scholarly journals Efficacy of bedaquiline in the treatment of drug-resistant tuberculosis: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ming-Gui Wang ◽  
Shou-Quan Wu ◽  
Jian-Qing He
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Randomized Controlled ◽  
Resistant Tuberculosis ◽  
Culture Conversion

Abstract Background Drug-resistant tuberculosis (DR-TB) remains a major public health concern worldwide. Bedaquiline, a novel diarylquinoline, was added to the WHO-recommended all-oral regimen for patients with multidrug-resistant tuberculosis. We performed a systematic review and meta-analysis to determine the effect of bedaquiline on tuberculosis treatment outcomes. Methods We searched the PubMed, Web of Science and EMBASE databases for relevant studies published up to March 12, 2021. We included studies in which some participants received bedaquiline and others did not. Stata version 16.0 (Stata Corp., College Station, Texas, USA) was used to analyze the results of the meta-analysis. Risk ratios (RRs) with 95% confidence intervals (95% CIs) were calculated to evaluate the effect of bedaquiline on drug-resistant tuberculosis. Between-study heterogeneity was examined by the I-squared test. Randomized controlled trials were assessed for quality using the Jadad scale, and cohort studies were assessed using the Newcastle–Ottawa scale. Results Eight studies, including 2 randomized controlled trials and 6 cohort studies involving a total of 21,836 subjects, were included. When compared with the control, bedaquiline treatment was associated with higher rates of culture conversion (risk ratio (RR):1.272 (1.165–1.389), P < 0.001). We found substantial evidence of a significant reduction in all-cause death (RR: 0.529 (0.454–0.616), P < 0.001)) in the bedaquiline treatment group. There was no significant reduction in treatment success (RR = 0.980 (0.948–1.013, P = 0.234)). Conclusions This study demonstrated that compared with patients who do not receive bedaquiline, this drug has the potential to achieve a higher culture conversion rate and a lower mortality risk among drug-resistant tuberculosis cases.

Linezolid for the treatment of extensively drug-resistant tuberculosis: a systematic review and meta-analysis

2019 ◽  
Vol 23 (12) ◽  
pp. 1293-1307 ◽  
Author(s):  
Z. Lifan ◽  
B. Sainan ◽  
S. Feng ◽  
Z. Siyan ◽  
L. Xiaoqing
Keyword(s):  
Systematic Review ◽  
Initial Dose ◽  
Meta Analysis ◽  
Treatment Success ◽  
Drug Resistant ◽  
Drug Resistant Tuberculosis ◽  
Sputum Culture Conversion ◽  
Resistant Tuberculosis ◽  
Extensively Drug Resistant ◽  
Culture Conversion

SETTING: Studies have shown that linezolid (LZD) can be used to treat extensively drug-resistant tuberculosis (XDR-TB).OBJECTIVE: To conduct a systematic review and meta-analysis to assess existing evidence concerning efficacy and safety of LZD for XDR-TB treatment.DESIGN: The MEDLINE@OVID, PubMed, EMBASE, the Cochrane Library, Clinical Trials, Sinomed, CMCI, CNKI, VIP and Wanfang databases were systematically searched for randomised controlled trials, cohort studies, case series or case reports on XDR-TB patients treated with LZD from January 2000 to December 2016. Summary estimates of the rate of sputum culture conversion, treatment success and adverse effects were calculated; data that could not be combined were summarised and described qualitatively. The combined results were examined for heterogeneity, sensitivity and publishing bias.RESULTS: Twenty-two original studies covering a total of 302 patients with XDR-TB fulfilled the inclusion criteria. Pooled estimates for sputum culture conversion and treatment success rates were respectively 93.2% and 67.4% in XDR-TB patients on LZD treatment. The pooled estimates for the rate of myelosuppression, peripheral neuropathy, optic neuritis and adverse reactions of the gastrointestinal tract were respectively 42.5%, 26.0%, 19.0% and 35.0%. Heterogeneity was mostly due to the initial dose of LZD (≤600 mg/d or >600 mg/d), as patients with a high initial dose of LZD were more likely to have myelosuppression (48.4% vs. 24.8%, P = 0.010) and adverse events of the gastrointestinal tract (41.3% vs.15.4%, P = 0.100).CONCLUSION: LZD appears to be effective for XDR-TB, but adverse events are common. An LZD dose of ≤600 mg/d as the initial dose for treating XDR-TB patients is recommended.

scholarly journals Weight-Bearing and Mobilization in the Postoperative Care of Ankle Fractures: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Cohort Studies

PLoS ONE ◽  
2015 ◽  
Vol 10 (2) ◽  
pp. e0118320 ◽  
Author(s):  
Diederik P. J. Smeeing ◽  
Roderick M. Houwert ◽  
Jan Paul Briet ◽  
Johannes C. Kelder ◽  
Michiel J. M. Segers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Randomized Controlled Trials ◽  
Postoperative Care ◽  
Meta Analysis ◽  
Weight Bearing ◽  
Ankle Fractures ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Fracture Risks in Patients Treated With Different Oral Anticoagulants: A Systematic Review and Meta‐Analysis

2021 ◽  
Author(s):  
Huei‐Kai Huang ◽  
Carol Chiung‐Hui Peng ◽  
Shu‐Man Lin ◽  
Kashif M. Munir ◽  
Rachel Huai‐En Chang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cohort Studies ◽  
Fracture Risk ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Controlled Trials ◽  
Data Synthesis ◽  
Randomized Controlled ◽  
Fracture Risks

Background Evidence on the differences in fracture risk associated with non‐vitamin K antagonist oral anticoagulants (NOAC) and warfarin is inconsistent and inconclusive. We conducted a systematic review and meta‐analysis to assess the fracture risk associated with NOACs and warfarin. Methods and Results We searched PubMed, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov from inception until May 19, 2020. We included studies presenting measurements (regardless of primary/secondary/tertiary/safety outcomes) for any fracture in both NOAC and warfarin users. Two or more reviewers independently screened relevant articles, extracted data, and performed quality assessments. Data were retrieved to synthesize the pooled relative risk (RR) of fractures associated with NOACs versus warfarin. Random‐effects models were used for data synthesis. We included 29 studies (5 cohort studies and 24 randomized controlled trials) with 388 209 patients. Patients treated with NOACs had lower risks of fracture than those treated with warfarin (pooled RR, 0.84; 95% CI, 0.77–0.91; P <0.001) with low heterogeneity ( I 2 =38.9%). NOACs were also associated with significantly lower risks of hip fracture than warfarin (pooled RR, 0.89; 95% CI, 0.81–0.98; P =0.023). A nonsignificant trend of lower vertebral fracture risk in NOAC users was also observed (pooled RR, 0.74; 95% CI, 0.54–1.01; P =0.061). Subgroup analyses for individual NOACs demonstrated that dabigatran, rivaroxaban, and apixaban were significantly associated with lower fracture risks. Furthermore, the data synthesis results from randomized controlled trials and real‐world cohort studies were quite consistent, indicating the robustness of our findings. Conclusions Compared with warfarin, NOACs are associated with lower risks of bone fracture.

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