scholarly journals A meta-analysis of prospective studies comparing the results of laminoplasty and laminectomy with instrumental fixation in the surgical treatment of patients with multilevel degenerative cervical spine diseases

2020 ◽  
Vol 75 (1) ◽  
pp. 54-68
Author(s):  
Vadim A. Byvaltsev ◽  
Andrey A. Kalinin ◽  
Marat A. Aliev ◽  
Valeriy V. Shepelev ◽  
Bobur R. Yusupov ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cervical Spine ◽  
Surgical Treatment ◽  
Perioperative Complications ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Random Effect ◽  
Cochrane Library ◽  
Continuous Variables ◽  
Degenerative Diseases

Background: Dorsal decompressive-stabilizing techniques laminotomy with laminoplasty (LP) and laminectomy with instrumental fixation (LF) are effective methods for surgical treatment of patients with multi-level degenerative diseases of the cervical spine. At the same time, there is currently no priority in determining the optimal method for posterior decompression and stabilization. Aim: conduct a comparative analysis of intraoperative parameters, clinical outcomes, radiological results and complications of LP and LF in the treatment of patients with multilevel degenerative diseases of the cervical spine. Methods: A meta-analysis of prospective cohort clinical trials was carried out, the primary sources were searched using the databases PubMed, CNKI, eLibrary and the Cochrane Library, published until March 2019, which compared the results of applying the LP and LF methods in the treatment of patients with multilevel degenerative diseases of the cervical spine. For dichotomous variables, the relative risk and the 95% confidence interval were calculated; in turn, for the continuous variables, the standardized difference of the mean values and their 95% confidence intervals were used, using random effect models and a fixed effect. Resuts: The meta-analysis included 6 prospective clinical trials, one of which was a randomized controlled trial. In total, the results of surgical treatment of 493 patients with multilevel degenerative diseases of the cervical spine were evaluated. In the group of drugs, statistically significantly smaller parameters of the duration of surgical intervention were verified (p 0.00001). At the same time, comparable parameters of cervical lordosis after surgery, the level of pain in the cervical spine, functional status according to NDI and JOA after surgery, the frequency of perioperative complications (p = 0.17, p = 0.05, p = 0.94, p = 0.96, p = 0.24, respectively). Conclusions: A meta-analysis showed that the functional outcomes of LP and LF, as well as instrumental results in the treatment of multilevel degenerative diseases of the cervical spine, are not clinically significant. In this case, the LP technique can be performed in a shorter period of time compared with LF.

scholarly journals Clinical and Molecular Characteristics Associated with Survival in Advanced Melanoma Treated with Checkpoint Inhibitors

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Sunil Badami ◽  
Sunil Upadhaya ◽  
Ravi Kanth Velagapudi ◽  
Pushyami Mikkilineni ◽  
Ranju Kunwor ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Randomized Clinical Trials ◽  
Checkpoint Inhibitors ◽  
Meta Analysis ◽  
Random Effect ◽  
Eastern Cooperative Oncology Group ◽  
Advanced Melanoma ◽  
Cochrane Library ◽  
Molecular Characteristics ◽  
Significant Heterogeneity

Background. We performed meta-analysis to gather more evidence regarding clinical-molecular subgroups associated with better overall survival (OS) in advanced melanoma treated with checkpoint inhibitors. Materials and Methods. We performed a systematic search of PubMed, Scopus, Cochrane Library, and clinical trial.gov. Randomized clinical trials that compared a checkpoint inhibitor (nivolumab or pembrolizumab) with investigator choice chemotherapy or ipilimumab were included in our study. Hazard ratios (HR) and confidence interval (CI) were calculated for progression-free survival (PFS) and OS for each subgroup using generic inverse model along with the random effect method. Results. A total of 6 clinical trials were eligible for the meta-analysis. OS was prolonged in wild BRAF subgroup (HR 0.65, 95% CI 0.49-0.85, p 0.002), Programmed cell death subgroup (PD-1+) (HR 0.57, 95% CI 0.41-0.80, p 0.001), and high lactate dehydrogenase (LDH) level subgroup (HR 0.60, 95% CI 0.38-0.95, p 0.03). Similarly, we found increased OS in eastern cooperative oncology group (ECOG) 1, males and age >65 years subgroups. Conclusions. Checkpoint inhibitors significantly increased OS in patients with wild BRAF, positive PD-1, and high LDH. However, results should be interpreted keeping in mind associated significant heterogeneity. The results of this study should help in designing future clinical trials.

