scholarly journals Incorporating adjustments for variability in control group response rates in network meta-analysis: a case study of biologics for rheumatoid arthritis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Chris Cameron ◽  
Abhishek Varu ◽  
Arthur Lau ◽  
Mahdi Gharaibeh ◽  
Marcelo Paulino ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Response Rates ◽  
Control Group ◽  
Severe Rheumatoid Arthritis ◽  
American College Of Rheumatology ◽  
Group Response ◽  
Study Heterogeneity ◽  
Treatment Comparisons

Abstract Background The importance of adjusting for cross-study heterogeneity in control group response rates when conducting network meta-analyses (NMA) was demonstrated using a case study involving a comparison of biologics for the treatment of moderate-to-severe rheumatoid arthritis. Methods Bayesian NMAs were conducted for American College of Rheumatology (ACR) 50 treatment response based upon a set of randomized controlled trials (RCTs) identified by a recently completed systematic review of the literature. In addition to the performance of an unadjusted NMA, a model adjusting for cross-study heterogeneity of control group response rates using meta-regression was fit to the data. Model fit was evaluated, and findings from both analyses were compared with regard to clinical interpretations. Results ACR 50 response data from a total of 51 RCTs and 16,223 patients were analyzed. Inspection of cross-study variability in control group response rates identified considerable differences between studies. NMA incorporating adjustment for this variability was associated with an average change of 38.1% in the magnitude of the ORs between treatment comparisons, and over 64% of the odds ratio changed by 15% or more. Important changes in the clinical interpretations drawn from treatment comparisons were identified with this improved modeling approach. Conclusions In comparing biologics for moderate to severe rheumatoid arthritis, failure to adjust for cross-trial differences in the control arm response rates in NMA can lead to biased estimates of comparative efficacy between treatments.

scholarly journals The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

2021 ◽  
Vol 28 ◽  
pp. 107327482199743
Author(s):  
Ke Chen ◽  
Xiao Wang ◽  
Liu Yang ◽  
Zheling Chen
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Meta Analysis ◽  
Response Rates ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival ◽  
And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

Abstract 631: Evaluation of Risk Factors for Cardiovascular Disease in Rheumatoid Arthritis

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Vitor M Rocha ◽  
Maria Guadalupe B Pippa
Keyword(s):  
Rheumatoid Arthritis ◽  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Total Cholesterol ◽  
Normal Population ◽  
Control Group ◽  
American College Of Rheumatology ◽  
Increased Risk ◽  
Systemic Inflammatory Disease

Backgroung: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease, that appear to be responsible for 50% of mortality for thrombotic events such as Myocardial Infarction (MI) and Ischemic Stroke (SI) in RA patients. Occur approximately a decade earlier in these patients compared with the normal population. Objectives: To determine the risk of developing cardiovascular disease in patients with Rheumatoid Arthritis according to the classification criteria of the American College of Rheumatology. Methods: To assess the risk of cardiovascular diseases we studied 78 patients diagnosed with Rheumatoid Arthritis. For this we used the criteria of the risk score of Acute Coronary Disease in 10 years according to the Framingham Heart Study. A control group consisted of 21 patients with osteoarthritis and fibromyalgia was also assessed using the same criteria, where age, sex, systolic blood pressure values, total cholesterol, cholesterol HDL, presence of smoking and diagnosis of diabetes, were scored. Results: Patients with rheumatoid arthritis had a mean disease duration of 12.8 years (SD=7.4), age 58.6 years (SD=10.3) and the control group 59.3 years (SD=10,0). The old values of total cholesterol, HDL, blood pressure and being with Diabetes Mellitus showed positive correlations with the Cardiovascular Risk, and Blood Pressure in the index this correlation was stronger (r=+0.593) in Rheumatoid Arthritis and age (r=+0.702) in the control group. The Global Cardiovascular Risk in each group were considered low (7,8 points to Rematoid Artrhrits and 9,3 points to the control group). Conclusion: The results showed no increased risk of cardiovascular disease when compared to control group. Remember that control group fact be constituted by a larger number of diabetics, which likely impact these results.

