indirect Comparisons

Abstract Background: Myelodysplastic syndromes (MDS) are clonal hematological diseases which present with cytopenias. Hematopoietic cell transplantation is usually limited to fit patients with higher risk MDS and donor availability. Hypomethylating agents (azacitidine and decitabine) have been the mainstay option for the management of MDS with different clinical efficacy in low versus high risk MDS trials. No trials have compared the two agents. Aim: To conduct a systematic review and network analysis comparing the efficacy of azacitidine to decitabine. Methods: The protocol of the systematic review was developed a priori. A comprehensive search of several databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus) was conducted from each database's earliest inception through November 20th, 2014 without language restrictions. Trials enrolling adults diagnosed with MDS who received hypomethylating agents (azacitidine or decitabine) therapy were included. Studies were screened by two independent reviewers and differences were resolved by consensus. The Cochrane Risk of bias tool was used to appraise the trials. Random effects model was used to pool relative risks (RR) of outcomes (overall survival, overall response rate, hematologic improvement and grade 3 or 4 toxicity). Adjusted indirect comparisons were used to estimate RR for indirect comparisons (Glenny AM, et al. Health Technol Assess. 2005). All statistical analyses were conducted using STATA, version 13 (StataCorp LP, College Station, TX). Results: Only four trials met the eligibility criteria (Figure 1). Two trials compared Azacitidine (75mg/m²/day SC x 7 days) to the best suppurative care (BSC) and included 549 patients (278 azacitidine and 271 BSC, age average: 69; range: 31-92), and the other 2 compared decitabine (15 mg/m² IV q 8 hours x9) to BSC and included 403 patients (208 Decitabine and 195 BSC, age average: 69.7; range: 60-90) (Table 1). The proportion of patients with intermediate-2 and high-risk myelodysplastic syndrome (based on International Prognostic Scoring System (IPSS)) in trials comparing decitabine to BSC was 82.21% and 83.08%; respectively, and in trials comparing azacitidine to BSC was 62.59% and 61.26%; respectively. The risk of bias was moderate overall. Compared to BSC, azacitidine was significantly associated with lower risk of death (RR=0.83, 95% CI: 0.74-0.94, p=0.002) whereas the effect of decitabine did not reach statistical significance (RR=0.88, 95% CI: 0.77-1.001, p=0.053). Both drugs were superior to BSC in terms of partial and complete response. Head to head comparisons were not statistically significant (except for the outcome of complete response where low certainty evidence suggested that azacitidine treated patients were less likely to have complete response compared to decitabine (RR=0.11, 95% CI= 0.01, 0.86, p=0.04). (Table 2). Conclusion: Azacitidine and decitabine are both superior to BSC. The available indirect evidence comparing the two agents warrants low certainty and cannot reliably confirm superiority of either agent. Head-to-head trials are needed. In the meantime, the choice of agent should be driven by patients' preferences, drug availability and cost. Table 2. Results of meta-analysis Outcome Azacitidine VS. Decitabine Azacitidine VS. BSC Decitabine VS. BSC RR LCI HCI P value RR LCI HCI P value RR LCI HCI P value Death 0.95 0.79 1.13 0.54 0.83 0.74 0.94 0.002 0.88 0.77 1.001 0.05 Complete response 0.11 0.01 0.86 0.04* 2.56 1.44 4.58 0.001 23.46 3.22 170.84 0.002 Partial response 0.35 0.04 3.03 0.34 4.91 2.27 10.63 <0.0001 14.02 1.87 105.08 0.01 Major erythroid improvement 0.47 0.03 8.37 0.60 6.37 3.93 10.33 <0.0001 13.67 0.79 235.57 0.07 Major platelet improvement 1.51 0.30 7.56 0.62 4.80 2.98 7.70 <0.0001 3.19 0.68 14.89 0.14 Major neutrophil improvement 2.89 0.56 14.82 0.20 2.63 1.68 4.12 <0.0001 0.91 0.19 4.38 0.907 Hematologic improvement 0.25 0.06 1.09 0.07 2.18 1.67 2.85 <0.0001 8.62 2.05 36.32 0.003 Anemia 1.18 0.53 2.63 0.69 0.89 0.75 1.06 0.198 0.76 0.35 1.66 0.49 Neutropenia 0.99 0.75 1.30 0.92 1.87 1.63 2.14 <0.0001 1.90 1.49 2.42 <0.0001 Thrombocytopenia 0.87 0.64 1.18 0.37 1.63 1.43 1.86 <0.0001 1.87 1.43 2.45 <0.0001 Infection 1.13 0.52 2.43 0.76 1.25 0.60 2.60 0.55 1.11 0.87 1.42 0.41 *These results warrant low certainty due to imprecision (very small number of events) and are driven by 14 patients achieving complete response in BSC arm in one trial. Disclosures Al-Kali: Celgene: Research Funding.

