Randomized controlled trials (RCTs) examining continuous (CS) versus intermittent strategies (IS) of delivering systemic treatment (Tx) for untreated metastatic colorectal cancer (mCRC): An updated meta-analysis from the Cancer Care Ontario program in evidence-based care.

3534 Background: Given the varying impact on efficacy demonstrated in individual RCTs of CS vs IS of delivering systemic Tx for mCRC, a meta-analysis of the available RCTs was performed. Methods: RCTs that compared a CS versus IS of delivering systemic Tx were identified by a systematic search (MEDLINE, EMBASE and ASCO and ESMO proceedings) and review. The results of identified trials were clinically homogeneous (Table) so the data was pooled using Review Manager software (RevMan 5.2). Overall survival (OS) hazard ratios were extracted directly from the most recently reported trial results. A random effects model was used for all pooling. Results: 10 RCTs were identified (n= 4,296). After an induction period, the maintenance Tx patients received during the IS was: none (5 trials, n=2,562), fluoropyrimidine (F) (2 trials, n=759), biologic (B) (2 trials, n=852), F+B (1 trial, n=123). Results of the meta-analysis are summarized in the Table (HR>1 favors CS). Sensitivity analyses performed demonstrate results are robust independent of the induction or maintenance Tx used. QOL (data from 2 trials) was either the same in both arms (single Tx induction trial with no maintenance Tx, n=354) or improved in the IS arm (combination tx induction trial with no maintenance Tx, n=1,630). Conclusions: IS of delivering systemic Tx for mCRC do not result in a statistically significant reduction in OS compared to a CS of delivery whether or not maintenance therapy is included. QOL is the same or better with an IS. [Table: see text]

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The effectiveness of enhanced evidence-based care for depressive disorders: a meta-analysis of randomized controlled trials

Translational Psychiatry ◽

10.1038/s41398-021-01638-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Le Xiao ◽

Han Qi ◽

Wei Zheng ◽

Yu-Tao Xiang ◽

Thomas J. Carmody ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Usual Care ◽

Depressive Disorders ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Evidence Based ◽

Randomized Controlled ◽

Measurement Based Care ◽

Evidence Based Care

AbstractSeveral care models have been developed to improve treatment for depression, all of which provide “enhanced” evidence-based care (EEC). The essential component of these approaches is Measurement-Based Care (MBC). Specifically, Collaborative Care (CC), and Algorithm-guided Treatment (AGT), and Integrated Care (IC) all use varying forms of rigorous MBC assessment, care management, and/or treatment algorithms as key instruments to optimize treatment delivery and outcomes for depression. This meta-analysis systematically examined the effectiveness of EEC versus usual care for depressive disorders based on cluster-randomized studies or randomized controlled trials (RCTs). PubMed, the Cochrane Library, and PsycInfo, EMBASE, up to January 6th, 2020 were searched for this meta-analysis. The electronic search was supplemented by a manual search. Standardized mean difference (SMD), risk ratio (RR), and their 95% confidence intervals (CIs) were calculated and analyzed. A total of 29 studies with 15,255 participants were analyzed. EEC showed better effectiveness with the pooled RR for response of 1.30 (95%CI: 1.13–1.50, I2 = 81.9%, P < 0.001, 18 studies), remission of 1.35 (95%CI: 1.11–1.64, I2 = 85.5%, P < 0.001, 18 studies) and symptom reduction with a pooled SMD of −0.42 (95%CI: −0.61–(−0.23), I2 = 94.3%, P < 0.001, 19 studies). All-cause discontinuations were similar between EEC and usual care with the pooled RR of 1.08 (95%CI: 0.94–1.23, I2 = 68.0%, P = 0.303, 27 studies). This meta-analysis supported EEC as an evidence-based framework to improve the treatment outcome of depressive disorders.Review registration: PROSPERO: CRD42020163668

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