scholarly journals Current evidence for COVID-19 therapies: a systematic literature review

2021 ◽  
Vol 30 (159) ◽  
pp. 200384
Author(s):  
Tobias Welte ◽  
Lucy J. Ambrose ◽  
Gillian C. Sibbring ◽  
Shehla Sheikh ◽  
Hana Müllerová ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Standard Care ◽  
Severe Disease ◽  
Therapeutic Interventions ◽  
Disease Stage ◽  
Current Evidence ◽  
Treatment And Prevention ◽  
Significant Efficacy ◽  
Immunomodulatory Therapies

Effective therapeutic interventions for the treatment and prevention of coronavirus disease 2019 (COVID-19) are urgently needed. A systematic review was conducted to identify clinical trials of pharmacological interventions for COVID-19 published between 1 December 2019 and 14 October 2020. Data regarding efficacy of interventions, in terms of mortality, hospitalisation and need for ventilation, were extracted from identified studies and synthesised qualitatively. In total, 42 clinical trials were included. Interventions assessed included antiviral, mucolytic, antimalarial, anti-inflammatory and immunomodulatory therapies. Some reductions in mortality, hospitalisation and need for ventilation were seen with interferons and remdesivir, particularly when administered early, and with the mucolytic drug, bromhexine. Most studies of lopinavir/ritonavir and hydroxychloroquine did not show significant efficacy over standard care/placebo. Dexamethasone significantly reduced mortality, hospitalisation and need for ventilation versus standard care, particularly in patients with severe disease. Evidence for other classes of interventions was limited. Many trials had a moderate-to-high risk of bias, particularly in terms of blinding; most were short-term and some included low patient numbers.This review highlights the need for well-designed clinical trials of therapeutic interventions for COVID-19 to increase the quality of available evidence. It also emphasises the importance of tailoring interventions to disease stage and severity for maximum efficacy.

scholarly journals Current evidence for COVID-19 therapies: a systematic literature review

2020 ◽  
Author(s):  
Tobias Welte ◽  
Lucy J. Ambrose ◽  
Gillian C. Sibbring ◽  
Shehla Sheikh ◽  
Hana Müllerová ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Standard Care ◽  
Severe Disease ◽  
Therapeutic Interventions ◽  
Disease Stage ◽  
Current Evidence ◽  
Treatment And Prevention ◽  
Significant Efficacy ◽  
Immunomodulatory Therapies

AbstractEffective therapeutic interventions for the treatment and prevention of COVID-19 are urgently needed. A systematic review was conducted to identify clinical trials of pharmacological interventions for COVID-19 published between 1 December 2019 and 14 October 2020. Data regarding efficacy of interventions, in terms of mortality, hospitalisation and need for ventilation, were extracted from identified studies and synthesised qualitatively.In total, 42 clinical trials were included. Interventions assessed included antiviral, mucolytic, anti-malarial, anti-inflammatory and immunomodulatory therapies. Some reductions in mortality, hospitalisation and need for ventilation were seen with interferons and remdesivir, particularly when administered early, and with the mucolytic drug, bromhexine. Most studies of lopinavir/ritonavir and hydroxychloroquine did not show significant efficacy over standard care/placebo. Dexamethasone significantly reduced mortality, hospitalisation and need for ventilation versus standard care, particularly in patients with severe disease. Evidence for other classes of interventions was limited. Many trials had a moderate-to-high risk of bias, particularly in terms of blinding; most were short-term; and some included low patient numbers.This review highlights the need for well-designed clinical trials of therapeutic interventions for COVID-19 to increase the quality of available evidence. It also emphasises the importance of tailoring interventions to disease stage and severity for maximum efficacy.

scholarly journals P121 The efficacy of treatment interventions on fatigue in adolescents with juvenile idiopathic arthritis: a literature review

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Sebastian Moshtael ◽  
Sonia Khanom ◽  
Janet E McDonagh
Keyword(s):  
Quality Of Life ◽  
Juvenile Idiopathic Arthritis ◽  
Young People ◽  
Rating Scale ◽  
Outcome Measure ◽  
Therapeutic Interventions ◽  
Current Evidence ◽  
Original Research ◽  
Qualitative Synthesis

