Efficacy of plasma exchange for antineutrophil cytoplasmic antibody-associated systemic vasculitis: a systematic review and meta-analysis

Abstract Objective To assess through systematic review and meta-analysis whether plasma exchange (PE) is associated with prognosis in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients. Methods A systematic search of PubMed, MEDLINE, Embase, and CENTRAL databases from inception to 17 June 2020 was conducted. Ongoing or unpublished trials were also searched in ClinicalTrials.gov and the World Health Organization trials portal. Randomised controlled trials (RCTs) comparing PE vs. non-PE in AAV patients (microscopic polyangiitis [MPA], granulomatosis with polyangiitis [GPA], or eosinophilic granulomatosis with polyangiitis [EGPA]) were included. The combined risk ratio (RR) was calculated by the random-effects model using the Mantel-Haenszel method. Heterogeneity was measured using the I2 statistic. Primary outcomes were mortality, clinical remission (CR), and adverse events (AEs). Results Four RCTs comparing PE vs. no PE (N = 827) and 1 RCT comparing PE vs. pulse steroid treatment (N = 137) were included. All participants were MPA or GPA patients (no EGPA patients). PE was not associated with main primary outcomes compared with no PE (mortality RR 0.93 [95% confidence interval {CI} 0.70–1.24], I2 = 0%; CR RR 1.02 [95% CI 0.91–1.15], I2 = 0%; and AE RR 1.10 [95% CI 0.73–1.68], I2 = 37%) or pulse steroid (mortality RR 0.99 [95% CI 0.71–1.37]; CR [the Birmingham Vasculitis Activity score] mean difference − 0.53 [95% CI − 1.40–0.34]; and AE RR 1.05 [95% CI 0.74–1.48]). Focusing on the early treatment phases, PE was associated with a reduction in end-stage renal disease incidence compared with both no PE (PE 1/43 vs. no PE 10/41; RR 0.14 [0.03–0.77] at 3 months) and pulse steroid (PE 11/70 vs. pulse steroid 23/67; RR 0.46 [0.24–0.86] at 3 months). Conclusion We carried out a systematic review and meta-analysis targeting all AAV patients, including MPA, GPA, and EGPA. In AAV patients, performing PE was not associated with the risk of mortality, CR, and AE. No RCT exists evaluating the efficacy of PE for EGPA; hence, this is required in the future. The results may affect the development of guidelines for AAV and may indicate the direction of future clinical research on AAV. Trial registration UMIN R000045239, PROSPERO CRD42020182566.

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Accuracy of Ultrasound in Diagnosis of Pneumothorax: A Comparison between Neonates and Adults—A Systematic Review and Meta-Analysis

Canadian Respiratory Journal ◽

10.1155/2019/5271982 ◽

2019 ◽

Vol 2019 ◽

pp. 1-16 ◽

Cited By ~ 2

Author(s):

Hamid Dahmarde ◽

Fateme Parooie ◽

Morteza Salarzaei

Keyword(s):

