scholarly journals The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ching-Yi Chen ◽  
Chao-Hsien Chen ◽  
Cheng-Yi Wang ◽  
Chih-Cheng Lai ◽  
Chien-Ming Chao ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Usual Care ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Meta Analysis ◽  
Lung Function Decline ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background The effect of additional antimicrobial agents on the clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) is unclear. Methods We performed comprehensive searches of randomized control trials (RCTs) that compared the clinical efficacy of additional antimicrobial agents to those of placebo or usual care in the treatment of IPF patients. The primary outcome was all-cause mortality, and the secondary outcomes were changes in forced vital capacity (FVC), diffusing capacity of the lung for carbon monoxide (DLCO), and the risk of adverse events (AEs). Results Four RCTs including a total of 1055 patients (528 receiving additional antibiotics and 527 receiving placebo or usual care) were included in this meta-analysis. Among the study group, 402 and 126 patients received co-trimoxazole and doxycycline, respectively. The all-cause mortality rates were 15.0% (79/528) and 14.0% (74/527) in the patients who did and did not receive additional antibiotics, respectively (odds ratio [OR] 1.07; 95% confidence interval [CI] 0.76 to 1.51; p = 0.71). No significant difference was observed in the changes in FVC (mean difference [MD], 0.01; 95% CI − 0.03 to 0.05; p = 0.56) and DLCO (MD, 0.05; 95% CI − 0.17 to 0.28; p = 0.65). Additional use of antimicrobial agents was also associated with an increased risk of AEs (OR 1.65; 95% CI 1.19 to 2.27; p = 0.002), especially gastrointestinal disorders (OR 1.54; 95% CI 1.10 to 2.15; p = 0.001). Conclusions In patients with IPF, adding antimicrobial therapy to usual care did not improve mortality or lung function decline but increased gastrointestinal toxicity.

scholarly journals The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Ching-Yi Chen ◽  
Chao-Hsien Chen ◽  
Cheng-Yi Wang ◽  
Chih-Cheng Lai ◽  
Chien-Ming Chao ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Usual Care ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Meta Analysis ◽  
Lung Function Decline ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background The effect of additional antimicrobial agents on the clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) is unclear. Methods We performed comprehensive searches of randomized control trials (RCTs) that compared the clinical efficacy of additional antimicrobial agents to those of placebo or usual care in the treatment of IPF patients. The primary outcome was all-cause mortality, and the secondary outcomes were changes in forced vital capacity (FVC), diffusing capacity of the lung for carbon monoxide (DLCO), and the risk of adverse events (AEs). Results Four RCTs including a total of 1055 patients (528 receiving additional antibiotics and 527 receiving placebo or usual care) were enrolled in this meta-analysis. Among the study group, 402 and 126 patients received co-trimoxazole and doxycycline, respectively. The all-cause mortality rates were 15.0% (79/528) and 14.0% (74/527) in the patients who did and did not receive additional antibiotics, respectively (odds ratio [OR], 1.07; 95% confidence interval [CI], 0.76 to 1.51; p = 0.71). No significant difference was observed in the changes in FVC (mean difference [MD], 0.01; 95% CI, -0.03 to 0.05; p = 0.56) and DLCO (MD, 0.05; 95% CI, -0.17 to 0.28; p = 0.65). Additional use of antimicrobial agents was also associated with an increased risk of AEs (OR, 1.65; 95% CI, 1.19–2.27; p = 0.002), especially gastrointestinal disorders (OR, 1.54; 95% CI, 1.10–2.15; p = 0.001). Conclusion In patients with IPF, adding antimicrobial therapy to usual care did not improve mortality or lung function decline but increased gastrointestinal toxicity.