Abstract Background/Aims  Fatigue has been reported by young people and professionals alike as a major challenge for people living with juvenile idiopathic arthritis (JIA) . It remains unclear as to how therapeutic interventions impacts on this major symptom. The aim of this review was to determine the current evidence for the effectiveness of therapeutic interventions, non- pharmacological and pharmacological, on improving fatigue in adolescents with JIA. Methods  Three electronic databases (MEDLINE, EMBASE, PsycINFO) were searched from 2000 to Feb 2020; in addition to manual searches. Articles were eligible for inclusion if they (i) were original research papers, (ii) had fatigue as a primary outcome measure (iii) included adolescents (10-25 years) and (iv) were available in the English language. Results  Of the 3,142 records identified, 31 underwent full text assessment and 4 studies were included in the qualitative synthesis including 2 from the Netherlands, 1 Germany, and 1 from Canada. The total number of participants across the 4 studies was 824. Three were randomised controlled trials of nonpharmacological interventions and one was a cohort study from a national drug registry including older adolescents JIA (mean: 19-years). Measurement tools included the Paediatric Quality of life multidimensional fatigue scale, (2 studies), the Checklist for Individual Strength CIS-20 (1 study), a numeric rating scale (1 study). In one study a visual analogue scale for energy level was also utilised. In 2 studies baseline prevalence of fatigue was reported as 60% and 76% respectively. Significant reduction in fatigue was observed in all three nonpharmacological studies. In the registry study, fatigue was noted to be prevalent in spite of the disease being in inactive or minimally active on biologic therapy. In 3 studies the relationship between health-related quality of life and fatigue was highlighted and showed a decreased quality of life in fatigued young people. Conclusion  Fatigue is a significant problem in JIA during adolescence and influences quality of life. Improvements in fatigue with non-pharmacological interventions have been reported. However, at present, data is insufficient to conclusively decide which treatment intervention is most efficacious in treating fatigue in young people with JIA. Fatigue should be considered as an important outcome measure for the management of JIA in future evaluations of interventions. Disclosure  S. Moshtael: None. S. Khanom: None. J.E. McDonagh: None.

scholarly journals Current evidence on chloroquine and hydroxychloroquine and their role in the treatment and prevention of COVID-19

2020 ◽  
Author(s):  
Rephaim Mpofu ◽  
Clifford George Banda ◽  
Hannah Gunter ◽  
Enkosi Mondleki ◽  
Gayle Tatz ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Evidence ◽  
Cardiac Conduction ◽  
Current Evidence ◽  
Regulatory Agencies ◽  
Close Monitoring ◽  
Treatment And Prevention ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Robust Evidence

Although chloroquine and hydroxychloroquine have not yet been shown to be safe or effective for the treatment or prevention of COVID-19, regulatory agencies in some countries have authorised their use in Coronavirus disease 2019 (COVID-19) due to the lack of available interventions. Several large clinical trials are currently underway to investigate these agents as potential therapeutic options for COVID-19. Previous research against similar pathogens that cause severe acute respiratory syndrome and Middle East respiratory syndrome has identified chloroquine and hydroxychloroquine as possible antiviral candidates against SARS-CoV-2. Despite promising pre-clinical evidence, data have thus far failed to confirm their efficacy, and recent studies suggest potential dose-related cardiotoxicity and mortality. Close monitoring for cardiac conduction abnormalities is advised with higher-than-approved doses. Additional, robust evidence from randomised controlled trials and meta-analyses are required to make informed risk-benefit assessments. Finally, the off-label prescription of these agents should be judiciously considered, and any such use should be conducted within clinical trials, or under the Monitored Emergency Use of Unregistered and Investigational Interventions framework.

scholarly journals Current evidence on chloroquine and hydroxychloroquine and their role in the treatment and prevention of COVID-19

2020 ◽  
Author(s):  
Rephaim Mpofu ◽  
Clifford G. Banda ◽  
Hannah Gunter ◽  
Enkosi Mondleki ◽  
Gayle Tatz ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Clinical Evidence ◽  
Cardiac Conduction ◽  
Current Evidence ◽  
Regulatory Agencies ◽  
Close Monitoring ◽  
Treatment And Prevention ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Robust Evidence