scholarly journals Comparison Outcomes of Discover Total Disk Arthroplasty and Anterior Cervical Discectomy with Fusion in Surgical Treatment of Cervical Disk Degenerative Disease: a Meta-Analysis of Randomized Trials

2018 ◽  
Vol 24 (4) ◽  
pp. 137-147
Author(s):  
V. A. Byvaltsev ◽  
I. A. Stepanov ◽  
M. A. Aliyev ◽  
B M. Avakov ◽  
B. R. Yussupov ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Cervical Spine ◽  
Surgical Treatment ◽  
Adverse Events ◽  
Confidence Interval ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Degenerative Disease ◽  
Upper Limbs ◽  
Cervical Disk

The purpose —to compare the effectiveness of Discover cervical disk arthroplasty (CDA) and anterior cervical discectomy with fusion (ACDF) in the surgical treatment of cervical intervertebral disk (IVD) degenerative disease.Study design —a meta-analysis of randomized clinical trials.Material and Methods.Randomized clinical trials were conducted in the Pubmed, EMBASE, ELibrary and Cochrane Library databases published from 2008 to October 2018, which compared the results of Discover CDA and ACDF techniques in the surgical treatment of cervical IVD degenerative disease. For dichotomous variables, the relative risk and 95% confidence interval were calculated, standardized difference of mean values and their 95% confidence interval were used for continuous variables using the random effects model.Results.This meta-analysis included 9 randomized controlled clinical trials, including the results of surgical treatment of 513 patients with degenerative disease of the cervical IVD. In the CDA group, the operation time was significantly shorter, in contrast to the group of patients who underwent ACDF (p<0.0001). The values of blood loss (p = 0.89), levels of quality of life for patients according to the Neck Disability Index (NDI) (p = 0.22), severity of pain in the cervical spine (p = 0.50) and upper limbs on a visual analogue scale (VAS) (p = 0.16), as well as the prevalence of secondary surgical procedures (p = 0.68) and adverse events (p = 0.40) between the compared groups did not have significant differences. At the same time, significantly large values of the range of motion at the operated level were noted in the CDA group (p<0.00001).Conclusion.Discover CDA in comparison with ACDF has a significantly large values of range of motion at the operated level. At the same time, there were no statistically significant differences in the NDI scores, VAS pain scores in cervical spine and upper limbs, and the prevalence of secondary surgical procedures and adverse events between the compared groups of respondents were not identified.

scholarly journals Effect of n-3 long-chain polyunsaturated fatty acid intake on the eicosanoid profile in individuals with obesity and overweight: a systematic review and meta-analysis of clinical trials

2021 ◽  
Vol 10 ◽  
Author(s):  
Guilherme R. B. Schweitzer ◽  
Isabela N. M. S. Rios ◽  
Vivian S. S. Gonçalves ◽  
Kelly G. Magalhães ◽  
Nathalia Pizato
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Arachidonic Acid ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Primary Objective ◽  
Cochrane Library ◽  
Chain Polyunsaturated Fatty Acid ◽  
Obesity And Overweight