Systematic Review ◽

Confidence Interval ◽

Odds Ratio ◽

English Language ◽

Meta Analysis ◽

Diagnostic Odds Ratio ◽

World Health ◽

Cochrane Library ◽

Chest Ultrasonography ◽

Link Type

Objective. The present systematic review and meta-analysis were conducted to investigate the accuracy of ultrasound in the diagnosis of pneumothorax in neonates and adults. Method. The searches were conducted by two independent researchers (MS and HD) to find the relevant studies published from 01/01/2009 until the end of 01/01/2019. We searched for published literature in the English language in MEDLINE via PubMed, Embase™ via ovid, the Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS, and we searched OpenGrey (http://www.opengrey.eu/) and the World Health Organization Clinical Trials Registry (http://who.int/ictrp) for unpublished literature and ongoing studies. The keywords used in the search strategy were pneumothorax or ultrasound or chest ultrasonography or neonate or adult or aerothorax or sensitivity or specificity or diagnostic accuracy. The list of previous study resources and systematic reviews was also searched for identifying the published studies (MS and HD). Analyses were performed using Meta-Disc 1.4. Results. In total, 1,565 patients (255 neonates, 1212 adults, and 101 pediatrics suspected of pneumothorax) were investigated in 10 studies. The overall specificity of chest ultrasound in the diagnosis of pneumothorax in both populations of adults and neonates was 85.1% at the confidence interval of 95 percent (95% CI 81.1%–88.5%). At the confidence interval of 95 percent, the sensitivity was 98.6% (95% CI 97.7%–99.2%). The diagnostic odds ratio was 387.72 (95% CI 76.204–1972.7). For the diagnosis of pneumothorax in neonates, the ultrasound sensitivity was 96.7% at the confidence interval of 95 percent (95% CI 88.3%–99.6%). At the confidence interval of 95 percent, the specificity was 100% (95% CI 97.7%–100%). For the diagnosis of pneumothorax in adults, the ultrasound sensitivity was 82.9% at the confidence interval of 95 percent (95% CI 78.3–86.9%). At the confidence interval of 95 percent, the specificity was 98.2% (95% CI 97.0%–99.0%). The diagnostic odds ratio was 423.13 (95% CI 45.222–3959.1). Analyzing studies indicated that the sensitivity of “absence lung sliding” sign for the diagnosis of pneumothorax was 87.2% (95% CI 77.7–93.7), and specificity was 99.4% (95% CI 96.5%–100%). DOR was 556.74 (95% CI 100.03–3098.7). The sensitivity of “lung point” sign for the diagnosis of pneumothorax was 82.1% (95% CI 71.7%–89.8%), and the specificity was 100% (at the confidence interval of 95% CI 97.6%–100%). DOR was 298.0 (95% CI 58.893–1507.8). Conclusion. The diagnosis of pneumothorax using ultrasound is accurate and reliable; additionally, it can result in timely diagnoses specifically in neonatal pneumothorax. Using this method facilitates the therapy process; lack of ionizing radiation and easy operation are benefits of this imaging technique.

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Antineutrophil Cytoplasmic Antibodies and Organ-Specific Manifestations in Eosinophilic Granulomatosis with Polyangiitis: A Systematic Review and Meta-Analysis

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2020.07.038 ◽

2020 ◽

Cited By ~ 1

Author(s):

Hua-Ching Chang ◽

Pai-Chien Chou ◽

Chun-Yu Lai ◽

Hsiou-Hsin Tsai

Keyword(s):

Systematic Review ◽

Granulomatosis With Polyangiitis ◽

Meta Analysis ◽

Antineutrophil Cytoplasmic Antibodies ◽

Eosinophilic Granulomatosis With Polyangiitis ◽

Organ Specific ◽

Eosinophilic Granulomatosis

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Eosinophilic Granulomatosis with Polyangiitis: A Systematic Review and Meta‐Analysis of Test Accuracy and Benefits and Harms of Common Treatments

ACR Open Rheumatology ◽

10.1002/acr2.11194 ◽

2021 ◽

Vol 3 (2) ◽

pp. 101-110

Author(s):

Jason M. Springer ◽

Mohamad A. Kalot ◽

Nedaa M. Husainat ◽

Kevin W. Byram ◽

Anisha B. Dua ◽

...

Keyword(s):

Systematic Review ◽

Granulomatosis With Polyangiitis ◽

Meta Analysis ◽

Eosinophilic Granulomatosis With Polyangiitis ◽

Test Accuracy ◽

Eosinophilic Granulomatosis

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POS0246 THE WORLDWIDE INCIDENCE AND PREVALENCE OF ANCA VASCULITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF EPIDEMIOLOGICAL STUDIES

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1630 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 344.1-345

Author(s):

R. Redondo Rodriguez ◽

N. Mena-Vázquez ◽

A. M. Cabezas-Lucena ◽

F. Godoy-Navarrete ◽

M. Morales-Águila ◽

...