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Effectiveness and feasibility of telerehabilitation in patients with COVID-19: a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2021-058932 ◽

2022 ◽

Vol 12 (1) ◽

pp. e058932

Author(s):

Abubeker Alebachew Seid ◽

Setognal Birara Aychiluhm ◽

Ahmed Adem Mohammed

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Meta Analysis ◽

Risk Of Bias ◽

Mean Difference ◽

Cochrane Library ◽

P Value ◽

Published Data ◽

Respiratory Rehabilitation

IntroductionRespiratory rehabilitation is the use of exercise, education, and behavioural interventions to alleviate symptoms and improve quality of life. Recent studies highlight that respiratory rehabilitation is effective and safe for patients with COVID-19. We aim to evaluate the effectiveness and feasibility of respiratory telerehabilitation on patients infected with COVID-19 by conducting a systematic review and meta-analysis.Methods and analysisPubMed, Web of Science, Science Direct, Physiotherapy Evidence Database, Google Scholar and Cochrane Library databases will be searched from inception to the end of November 2021. Randomised controlled trials investigating the effectiveness of telerehabilitation in the management of COVID-19 will be included. The primary outcomes will be functional capacity, cardiopulmonary exercise tests and quality of life. Secondary outcomes will include anxiety/depression level, sleep quality, mortality rate, completion rate, reason for withdrawal, adverse events, service satisfaction, cost-effectiveness and other potential factors. Two reviewers will independently screen and extract data and perform quality assessment of included studies. The Cochrane risk of bias tool will be used to assess risk of bias. Review Manager V.5.4 (Cochrane Collaboration) software will be used for statistical analysis. Heterogeneity will be analysed using I² statistics. Mean difference or standardised mean difference with 95% CI and p value will be used to calculate treatment effect for outcome variables.Ethics and disseminationEthical approval is not required because this systematic review and meta-analysis is based on previously published data. Final result will be published in peer-reviewed journal and presented at relevant conferences and events.PROSPERO registration numberCRD42021287975.

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The Benefits and Harms of Systemic Dehydroepiandrosterone (DHEA) in Postmenopausal Women With Normal Adrenal Function: A Systematic Review and Meta-analysis

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-2261 ◽

2014 ◽

Vol 99 (10) ◽

pp. 3536-3542 ◽

Cited By ~ 57

Author(s):

Tarig Elraiyah ◽

Mohamad Bassam Sonbol ◽

Zhen Wang ◽

Tagwa Khairalseed ◽

Noor Asi ◽

...

Keyword(s):

Systematic Review ◽

Postmenopausal Women ◽

Meta Analysis ◽

Risk Of Bias ◽

Adrenal Function ◽

P Value ◽

Controlled Trials ◽

Cochrane Central Register ◽

Mineral Density ◽

Sexual Symptoms

Abstract Context: Exogenous dehydroepiandrosterone (DHEA) therapy has been proposed to replenish the depletion of endogenous DHEA and its sulfate form, which occurs with advancing age and is thought to be associated with loss of libido and menopausal symptoms. Objective: We conducted a systematic review and meta-analysis to summarize the evidence supporting the use of systemic DHEA in postmenopausal women with normal adrenal function. Methods: We searched MEDLINE, EMBASE, PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through January 2014. Pairs of reviewers, working independently, selected studies and extracted data from eligible randomized controlled trials (RCTs). We used the random-effects model to pool across studies and evaluated heterogeneity using the I2 statistic. Results: We included 23 RCTs with moderate to high risk of bias enrolling 1188 women. DHEA use was not associated with significant improvement in libido or sexual function (standardized mean difference, 0.35; 95% confidence interval, −0.02 to 0.73; P value = .06; I2 = 62%). There was also no significant effect of DHEA on serious adverse effects, serum lipids, serum glucose, weight, body mass index, or bone mineral density. This evidence warranted low confidence in the results, mostly due to imprecision, risk of bias, and inconsistency across RCTs. Conclusions: Evidence warranting low confidence suggests that DHEA administration does not significantly impact sexual symptoms or selected metabolic markers in postmenopausal women with normal adrenal function.

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