Prognostic role of Krebs von den Lungen-6 (KL-6) measurement in idiopathic pulmonary fibrosis: a systematic review and meta-analysis

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Elena Aloisio ◽  
Federica Braga ◽  
Chiara Puricelli ◽  
Mauro Panteghini
Keyword(s):  
Systematic Review ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Binary Data ◽  
Meta Analysis ◽  
Mortality Prediction ◽  
Asian Populations ◽  
Increased Risk ◽  
Using Data ◽  
Patient Prognosis

Abstract Objectives Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial disease with limited therapeutic options. The measurement of Krebs von den Lungen-6 (KL-6) glycoprotein has been proposed for evaluating the risk of IPF progression and predicting patient prognosis, but the robustness of available evidence is unclear. Methods We searched Medline and Embase databases for peer-reviewed literature from inception to April 2020. Original articles investigating KL-6 as prognostic marker for IPF were retrieved. Considered outcomes were the risk of developing acute exacerbation (AE) and patient survival. Meta-analysis of selected studies was conducted, and quantitative data were uniformed as odds ratio (OR) or hazard ratio (HR) estimates, with corresponding 95% confidence intervals (CI). Results Twenty-six studies were included in the systematic review and 14 were finally meta-analysed. For AE development, the pooled OR (seven studies) for KL-6 was 2.72 (CI 1.22–6.06; p=0.015). However, a high degree of heterogeneity (I2=85.6%) was found among selected studies. Using data from three studies reporting binary data, a pooled sensitivity of 72% (CI 60–82%) and a specificity of 60% (CI 52–68%) were found for KL-6 measurement in detecting insurgence of AE in IPF patients. Pooled HR (seven studies) for mortality prediction was 1.009 (CI 0.983–1.036; p=0.505). Conclusions Although our meta-analysis suggested that IPF patients with increased KL-6 concentrations had a significant increased risk of developing AE, the detection power of the evaluated biomarker is limited. Furthermore, no relationship between biomarker concentrations and mortality was found. Caution is also needed when extending obtained results to non-Asian populations.

Abstract WP112: Thrombolysis for AIS in the Unwitnessed or Extended Therapeutic Time Window: A Systematic Review and Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Aristeidis H Katsanos ◽  
Konark Malhotra ◽  
Amrou Sarraj ◽  
Andrew Barreto ◽  
Martin Köhrmann ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Time Window ◽  
Meta Analysis ◽  
Onset Time ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Functional Improvement ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Introduction: We sought to assess the utility of intravenous thrombolysis (IVT) treatment in acute ischemic stroke (AIS) patients with unclear symptom onset time or outside the 4.5 hour time window, selected by advanced neuroimaging. Methods: We performed random-effects meta-analyses on the unadjusted and adjusted for potential confounders associations of IVT (alteplase 0.9 mg/kg) with the following outcomes: 3-month favorable functional outcome [FFO, modified Rankin Scale (mRS) scores: 0-1], 3-month functional independence (FI, mRS-scores: 0-2), 3-month mortality, 3-month functional improvement (assessed with ordinal analysis on the mRS-scores), symptomatic intracranial hemorrhage (sICH) and complete recanalization (CR). Results: We identified 4 eligible RCTs (859 total patients). In unadjusted analyses IVT was associated with higher likelihood of 3-month FFO (OR=1.48, 95%CI:1.12-1.96), FI (OR=1.42, 95%CI:1.07-1.90), sICH (OR=5.28, 95%CI:1.35-20.68) and CR (OR=3.29, 95%CI:1.90-5.69), with no significant difference in the odds of all-cause mortality risk at three months (OR=1.75, 95%CI: 0.93-3.29). In the adjusted analyses IVT was also associated with higher odds of 3-month FFO (OR adj =1.62, 95%CI:1.20-2.20), functional improvement (OR adj =1.42, 95%CI: 1.11-1.81) and sICH (OR adj =6.22, 95%CI: 1.37-28.26). There was no association between IVT and FI (OR adj =1.61, 95%CI: 0.94-2.75) or all-cause mortality at three months (OR adj =1.75, 95%CI: 0.93-3.29). No evidence of heterogeneity was evident in any of the analyses (I 2 =0). Conclusion: IVT in AIS patients with unknown symptom onset time or elapsed time from symptom onset more than 4.5 hours, selected with advanced neuroimaging, results in a higher likelihood of complete recanalization and functional improvement at three months despite the increased risk of sICH.