Keyword(s):

Systematic Review ◽

Granulomatosis With Polyangiitis ◽

Meta Analysis ◽

Geographic Area ◽

Epidemiological Studies ◽

Eosinophilic Granulomatosis With Polyangiitis ◽

Anca Vasculitis ◽

Pooled Prevalence ◽

The Individual ◽

Incident Cases

Objectives:To evaluate the worldwide incidence and prevalence of ANCA vasculitis through a systematic review of the literature and meta-analysis.Methods:A systematic search of MEDLINE and EMBASE search engines was carried out for studies that analyzed the incidence and prevalence of ANCA vasculitis in different geographical areas. Inclusion criteria: patients diagnosed with ANCA vasculitis according to ACR criteria/ Chapel Hill Consensus and adult patients (> 16 years). All ANCA vasculitis (microscopic polyangiitis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis) were considered. Exclusion criteria: editorials, conference abstracts, case or cases series reports and narrative reviews; insufficient description of the methods; lack of data to compute incidence or prevalence; and duplicate studies.Variables: Main variable: the pooled prevalence measured by the number of prevalent cases per million / person-year (95% CI) and the pooled incidence measured as the number of incident cases per million / person-year (95% CI). Secondary variables: the prevalence and incidence of each vasculitis ANCA and according geographic area. A meta-analysis was undertaken to estimate the pooled incidence and the pooled prevalence per million / person-years. The 95% CI and I2 for heterogeneity were calculated.Results:Twenty four studies were included. The pooled incidence (95% CI) was 12.2 per million / person-year (8.4-16.5) and the pooled prevalence (95% CI) was 130 per million / person-year (67.5-213). The individual incidence for each vasculitis was: GPA (6.7), MPA (5.9) and EGPA (1.6). The individual prevalence for each vasculitis was: GPA (69.3), MPA (21.9) and EGPA (13.5).In the analysis by continents, the pooled incidence for GPA vasculitis was higher in Europe (7.5), while the pooled incidence for MPA vasculitis was higher in America (6.9) and for EGPA vasculitis it was higher in Asia (1.8). The pooled prevalence for GPA and MPA vasculitis was higher in Europe (83.9,24.4 respectively) than in America (14.2, 12.8 respectively).Conclusion:The pooled incidence and the pooled prevalence are higher in the case of GPA vasculitis compared to the rest of ANCA vasculitis. In general there is a predominance of incidence and prevalence of all ANCA vasculitis in the northern hemisphere compared to the south.Figure 1.The pooled incidence ANCA vasculitis.Figure 2.The pooled prevalence ANCA vasculitisDisclosure of Interests:None declared

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Interventions to Reduce Alcohol Harms in Low and Middle Income Countries: a Systematic Review and Meta Analysis

10.31234/osf.io/mg5s4 ◽

2018 ◽

Author(s):

Joao Ricardo Nickenig Vissoci

Keyword(s):