Although chloroquine and hydroxychloroquine have not yet been shown to be safe or effective for the treatment or prevention of COVID-19, regulatory agencies in some countries have authorised their use in Coronavirus disease 2019 (COVID-19) due to the lack of available interventions. Several large clinical trials are currently underway to investigate these agents as potential therapeutic options for COVID-19. Previous research against similar pathogens that cause severe acute respiratory syndrome and Middle East respiratory syndrome has identified chloroquine and hydroxychloroquine as possible antiviral candidates against SARS-CoV-2. Despite promising pre-clinical evidence, data have thus far failed to confirm their efficacy, and recent studies suggest potential dose-related cardiotoxicity and mortality. Close monitoring for cardiac conduction abnormalities is advised with higher-than-approved doses. Additional, robust evidence from randomised controlled trials and meta-analyses are required to make informed risk-benefit assessments. Finally, the off-label prescription of these agents should be judiciously considered, and any such use should be conducted within clinical trials, or under the Monitored Emergency Use of Unregistered and Investigational Interventions framework.

scholarly journals Acupressure and Dementia - A Review of Current Evidence

2021 ◽  
Author(s):  
Soo Liang Ooi ◽  
Gillian Drew ◽  
Sok Cheon Pak
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Sleep Disturbances ◽  
Psychological Symptoms ◽  
Pharmacological Therapy ◽  
Current Evidence ◽  
High Quality Research ◽  
Dementia Patients ◽  
Moderate Dementia

Introduction: Dementia is a cognitive decline with patients often exhibit behavioural and psychological symptoms, severely affecting the quality of life and placing a heavy burden on caregivers. Acupressure has reported benefits for dementia. This study aims to critically review the available evidence for its use as a non-pharmacological therapy. Methods: Systematic search of major research databases for human clinical trials using acupressure as an intervention for dementia patients was conducted. Results were synthesised for the effects of acupressure on various outcome measures of interest for dementia.Results: Twelve clinical trials (N=973), including eight randomised control studies, were included in this review. The study sample was predominantly institutionalised residents with moderate to severe dementia. Baihui (GV20), Shenmen (HT7), Fengchi (GB20), Neiguan (PC6), Sanyinjiao (SP6), and Yingtang (EX-HN3) were the most used acupoints for intervention. Acupressure techniques employed in these clinical trials vary greatly with no standardised approach. This review finds inconsistent evidence in the effectiveness of acupressure in reducing agitation and behavioural disturbances. However, the treatment appears to improve their ease of care and reduce physical stress. Affixing acupressure devices on selected acupoints can also potentially improve psychiatric pain, anxiety, and depression. Long-term (6 months) treatment can potentially improve the cognitive function, activities of daily living, and quality of life of patients with mild to moderate dementia. The effect of acupressure on sleep disturbances remains unclear. Conclusion: More high-quality research on acupressure is needed to fill the gaps in knowledge and inform better care for dementia patients in the future.

scholarly journals Establishing anchor-based minimally important differences (MID) with the EORTC quality-of-life measures: a meta-analysis protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019117 ◽  
Author(s):  
Zebedee Jammbe Musoro ◽  
Jean-Francois Hamel ◽  
Divine Ewane Ediebah ◽  
Kim Cocks ◽  
Madeleine T King ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Patient Data ◽  
Disease Stage ◽  
Healthcare Intervention ◽  
Life Questionnaire ◽  
Eortc Qlq C30 ◽  
Eortc Qlq ◽  
Eortc Quality

IntroductionAs patient assessment of health-related quality of life (HRQOL) in cancer clinical trials has increased over the years, so has the need to attach meaningful interpretations to differences in HRQOL scores between groups and changes within groups. Determining what represents a minimally important difference (MID) in HRQOL scores is useful to clinicians, patients and researchers, and can be used as a benchmark for assessing the success of a healthcare intervention. Our objective is to provide an evidence-based protocol to determine MIDs for the European Organisation for Research and Treatment for Cancer Quality of life Questionnaire core 30 (EORTC QLQ-C30). We will mainly focus on MID estimation for group-level comparisons. Responder thresholds for individual-level change will also be estimated.Methods and analysisData will be derived from published phase II and III EORTC trials that used the QLQ-C30 instrument, covering several cancer sites. We will use individual patient data to estimate MIDs for different cancer sites separately. Focus is on anchor-based methods. Anchors will be selected per disease site from available data. A disease-oriented and methodological panel will provide independent guidance on anchor selection. We aim to construct multiple clinical anchors per QLQ-C30 scale and also to compare with several anchor-based methods. The effects of covariates, for example, gender, age, disease stage and so on, will also be investigated. We will examine how our estimated MIDs compare with previously published guidelines, hence further contributing to robust MID guidelines for the EORTC QLQ-C30.Ethics and disseminationAll patient data originate from completed clinical trials with mandatory written informed consent, approved by local ethical committees. Our findings will be presented at scientific conferences, disseminated via peer-reviewed publications and also compiled in a MID ‘blue book’ which will be made available online on the EORTC Quality of Life Group website as a free guideline document.