Abstract Dietary n-3 polyunsaturated fatty acids (PUFAs) present beneficial effects on counteracting inflammation status, displaying a critical anti-inflammatory role and maintaining physiological homeostasis in obesity. The primary objective of this systematic review was to evaluate the effect of n-3 PUFAs intake on the eicosanoid profile of people with obesity and overweight. The search strategy on Embase, Scopus, PubMed, Web of Science, Cochrane Library, Google Scholar and ProQuest was undertaken until November 2019 and updated January 2021. The effect size of n-3 PUFAs on prostaglandins was estimated by Glass's, type 1 in a random-effect model for the meta-analysis. Seven clinical trials met the eligible criteria and a total of 610 subjects were included in this systematic review, and four of seven studies were included in meta-analysis. The intake of n-3 PUFAs promoted an overall reduction in serum pro-inflammatory eicosanoids. Additionally, n-3 PUFAs intake significantly decreased the arachidonic acid COX-derived PG eicosanoid group levels (Glass's Δ −0⋅35; CI −0⋅62, −0⋅07, I2 31⋅48). Subgroup analyses showed a higher effect on periods up to 8 weeks (Glass's Δ −0⋅51; CI −0⋅76, −0⋅27) and doses higher than 0⋅5 g of n-3 PUFAs (Glass's Δ −0⋅46; CI −0⋅72, −0⋅27). Dietary n-3 PUFAs intake contributes to reduce pro-inflammatory eicosanoids of people with obesity and overweight. Subgroup's analysis showed that n-3 PUFAs can reduce the overall arachidonic acid COX-derived PG when adequate dose and period are matched.

scholarly journals Assessment of the Immune Effect and Safety of Cell Culture-Derived Influenza Vaccine from Egg-Derived by Meta Analysis

2020 ◽  
Vol 5 (10) ◽  
pp. 456-459
Author(s):  
Xingliang Geng ◽  
Ze Liu ◽  
Guoyang Liao
Keyword(s):  
Cell Culture ◽  
Clinical Trials ◽  
Randomised Controlled Trial ◽  
Influenza Vaccine ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Human Beings ◽  
Immune Effect ◽  
Randomised Controlled

Objective: The study was to evaluate the immune effect and safety difference of cell culture-derived influenza vaccine from egg-derived by meta analysis; Methods: It selected the article about clinical trials through medline, embase, cochrane library, FEBM, clinicaltrials.gov, WHO, and International Standard Randomised Controlled Trial Number Registry. There was no language restrictions (update to Apr 25, 2016). The threshold should contain cell culture-derived or egg-derived influenza vaccine for human beings; Result: It showed enough immune effect and accepted safety by using cell culture-derived influenza vaccine, compared with egg-derived influenza vaccine; Conclusion: The cell culture-derived influenza vaccine could be used for human after clinical trials, not differ from egg-derived.

Abiraterone acetate (AA) or docetaxel (D) in metastatic castration-sensitive prostate cancer (mCSPC): A systematic review and network meta-analysis of randomized clinical trials (RCTs).

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 243-243
Author(s):  
Irbaz Bin Riaz ◽  
Abdulaali Almutairi ◽  
Zeeshan Ali ◽  
Abdullah Alhifany ◽  
Sandipan Bhattacharjee ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Trials ◽  
Adverse Events ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Random Effect ◽  
Indirect Comparison ◽  
Cochrane Library ◽  
Cochrane Central Register