Systematic Review and Meta-analysis of Pirfenidone, Nintedanib, and Pamrevlumab for the Treatment of Idiopathic Pulmonary Fibrosis

2020 ◽  
pp. 106002802096445
Author(s):  
Enrica Di Martino ◽  
Alessio Provenzani ◽  
Patrizio Vitulo ◽  
Piera Polidori
Keyword(s):  
Systematic Review ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
World Health ◽  
Effect Model ◽  
All Cause Mortality ◽  
Positive Effect

Background: The comparative efficacy of pirfenidone, nintedanib, and pamrevlumab in slowing the rate of forced vital capacity (FVC) decline and mortality in patients with idiopathic pulmonary fibrosis (IPF) is unknown. Objective: To perform a systematic review and meta-analysis (MA) of these drugs for IPF. Methods: We searched CENTRAL, PubMed, EMBASE, ClincalTrials.gov, and the World Health Organization’s registry databases up to March 2020. Phase II/III randomized controlled trials in adults with IPF were eligible. The random-effect model was implemented calculating the effect size and respective 95% CI as Cohen’s d for change from baseline FVC (in percentage predicted and liters) and odds ratio (OR) for 10% reduction in FVC and all-cause mortality (ACM). Results: Six studies were included in the MA. For change from baseline in percentage predicted FVC, the MA indicated that the 3 drugs were more effective than placebo (pirfenidone: d=3.30%, 95% CI=2.15-4.45; nintedanib: d=3.15%, 95% CI=2.35-3.95; pamrevlumab: d=4.30%, 95% CI=0.45-8.15). These results are superimposable to those relating to change from baseline FVC in liters (pirfenidone: d=0.09L, 95% CI=0.04-0.14; nintedanib: d=0.13L, 95% CI=0.10-0.16; pamrevlumab: d=0.20L, 95% CI=0.05-0.35). Each drug had a positive effect on 10% reduction in FVC (pirfenidone: OR=0.57, 95% CI=0.45-0.74; nintedanib: OR=0.66, 95% CI=0.51-0.85; pamrevlumab: OR=0.24, 95% CI=0.08-0.73), but only pirfenidone showed an effect on ACM (OR=0.50; 95% CI=0.31-0.83). Conclusion and Relevance: This MA provided encouraging results on pamrevlumab efficacy in slowing the decline in FVC compared with pirfenidone and nintedanib. Actually, in phase 3, it could become a potential IPF treatment.

Sildenafil for idiopathic pulmonary fibrosis: A systematic review and meta-analysis

2021 ◽  
Author(s):  
Tyler Pitre ◽  
Muhammad Faran Khalid ◽  
Sonya Cui ◽  
Melanie C. Zhang ◽  
Renata Husnudinov ◽  
...  
Keyword(s):  
Systematic Review ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Meta Analysis ◽  
Rate Of Change ◽  
Point Estimate ◽  
Control Group ◽  
Randomized Controlled Studies ◽  
Significant Difference ◽  
Acute Exacerbations

Abstract Background: Patients with idiopathic pulmonary fibrosis have a poor overall prognosis and there are few evidence based drug therapies that reduce mortality. Objective: This systematic review and meta-analysis aims to assess whether sildenafil reduces mortality, reduces disease progression and the adverse side effects associated with it. Methods: In this review, randomized controlled studies (RCTs) were retrieved from MEDLINE, Cochrane, and EMBASE. The primary outcome was mortality. The secondary outcomes included change in FVC, acute exacerbations and hospitalizations and adverse drug effects leading to discontinuation. We used an inverse variance random effects meta-analysis method to calculate pooled odds ratio (OR) and standardized mean difference (SMD). Results: A total of 4 studies were included. Sildenafil probably reduces mortality when compared to placebo or to standard care, [OR 0.63 (0.38,1.03), I2=0%]. Pooled results showed sildenafil does not alter the rate of change of FVC [SMD 0.02 (-0.14,0.18)], or DLCO [SMR -0.01 (-0.18,0.17)], I2=0]. Pooled results showed sildenafil may not reduce the number of hospitalizations or acute exacerbations, [OR 1.06 (0.67,1.67)], I2= 0]. There was no significant difference in drug discontinuation due to adverse effects when comparing sildenafil to the control group, [OR 0.79 (0.56, 1.11)], I2=0]. Conclusion: Sildenafil probably reduces all-cause mortality in IPF patients. More studies need to be done in order to confirm the magnitude and reliability of the point estimate.