MAINTAINING WRIST FUNCTION IN SEVERE RHEUMATOID ARTHRITIS: A CASE STUDY OF REVISION SWANSON WRIST ARTHROPLASTY STAGED VIA A WRIST FUSION IN RHEUMATOID ARTHRITIS

Hand Surgery ◽  
2002 ◽  
Vol 07 (02) ◽  
pp. 183-185 ◽  
Author(s):  
J. N. Mutimer ◽  
G. E. B. Giddins
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Loss ◽  
Bone Stock ◽  
Severe Rheumatoid Arthritis ◽  
Rheumatoid Patient ◽  
Total Wrist Arthroplasty ◽  
Wrist Fusion ◽  
Wrist Function ◽  
Wrist Arthroplasty

We present a case of revision Swanson wrist arthroplasty staged via a wrist fusion in a patient with rheumatoid arthritis. Due to extensive bone loss in the rheumatoid patient, it may not be possible initially to revise a wrist arthroplasty; however after fusion with a bone graft to regain bone stock we have demonstrated that this is possible. It may even be possible to convert such a fusion to a total wrist arthroplasty.

scholarly journals Efficacy and safety of iguratimod combined with methotrexate vs. methotrexate alone in rheumatoid arthritis

2020 ◽  
Author(s):  
L.-J. Chen ◽  
Y.-J. Zhou ◽  
Z.-H. Wen ◽  
F. Tian ◽  
J.-Y. Li
Keyword(s):  
Rheumatoid Arthritis ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Combined Treatment ◽  
Cochrane Collaboration ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
American College Of Rheumatology ◽  
The Cochrane Collaboration

AbstractThe current systematic review and meta-analysis aims to evaluate the efficacy and safety of iguratimod (IGU) combined with methotrexate (MTX) versus MTX alone in rheumatoid arthritis (RA). Two independent investigators searched for original randomized controlled trials (RCTs) related to the combination of IGU and MTX in RA published before November 1, 2019, in PubMed, Cochrane Library, Embase, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), and WanFang Data. Additionally, we searched clinical trial registry websites. We assessed the methodological quality of the included trials using the Cochrane Collaboration tool and the seven-point Jadad scale. Statistical analyses were performed using Review Manager (RevMan) 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Meta-regression and publication bias analyses were performed using Stata version 14 software (StataCorp., College Station, TX, USA). A total of 7 RCTs consisting of 665 participants, with 368 participants in the active arm and 297 in the placebo arm, were included in the meta-analysis. The American College of Rheumatology (ACR) value was better in the IGU + MTX group than in the MTX alone group, with a pooled relative risk (RR) for ACR20 (American College of Rheumatology 20% improvement criteria), ACR50, and ACR70 of 1.40 (95% CI, 1.13–1.74), 2.09 (95% CI, 1.67–2.61), and 2.24 (95% CI, 1.53–3.28), respectively. The results of the meta-analysis demonstrated that there was no statistical significance in adverse events (1.06 (95% CI, 0.92–1.23)). The combined treatment is an effective, safe, and economical treatment option for patients who do not respond well to methotrexate alone or for patients who cannot afford expensive biologics that have no confirmed efficacy.

Metabolic and cardiovascular benefits of hydroxychloroquine in patients with rheumatoid arthritis: a systematic review and meta-analysis

2017 ◽  
Vol 77 (1) ◽  
pp. 98-103 ◽  
Author(s):  
Claire Rempenault ◽  
Bernard Combe ◽  
Thomas Barnetche ◽  
Cécile Gaujoux-Viala ◽  
Cédric Lukas ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Inflammatory Diseases ◽  
Meta Analysis ◽  
Survival Rates ◽  
Cochrane Library ◽  
Diabetes Incidence ◽  
American College Of Rheumatology ◽  
European League Against Rheumatism ◽  
Mean Differences ◽  
High Density Cholesterol

ObjectiveCardiovascular disease (CVD) is the leading cause of mortality in patients with rheumatoid arthritis (RA). Hydroxychloroquine (HCQ) has been shown to improve survival rates in other inflammatory diseases. We aimed to assess the available literature on the cardiovascular impact of HCQ in patients with RA.MethodsWe systematically searched for studies evaluating the effects of HCQ on cardiovascular outcomes of known risk factors for CVD in patients with RA. Databases searched were MEDLINE (via PubMed), EMBase, Cochrane Library and the American College of Rheumatology and European League Against Rheumatism annual meetings. A meta-analysis was performed with a random-effects model, estimating mean differences (MDs), HRs and 95% CIs. Data were extracted by one investigator and independently checked by another.ResultsThe literature search revealed 185 articles and abstracts of interest; further examination resulted in 16 studies fulfilling the criteria. The MDs between HCQ users and non-users in levels of total, low-density and high-density cholesterol and triglycerides were −9.8 (95% CI −14.0 to −5.6), −10.6 (95% CI −14.2 to −7.0), +4.1 (95% CI 2.2 to 6.0) and −19.2 (95% CI −27.2 to −11.1), respectively. Diabetes incidence was lower for HCQ ever users than never users (HR 0.59 (95% CI 0.49 to 0.70)). HCQ seemed to decrease insulin resistance and incidence of CVD, but data were too few for meta-analysis.ConclusionBesides its limited efficacy for disease activity and progression, HCQ may benefit the metabolic profile and to a lesser extent cardiovascular events in patients with RA, which suggests its usefulness combined with other conventional synthetic disease-modifying antirheumatic drugs.

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