243 Background: AA and D have been shown in separate trials to increase overall survival in patients with mCSPC compared to Androgen Derivation Therapy (ADT). In the absence of head to head clinical trials and to provide clinical guidance, we performed an indirect comparison of AA and D using network meta-analysis. Methods: We performed a search of MEDLINE, EMBASE, Cochrane Library, and Cochrane Central Register of Controlled Trials to identify relevant clinical trials. Collected data included hazard ratio and confidence interval (CI) for Overall Survival (OS) and number of adverse events in each study arm. Risk for bias was assessed using the Cochrane Collaboration’s tool. Bayesian network meta-analysis was conducted using WinBUGS 1.4.3 software (MRC Biostatistics Unit, Cambridge, UK) to perform an indirect comparison of D and AA. Results: Five clinical trials were included in this analysis. Two trials (LATITUDE, STAMPEDE) compared AA to ADT and three trials (CHAARTED,STAMPEDE, GETUG-AFU 15 study) compared D to ADT. Results from both fixed effect and random effect network meta-analyses for the primary outcome (OS) revealed no statistical significance between AA and D (HR 0.81,95%CI 0.65-1.01; HR 0.81, 95%CI 0.40-1.82) respectively. Comparatively, abiraterone had statistically significant fewer events of anemia (OR 0.14,95%CI 0.08-0.23), neutropenia (OR 0.06,95%CI 0.03-0.12), peripheral edema (OR 0.21,95%CI 0.09-0.44), dyspnea (OR 0.22,95%CI 0.08-0.51), nausea (OR 0.09,95%CI 0.02-0.24), diarrhea (OR 0.06,95%CI 0.02-0.15), constipation (OR 0.25,95%CI 0.11-0.53), and fatigue (OR 0.12,95%CI 0.07-0.20). AA had statistically significant more events of hot flashes (OR 3.85, 95% CI2.33-6.25). For other adverse events, both drugs were statistically similar. Conclusions: There is no difference in OS using AA for longer periods in CSPC than a regimen of a limited number of cycles of D. There are significant differences in side effect profile of these drugs. Further analyses are needed to determine cost effectiveness of AA vs D under consideration of comparative efficacy and safety.

scholarly journals The Treatment of Acne with the Addition and Subtraction of Loquat Qingfei Yin: A Meta-Analysis

2021 ◽  
Vol 5 (4) ◽  
pp. 167-176
Author(s):  
Wenjun Xue ◽  
Pengguang Xu
Keyword(s):  
Large Scale ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Collaboration ◽  
Effective Rate ◽  
Cochrane Library ◽  
Control Group ◽  
Comprehensive Collection

Objective: To systematically evaluate the efficacy and safety of Loquat Qingfei Yin (LQFY) in the treatment of acne. Methods: Using computer retrieval, comprehensive collection of the full text database of Chinese journals till December 2020 (CNKI), Wanfang Data Knowledge Service Platform (Wanfang), Viper Database (VIP), PubMed, Cochrane Library, Medline were included in the LQFY addition or subtraction treatment of acne randomized controlled trial (RCT). Screening of the literatures included in the Note Express 3.2.0. Assessment of the risk of bias in trials using Cochrane collaboration tools, and used Rev Man 5.3 to evaluate the curative effect. Results: 25 RCT, all in Chinese, there were 2257 cases. Of the 1216 cases who were treated, control group was 1041 cases. A random effect model was used for Meta analysis. The results showed that the effective rate of the treatment group was significantly higher than that of the control group, Differences were statistically significant (P=0.94, I2=0%), RR=2.87, CI [2.25,95 per cent 3.67], P<0.00001. Conclusion: There are limited evidence that LQFY is safe and effective in treating acne. However, this conclusion needs to be confirmed by a more large-scale, multi-center, high-quality RCTs.

scholarly journals The Effects of Aromatherapy on Premenstrual Syndrome Symptoms: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Somayeh Es-haghee ◽  
Fatemeh Shabani ◽  
Jessie Hawkins ◽  
Mohammad Ali Zareian ◽  
Fatemeh Nejatbakhsh ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Premenstrual Syndrome ◽  
Randomized Clinical Trials ◽  
Weighted Mean Difference ◽  
Meta Analysis ◽  
Random Effect ◽  
Random Effect Model ◽  
Cochrane Library ◽  
Control Group ◽  
Childbearing Age