scholarly journals Sex-related differences in catheter ablation of atrial fibrillation: a systematic review and meta-analysis

EP Europace ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. 1509-1518 ◽  
Author(s):  
Xiaocheng Cheng ◽  
Qiongwen Hu ◽  
Lei Gao ◽  
Jian Liu ◽  
Shu Qin ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Pacemaker Implantation ◽  
Major Complications ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Detailed Assessment

Abstract Aims The sex-related differences in the clinical outcomes of rhythm and safety after catheter ablation remain unclear. The purpose of this study was to compare the clinical outcomes of catheter ablation for atrial fibrillation (AF) in women and men. Methods and results The Medline and EMBASE databases were searched for published articles up to December 2018. Studies that met our predefined inclusion criteria were included. The primary endpoints were freedom from AF/atrial tachycardia (AT) recurrence, stroke/transient ischaemic attack (TIA), and all-cause mortality. After literature search and detailed assessment, 19 observational studies (151 370 patients; 34% women) were identified. Our analyses showed that the rate of freedom from AF/AT recurrence was lower in women than men at the 2.4-year follow-up [odds ratio (OR): 0.75, 95% confidence interval (CI) 0.69–0.81; P < 0.0001]. Moreover, women had an increased risk of stroke/TIA (OR: 1.42, 95% CI 1.21–1.67; P < 0.0001) and all-cause mortality (OR: 1.53, 95% CI 1.02–2.28; P = 0.04). Nevertheless, for the endpoint of all-cause mortality, there was no significant difference between the two genders in the subgroup of prospective studies (OR: 1.19, 95% CI 0.69–2.05; P = 0.53). Additionally, women were more likely to experience major complications compared with men (pericardial effusion/tamponade, major bleeding requiring transfusion, and pacemaker implantation). Conclusions Women who underwent catheter ablation of AF might experience lower efficacy and a higher risk of stroke/TIA and major complications than men. The reasons for these sex-related differences need to be further studied.

scholarly journals An increased risk of lung cancer in combined pulmonary fibrosis and emphysema patients with usual interstitial pneumonia compared with patients with idiopathic pulmonary fibrosis alone: a systematic review and meta-analysis

2021 ◽  
Vol 15 ◽  
pp. 175346662110170
Author(s):  
Qianqian Chen ◽  
Ping Liu ◽  
Hong Zhou ◽  
Hui Kong ◽  
Weiping Xie
Keyword(s):  
Lung Cancer ◽  
Systematic Review ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Interstitial Pneumonia ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Usual Interstitial Pneumonia ◽  
Fixed Effects Model ◽  
Increased Risk

Background: Lung cancer is an important complication of combined pulmonary fibrosis and emphysema (CPFE). Whether the risk of lung cancer is higher in CPFE patients with usual interstitial pneumonia (UIP) than those with idiopathic pulmonary fibrosis (IPF) alone, remains controversial. We conducted this systematic review and meta-analysis to evaluate the prevalence of lung cancer in CPFE patients with UIP compared with IPF patients. Methods: We searched the PubMed, Embase, and Cochrane databases for studies that focused on the incidence of lung cancer in CPFE/UIP and IPF groups. We used a fixed-effects model to analyze the odds ratios (ORs) with 95% confidence intervals (CIs) according to data heterogeneity. The cumulative effects based on the publication year and sample size were assessed by cumulative meta-analysis. Results: A total of nine studies with 933 patients, including 374 CPFE patients with UIP, fulfilled the inclusion criteria. Overall, CPFE patients with UIP have a higher risk of lung cancer than those with IPF alone (OR = 2.69; 95% CI: 1.78–4.05). There were increased risks of lung cancer in CPFE/UIP patients with the presence of emphysema (OR = 2.93; 95% CI: 1.79–4.79) or emphysema in ⩾10% of the lung volume (OR = 2.22; 95% CI: 1.06–4.68). Conclusions: Our systematic review and meta-analysis indicated a significantly higher prevalence of lung cancer in CPFE patients with UIP than in patients with IPF alone. The reviews of this paper are available via the supplemental material section.