Systematic Review ◽

Alcohol Use ◽

Randomized Controlled Trials ◽

Brain Stimulation ◽

Meta Analysis ◽

World Health ◽

Controlled Trials ◽

Middle Income ◽

Brief Motivational Intervention ◽

Randomized Controlled

BackgroundHarmful alcohol use leads to a large burden of disease and disability which disportionately impacts LMICs. The World Health Organization and the Lancet have issued calls for this burden to be addressed, but issues remain, primarily due to gaps in information. While a variety of interventions have been shown to be effective at reducing alcohol use in HICs, their efficacy in LMICs have yet to be assessed. This systematic review describes the current published literature on alcohol interventions in LMICs and conducts a meta analysis of clinical trials evaluating interventions to reduce alcohol use and harms in LMICs.MethodsIn accordance with PRISMA guidelines we searched the electronic databases Pubmed, EMBASE, Scopus,Web of Science, Cochrane, and Psych Info. Articles were eligible if they evaluated an intervention targeting alcohol-related harm in LMICs. After a reference and citation analysis, we conducted a quality assessment per PRISMA protocol. A meta-analysis was performed on the 39 randomized controlled trials that evaluated an alcohol-related outcome.ResultsOf the 3,801 articles from the literature search, 87 articles from 25 LMICs fit the eligibility and inclusion criteria. Of these studies, 39 randomized controlled trials were included in the meta-analysis. Nine of these studies focused specifically on medication, while the others focused on brief motivational intervention, brain stimulation, AUDIT-based brief interventions, WHO ASSIST-based interventions, group based education, basic screening and interventions, brief psychological or counseling, dyadic relapse prevention, group counseling, CBT, motivational + PTSD based interview, and health promotion/awareness. Conclusion Issues in determining feasible options specific to LMICs arise from unstandardized interventions, unequal geographic distribution of intervention implementation, and uncertain effectiveness over time. Current research shows that brain stimulation, psychotherapy, and brief motivational interviews have the potential to be effective in LMIC settings, but further feasibility testing and efforts to standardize results are necessary to accurately assess their effectiveness.

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Effect of interventions based on educational technologies on the prevention of sexually transmitted infections in incarcerated women: protocol of a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-043373 ◽

2021 ◽

Vol 11 (4) ◽

pp. e043373

Author(s):

Isaiane da Silva Carvalho ◽

Ryanne Carolynne Marques Gomes Mendes ◽

Priscila de Oliveira Cabral Melo ◽

Caroline Ferraz Simões ◽

Luciana Pedrosa Leal ◽

...

Keyword(s):

Systematic Review ◽

Health Education ◽

Sexually Transmitted Infections ◽

Fixed Effects ◽

Meta Analysis ◽

Incarcerated Women ◽

Mean Difference ◽

World Health ◽

Educational Technologies ◽

Sexually Transmitted

IntroductionPrisons are places with high vulnerability and high risk for the development of sexually transmitted infections. World Health Agencies recommend establishing intervention measures, such as information and education, on the prevention of diseases. Thus, technologies as tools for health education have been used to reduce sexually transmitted infections. However, no systematic review has investigated the effectiveness of these interventions. Therefore, this review’s objective is to examine the effect of educational technologies used for preventing sexually transmitted infections in incarcerated women.Methods and analysisPreferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be strictly followed. The following electronic databases will be searched: Scopus; Cumulative Index of Nursing and Allied Health, Education Resources Information Center, Embase, PsycINFO, PubMed/Medline, Web of Science and Google Scholar. Randomised clinical trials of interventions that used educational technologies to prevent sexually transmitted infections in incarcerated women will be searched in the databases from the beginning of 2020 until December by two researchers independently. A narrative synthesis will be constructed for all included studies, and if there are sufficient data, a meta-analysis will be performed using the Review Manager software (V.5.3). Continuous results will be presented as the weighted mean difference or the standardised mean difference with 95% CIs. Under the heterogeneity of the included studies, a random-effects or fixed-effects model will be used. The studies’ heterogeneity will be assessed by the I2 method. The sensitivity analysis will be carried out to examine the magnitude of each study’s influence on the general results. A significance level of p≤0.05 will be adopted.Ethics and disclosureEthical approval is not required because no primary data will be collected. The results will be published in journals reviewed by peers.PROSPERO registration numberCRD42020163820.

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Effect of consumption of animal milk compared to infant formula for non-breastfed/mixed-fed infants 6–11 months of age: a systematic review (protocol)

BMJ Open ◽

10.1136/bmjopen-2020-046370 ◽

2021 ◽

Vol 11 (2) ◽

pp. e046370

Author(s):

Aamer Imdad ◽

Julie Melissa Ehrlich ◽

Joseph Catania ◽

Emily Tanner-Smith ◽

Abigail Smith ◽

...