ObjectivesPremenstrual syndrome (PMS) is a common disturbance among women of childbearing age. Aromatherapy is a commonly used form of complementary and alternative medicine (CAM) to treat PMS. The purpose of this study is to quantify and summarize the effects of aromatherapy on premenstrual syndrome symptoms. Methods. PubMed, Scopus, and Cochrane Library databases were searched through relevant search terms until October 2020. The effect sizes were pooled as weighted mean difference (WMD) and 95% confidence interval (CI) using the random effect model. Egger tests and visual inspection of the funnel plot were performed to identify the existence of publication bias. The I-squared (I2) test was applied to measure heterogeneity. Results. Eight studies (n = 8) were included in this analysis. The quantitative synthesis of evidence found that aromatherapy decreases PMS scores (WMD –13.83; 95% CI (−22.04, −5.63), I2 = 94.5%), total psychological symptoms of PMS (WMD –3.51; 95% CI (−4.84, −2.18), I2 = 82.6%), anxiety of PMS (WMD–1.78; 95% CI (−3.17, −0.38), I2 = 94.2%), depression of PMS (WMD–2.0; 95% CI (−3.65, −0.34), I2 = 93.7%), and fatigue of PMS (WMD – 1.44; 95% CI (−2.44, −0.44), I2 = 89.7%) compared to the control group. Conclusion. Aromatherapy is an effective tool for the relief of PMS symptoms. Additional randomized controlled clinical trials with different durations and essential oils should be conducted to confirm our findings.

scholarly journals Day 5 versus Day 6 blastocyst transfers: a systematic review and meta-analysis of clinical outcomes

2019 ◽  
Vol 34 (10) ◽  
pp. 1948-1964 ◽  
Author(s):  
Mathilde Bourdon ◽  
Khaled Pocate-Cheriet ◽  
Astri Finet de Bantel ◽  
Veronika Grzegorczyk-Martin ◽  
Aureli Amar Hoffet ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Live Birth ◽  
Data Extraction ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Random Effect ◽  
Clinical Pregnancy ◽  
Cochrane Library ◽  
Significant Difference

Abstract STUDY QUESTION Is there a difference in clinical pregnancy and live birth rates (LBRs) between blastocysts developing on Day 5 (D5) and blastocysts developing on Day 6 (D6) following fresh and frozen transfers? SUMMARY ANSWER D5 blastocyst transfers (BTs) present higher clinical pregnancy and LBRs than D6 in both fresh and frozen transfers. WHAT IS KNOWN ALREADY BT is increasingly popular in assisted reproductive technology (ART) centers today. To our knowledge, no meta-analysis has focused on clinical outcomes in both fresh and frozen BT. Concerning frozen blastocysts, one meta-analysis in 2010 found no significant difference in pregnancy outcomes between D5 and D6 BT. Since then, ART practices have evolved particularly with the wide use of vitrification, and more articles comparing D5 and D6 BT cycles have been published and described conflicting results. STUDY DESIGN, SIZE, DURATION Systematic review and meta-analysis of published controlled studies. Searches were conducted from 2005 to February 2018 on MEDLINE and Cochrane Library and from 2005 to May 2017 on EMBASE, Eudract and clinicaltrials.gov, using the following search terms: blastocyst, Day 5, Day 6, pregnancy, implantation, live birth and embryo transfer (ET). PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 47 full-text articles were preselected from 808 references, based on title and abstract and assessed utilizing the Newcastle–Ottowa Quality Assessment Scales. Study selection and data extraction were carried out by two independent reviewers according to Cochrane methods. Random-effect meta-analysis was performed on all data (overall analysis) followed by subgroup analysis (fresh, vitrified/warmed, slow frozen/thawed). MAIN RESULTS AND THE ROLE OF CHANCE Data from 29 relevant articles were extracted and integrated in the meta-analysis. Meta-analysis of the 23 studies that reported clinical pregnancy rate (CPR) as an outcome, including overall fresh and/or frozen ET cycles, showed a significantly higher CPR following D5 ET compared with D6 ET (risk ratio (RR) = 1.27, 95% CI: 1.15–1.39, P < 0.001). For CPR, calculated subgroup RRs were 2.38 (95% CI: 1.74–3.24, P < 0.001) for fresh BT; 1.27 (95% CI: 1.16–1.39, P < 0.001) for vitrified/warmed BT; and 1.15 (95% CI: 0.93–1.41, P = 0.20) for slow frozen/thawed BT. LBR was also significantly higher after D5 BT (overall RR = 1.50 (95% CI: 1.32–1.69), P < 0.001). The LBR calculated RRs for subgroups were 1.74 (95% CI: 1.37–2.20, P < 0.001) for fresh BT; 1.38 (95% CI: 1.23–1.56, P < 0.001) for vitrified/warmed BT; and 1.44 (95% CI: 0.70–2.96, P = 0.32) for slow frozen/thawed BT. Sensitivity analysis led to similar results and conclusions: CPR and LBR were significantly higher following D5 compared to D6 BT. LIMITATIONS, REASONS FOR CAUTION The validity of meta-analysis results depends mainly on the quality and the number of the published studies available. Indeed, this meta-analysis included no randomized controlled trial (RCT). Slow frozen/thawed subgroups showed substantial heterogeneity. WIDER IMPLICATIONS OF THE FINDINGS In regards to the results of this original meta-analysis, ART practitioners should preferably transfer D5 rather than D6 blastocysts in both fresh and frozen cycles. Further RCTs are needed to address the question of whether D6 embryos should be transferred in a fresh or a frozen cycle. STUDY FUNDING/COMPETING INTEREST(S) This work was sponsored by an unrestricted grant from GEDEON RICHTER France. The authors have no competing interests to declare. REGISTRATION NUMBER CRD42018080151.