scholarly journals Prognosis of combined pulmonary fibrosis and emphysema: comparison with idiopathic pulmonary fibrosis alone

2019 ◽  
Vol 13 ◽  
pp. 175346661988811 ◽  
Author(s):  
Chun-guo Jiang ◽  
Qiang Fu ◽  
Chun-ming Zheng
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Poor Prognosis ◽  
Meta Analysis ◽  
Lower Lobe ◽  
Cochrane Central Register ◽  
Central Register ◽  
Significant Difference ◽  
Review Manager ◽  
Convincing Data

Background: Combined pulmonary fibrosis and emphysema (CPFE) is a syndrome characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis. However, whether CPFE has a higher or lower mortality than idiopathic pulmonary fibrosis (IPF) alone is still not clear. In this study we conducted a meta-analysis to assess the survival rate (SR) of CPFE versus IPF alone in clinical trials. Methods: We performed a systematic search of PubMed, Embase, and the Cochrane Central Register of Controlled Trials for trials published prior to 31 March 2018. Extracts from the literature were analyzed with Review Manager version 5.3. Results: Thirteen eligible trials were included in this analysis (involving 1710 participants). Overall, the pooled results revealed that no statistically significant difference was detected in the 1-year [relative risk (RR) = 0.98, 95% confidence interval (CI): 0.94–1.03, p = 0.47], 3-year (RR = 0.83, 95% CI: 0.68–1.01, p = 0.06), and 5-year (RR = 0.80, 95% CI: 0.59–1.07, p = 0.14) SRs of CPFE versus IPF alone. Conclusions: CPFE exhibits a very poor prognosis, similar to IPF alone. Additional studies are needed to provide more convincing data to investigate the natural history and outcome of patients with CPFE in comparison to IPF. The reviews of this paper are available via the supplemental material section.

scholarly journals Outcome After Mitral Valve Repair Or Replacement For Non-Ischemic Mitral Regurgitation: A System Review And Meta-Analysis

2021 ◽  
Author(s):  
Qianqian Fan ◽  
Xiaoguang Li ◽  
Guilan Cao ◽  
Puliang Yu ◽  
Fengxiao Zhang
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Cochrane Central Register ◽  
Valve Repair ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background: Mitral regurgitation (MR) is a rather common valvular heart disease. The purpose of this meta-analysis is to compare the outcomes, and complications of mitral valve replacement (MVR) with surgical mitral valve repair (MVr) of non-ischemic MR (NIMR).Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through Oct 2020. 4834 studies were reviewed, and only 20 studies enrolling a total of 21,898 patients with NIMR were included. Eligible studies were enrolling patients with MR and reporting early (30-day or in-hospital) or late all-cause mortality. For each study, data regarding all-cause mortality and incidence of reoperation and operative complications in both groups were used to generate odds ratios (ORs) or hazard ratios (HRs). Results: The pooled analysis showed that lower age, rate of women and incident of hypertension, significantly rates of diabetes and atrial fibrillation in MVR group than MVr group, no significant difference in rates of pre-operative left ventricle ejection fraction (LVEF) and heart failure. Subjects in MVr group is slightly less than MVR group. Replacement of MR has significantly increased risk of early and late mortality. Moreover, the rate of re-operation and post-operative MR in MVr group is lower than MVR group.Conclusions: In patients with NIMR, MVr procedure achieves higher survival and fewer complications than surgical MVR. Given these results, MVr surgery should be a priority for NIMR patients.

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