Keyword(s):

Systematic Review ◽

Infant Formula ◽

Breast Feeding ◽

Meta Analysis ◽

Risk Of Bias ◽

World Health ◽

Control Group ◽

Breastfed Infants ◽

Evaluation Approach ◽

Animal Milk

IntroductionPrevalence rates of breastfeeding remain low even though the World Health Organization (WHO) and the American Academy of Pediatrics recommend exclusive breast feeding for the first 6 months of life in combination with appropriate complementary feeding beyond six 6 months of age. There have been several studies that address the implication of drinking animal milk and/or infant formula on children’s health and development when breast feeding is not offered during the first year of life. Vast improvements have been made in infant formula design, which may increase its benefits compared with animal’s milk. The objective of this review is therefore to synthesise the most recent evidence on the effects of the consumption of animal milk compared with infant formula in non-breastfed or mixed breastfed infants aged 6–11 months.Methods and analysisWe will conduct a systematic review and meta-analysis of studies that assessed the effect of animal milk compared with formula or mixed-fed (breastmilk and formula) on infants aged 6–11 months. The primary outcomes of interest include anaemia, gastrointestinal blood loss, weight for age, height for age and weight for height. We will include randomised and non-randomised studies with a control group. We will use the Cochrane risk of bias tools to assess the risk of bias. We will use meta-analysis to pool findings if the identified studies are conceptually homogenous and data are available from more than one study. We will assess the overall quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.Ethics and disseminationThis is a systematic review, so no patients will be directly involved in the design or development of this study. The findings from this systematic review will be disseminated to relevant patient populations and caregivers and will guide the WHO’s recommendations on formula consumption versus animal milk in infants aged 6–11 months.Trial registration numberCRD42020210925.

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A living WHO guideline on drugs to prevent covid-19

BMJ ◽

10.1136/bmj.n526 ◽

2021 ◽

pp. n526

Author(s):

François Lamontagne ◽

Thomas Agoritsas ◽

Reed Siemieniuk ◽

Bram Rochwerg ◽

Jessica Bartoszko ◽

...

Keyword(s):

Systematic Review ◽

Guideline Development ◽

Meta Analysis ◽

World Health ◽

Policy And Practice ◽

Assessment Development ◽

Research Priority ◽

Health Organization ◽

Almost All ◽

Drug Interventions

Abstract Clinical question What is the role of drugs in preventing covid-19? Why does this matter? There is widespread interest in whether drug interventions can be used for the prevention of covid-19, but there is uncertainty about which drugs, if any, are effective. The first version of this living guideline focuses on the evidence for hydroxychloroquine. Subsequent updates will cover other drugs being investigated for their role in the prevention of covid-19. Recommendation The guideline development panel made a strong recommendation against the use of hydroxychloroquine for individuals who do not have covid-19 (high certainty). How this guideline was created This living guideline is from the World Health Organization (WHO) and provides up to date covid-19 guidance to inform policy and practice worldwide. Magic Evidence Ecosystem Foundation (MAGIC) provided methodological support. A living systematic review with network analysis informed the recommendations. An international guideline development panel of content experts, clinicians, patients, an ethicist and methodologists produced recommendations following standards for trustworthy guideline development using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Understanding the new recommendation The linked systematic review and network meta-analysis (6 trials and 6059 participants) found that hydroxychloroquine had a small or no effect on mortality and admission to hospital (high certainty evidence). There was a small or no effect on laboratory confirmed SARS-CoV-2 infection (moderate certainty evidence) but probably increased adverse events leading to discontinuation (moderate certainty evidence). The panel judged that almost all people would not consider this drug worthwhile. In addition, the panel decided that contextual factors such as resources, feasibility, acceptability, and equity for countries and healthcare systems were unlikely to alter the recommendation. The panel considers that this drug is no longer a research priority and that resources should rather be oriented to evaluate other more promising drugs to prevent covid-19. Updates This is a living guideline. New recommendations will be published in this article and signposted by update notices to this guideline. Readers note This is the first version of the living guideline for drugs to prevent covid-19. It complements the WHO living guideline on drugs to treat covid-19. When citing this article, please consider adding the update number and date of access for clarity.

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