Meta Analysis of Grade 3 and/or 4 Toxicities in Follicular (FL) and Mantle Cell (MCL) Non-Hodgkin Lymphoma (NHL) Patients Receiving Maintenance Rituximab (MR): Impact of Schedule, Histology, and Induction Regimen

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3654-3654
Author(s):  
Chadi Nabhan ◽  
Dana Villines ◽  
Brian C-H Chiu ◽  
Nicholas J. Ollberding ◽  
Tina V. Valdez ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Research Funding ◽  
Meta Analysis ◽  
Random Effect ◽  
Cochrane Library ◽  
Induction Phase ◽  
Low Grade ◽  
Front Line ◽  
Grade 3 ◽  
The Impact

Abstract Abstract 3654 Background: MR has improved the outcome and progression-free survival (PFS) of patients (pts) with FL and MCL. However, maintenance schedules have been empirically designed with no consensus on the optimal regimen. While toxicities are usually predictable, the impact of MR schedule on toxicities has not been previously reported and could influence selection of maintenance regimens. We analyzed grade 3 and/or 4 adverse events (AE) in FL and MCL pts enrolled in prospective MR trials in order to compare AEs by MR schedule, histology, and setting (front-line and relapsed). Methods: A systematic search of the Medline (Pub-Med, Google Scholar, Cochrane Library) electronic database was performed to identify prospective clinical trials employing MR in FL and MCL. The following search terms were used: “MR, maintenance immunotherapy, maintenance therapy, low-grade lymphoma, NHL, MCL, and FL”. Abstracts and studies using MR after autologous stem cell transplantation or radioimmunotherapy were excluded. The number of AE reported was considered as the unit of analysis. Data for overall Grade 3 and/or Grade 4 toxicity (AE reported at any phase of treatment) were further categorized as an AE occurring during the induction phase or the maintenance phase. The incidence, severity, and type of toxicity were analyzed by type of induction (R vs. R+chemotherapy), histology (FL, MCL and FL plus other low-grade histologies), setting (front-line vs. relapsed), and MR schedule (one dose every 2 months vs. one dose every 3 months vs. 4 weekly doses every 6 months; all given for 2 years) and analysis was performed using t-tests or one-way ANOVA weighted means by either the total sample or the MR phase sample. Means were calculated using both fixed-effect and random-effect models Results: Thirteen clinical trials met criteria, including six trials which were randomized controlled in the MR phase. Of the total 3,100 pts, 1,263 received MR. The mean percentage of Grade 3/4 toxicities during any phase of treatment was 26% (95% CI = 0.12–51.88) but in the MR phase, it was only 12.88% (95% CI = 6.50–19.26). The overall mean number of grade 3/4 toxicities during any phase of treatment was 173.85 (95% CI = 167.76–179.95) and it was 60.5 (95% CI 58–63) in the MR phase. Toxicities were significantly different between induction therapy regimens, front-line and the relapsed settings and histologies (all P < 0.001). Pts receiving MR every 2 months encountered more grade 3 and 4 toxicities (mean percentage = 33%, mean = 97.46, 95% CI = 