scholarly journals Interventions to reduce self-harm on in-patient wards: systematic review

BJPsych Open ◽  
2021 ◽  
Vol 7 (3) ◽  
Author(s):  
Rasanat Fatima Nawaz ◽  
Gurpreet Reen ◽  
Natasha Bloodworth ◽  
Daniel Maughan ◽  
Charles Vincent
Keyword(s):  
Suicide Attempts ◽  
Evidence Base ◽  
Therapeutic Interventions ◽  
Current Evidence ◽  
Behaviour Therapy ◽  
Substantial Evidence ◽  
Environmental Interventions ◽  
Patient Admissions ◽  
Self Harm

Background Incidents of self-harm are common on psychiatric wards. There are a wide variety of therapeutic, social and environmental interventions that have shown some promise in reducing self-harm in in-patient settings, but there is no consensus on the most appropriate means of reducing and managing self-harm during in-patient admissions. Aims To review interventions used to reduce self-harm and suicide attempts on adolescent and adult psychiatric in-patient wards. Method A systematic literature search was conducted between 14 March 2019 and 25 January 2021 using PsycINFO and Medline (PROSPERO ID: CRD42019129046). A total of 23 papers were identified for full review. Results Interventions fell into two categories, therapeutic interventions given to individual patients and organisational interventions aimed at improving patient–staff communication and the overall ward milieu. Dialectical behaviour therapy was the most frequently implemented and effective therapeutic intervention, with seven of eight studies showing some benefit. Three of the six ward-based interventions reduced self-harm. Two studies that used a combined therapeutic and ward-based approach significantly reduced self-harm on the wards. The quality of the studies was highly variable, and some interventions were poorly described. There was no indication of harmful impact of any of the approaches reported in this review. Conclusions A number of approaches show some promise in reducing self-harm, but the evidence is not strong enough to recommend any particular approach. Current evidence remains weak overall but provides a foundation for a more robust programme of research aimed at providing a more substantial evidence base for this neglected problem on wards.

scholarly journals Efficacy of Manual Therapy on Pain, Impact of Disease, and Quality of Life in the Treatment of Fibromyalgia: A Systematic Review

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. 461-475
Author(s):  
Nina Schulze
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Clinical Trials ◽  
Manual Therapy ◽  
Evaluation System ◽  
Risk Of Bias ◽  
Current Evidence ◽  
Life Questionnaire ◽  
Randomized Controlled

Background: Myofascial mobilization has been used as an intervention for patients with fibromyalgia (FM) for acting on ascending nociceptive pathways possibly involved in the central sensitization process, modulating the pain experience. However, there is still a gap in its efficacy compared with another hands-on approach because manual therapy has nonspecific effects, such as placebo. Objectives: This systematic review aims to review the scientific literature for an overview of the efficacy of manual therapy in pain, disease impact, and quality of life in patients with FM compared with control or other treatments through randomized clinical trials. Study Design: This study involved systematic review of published randomized controlled trials (RCTs). Setting: This study examined all RCTs evaluating the effect of manual therapy on pain, impact of disease, and quality of life for patients with FM. Methods: Systematic review. The research was performed in 9 databases: MEDLINE/PubMed, CINAHL, Web of Science, Scopus, ScienceDirect, Lilacs, SciELO, PEDro, and Cochrane. Searches were carried out from the end of the project until September 2019, with no language and year restrictions. Randomized controlled clinical trials that used the following outcome measures were included: Visual Analog Scale, Fibromyalgia Impact Questionnaire, and SF-36 Quality of Life Questionnaire. The risk of bias and quality of studies was assessed using the PEDro scale; the Cochrane risk-of-bias tool; and Grading of Recommendations Assessment, Development, and Evaluation System. Results: Seven studies were included (368 patients). The quantitative analysis was performed on 4 studies because of the lack of data in the others. Myofascial release was the most used modality. The level of evidence ranged from very low to moderate, mainly because of the inconsistency and inaccuracy of results. Limitations: The present systematic review presented limitations because of the heterogeneity of the included studies and only a short-term analysis of the intervention results. It was observed that other information, such as pressure, repetition, and/or sustaining manual therapy techniques, could be better described in future protocols, aiming at a better comparison between the techniques and their subsequent reproducibility. Conclusions: Current evidence of manual therapy in patients with FM, based on a very low to moderate quality of evidence, was inconclusive and insufficient to support and recommend the use of manual therapy in this population. To date, only general osteopathic treatment has achieved clinically relevant pain improvement when compared with control. Key words: Fibromyalgia, manual therapy, pain, quality of life, impact of disease, physiotherapy, manipulation techniques, mobilization