94.15–100.77) compared to 3 months (mean percentage = 21%, mean = 29.24, 95% CI = 27.92 –30.57) and 6 months (mean percentage = 13%, mean = 11.62, 95% CI = 10.70–12.54) schedules (P < 0.001). Pts receiving R+ chemo induction had more AEs compared to those receiving R induction [(mean=73.9 (95% CI 70.8–77.0) vs. 7.5 (95% CI 6.4–8.5), P<0.001]. Pts receiving MR in front-line had more AEs compared to those receiving MR in relapsed disease [mean= 73.1 (95% CI 69.9–76.6) vs. 43.3 (95% CI 41.3–45.3), P<0.001]. Pts with FL had more AEs compared to those with MCL [mean=72.9 (95% CI 69.8–75.9) vs. 15.3 (95% CI 13.2–17.3), P<0.001] Neutropenia and infections were the most common reported individual toxicities. Conclusions: Approximately 13% of patients receiving MR experience grade 3 and/or 4 toxicities, mainly neutropenia and infections. MR given every 6 months appears to cause fewer toxicities. Importantly, this meta-analysis did not compare relative efficacy amongst the three most commonly used MR schedules, but may be helpful in advising patients of relative risks amongst the three schedules. Disclosures: Nabhan: Genentech: Research Funding, Speakers Bureau. Ghielmini:Roche: Honoraria, Research Funding. Smith:Genentech/Roche: Data Safety Monitoring Board and advisory Board attendance Other.

scholarly journals The effect of rTMS in the management of pain associated with CRPS

2020 ◽  
Vol 11 (1) ◽  
pp. 363-370
Author(s):  
Min Cheol Chang ◽  
Sang Gyu Kwak ◽  
Donghwi Park
Keyword(s):  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Pain Syndrome ◽  
Treatment Session ◽  
Cochrane Library ◽  
Exclusion Criteria ◽  
Analgesic Effects ◽  
Randomized Controlled ◽  
Before And After

AbstractBackgroundTherapeutic management of pain in patients with complex regional pain syndrome (CRPS) is challenging. Repetitive transcranial magnetic stimulation (rTMS) has analgesic effects on several types of pain. However, its effect on CRPS has not been elucidated clearly. Therefore, we conducted a meta-analysis of the available clinical studies on rTMS treatment in patients with CRPS.Materials and methodsA comprehensive literature search was conducted using the PubMed, EMBASE, Cochrane Library, and SCOPUS databases. We included studies published up to February 09, 2020, that fulfilled our inclusion and exclusion criteria. Data regarding measurement of pain using the visual analog scale before and after rTMS treatment were collected to perform the meta-analysis. The meta-analysis was performed using Comprehensive Meta-analysis Version 2.ResultsA total of three studies (one randomized controlled trial and two prospective observational studies) involving 41 patients were included in this meta-analysis. No significant reduction in pain was observed immediately after one rTMS treatment session or immediately after the entire schedule of rTMS treatment sessions (5 or 10 sessions; P > 0.05). However, pain significantly reduced 1 week after the entire schedule of rTMS sessions (P < 0.001).ConclusionrTMS appears to have a functional analgesic effect in patients with CRPS.

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