scholarly journals Secukinumab: a review of the anti-IL-17A biologic for the treatment of psoriasis

2017 ◽  
Vol 9 (1) ◽  
pp. 5-21 ◽  
Author(s):  
Jillian Frieder ◽  
Dario Kivelevitch ◽  
Alan Menter
Keyword(s):  
Quality Of Life ◽  
Clinical Trials ◽  
Plaque Psoriasis ◽  
Current Evidence ◽  
Interleukin 17 ◽  
Therapeutic Effects ◽  
T Helper 17 ◽  
Systemic Inflammatory Disease ◽  
Related Quality

Psoriasis is a systemic inflammatory disease associated with numerous comorbidities and a profound impact on patients’ quality of life. While its complex immune pathogenesis is still not fully delineated, current evidence supports a fundamental role of the T-helper-17 (TH-17) pathway and its related interleukin-17 (IL-17) cytokine. Thus, new antipsoriatic therapies have been developed to block this key cytokine and its downstream effects. Secukinumab is a fully humanized, monoclonal anti-IL-17A antibody, and the first in its class to be approved by the US Food and Drug Administration for the treatment of moderate to severe plaque psoriasis. It has also been approved for the treatment of active psoriatic arthritis and ankylosing spondylitis. Its clinical efficacy in plaque psoriasis has been well demonstrated in numerous phase II and III clinical trials. In addition, it has shown superiority in clinical trials to current biologic agents including etanercept and ustekinumab, with a safe adverse event profile. In correlation with excellent skin improvements, secukinumab is also associated with significant improvements in health-related quality of life measures. Thus, secukinumab offers the potential for equal, or improved, therapeutic effects compared with other biologics, and is a valuable addition to our current antipsoriatic armamentarium.

scholarly journals Pilot Studies on Two Complementary Bath Products for Atopic Dermatitis Children: Pine-Tar and Tea

Medicines ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. 8 ◽  
Author(s):  
Kam Hon ◽  
Wing Ng ◽  
Jeng Kung ◽  
Ping Leung ◽  
Ting Leung
Keyword(s):  
Clinical Trials ◽  
Atopic Dermatitis ◽  
Disease Severity ◽  
Green Tea ◽  
Life Quality ◽  
Patient Acceptance ◽  
Pilot Studies ◽  
Before And After ◽  
Significant Efficacy

Background: Few standardized bath product clinical trials were performed for atopic dermatitis patients. Pine-tar and green tea extracts are plant-derived products that have been described as having anti-allergic effects which may reduce AD disease severity. Methods: The efficacy of two complementary bath products was studied and compared. Efficacy and acceptability of the bath products were measured by patient general acceptability of treatment (GAT: very good, good, fair or poor), disease severity (SCORAD: SCoring Atopic Dermatitis), quality of life (CDLQI: Children Dermatology Life Quality Index), and pertinent clinical parameters were measured before and after four weeks of treatment. Sample size calculations for further clinical trials were performed. In one group, nine AD patients were subjected to bathing with a pine-tar bath oil for 10–15 min daily for four weeks. In another group, 20 AD subjects bathed with a teabag containing green tea extracts for four weeks. Results: Significant improvements in clinical- and patient-orientated parameters were found in the pine-tar bathing group, but not the tea-bag bathing group. Both groups reported very good/good GAT on the studied products. Teabag bathing was considered not efficacious for further clinical trials. Conclusions: The pilot studies provided preliminary data on the efficacy of pine tar bath oil. We do not document a significant efficacy for bathing with tea extracts. Bathing with pine-tar is potentially a complementary topical treatment with good patient acceptance and adherence, but further evidence-based research for its recommendations is needed.

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