scholarly journals Efficacy and safety of Botulinum toxin A for improving esthetics in facial complex: A systematic review

2021 ◽  
Vol 32 (4) ◽  
pp. 31-44
Author(s):  
Ritu Gangigatti ◽  
Vincent Bennani ◽  
John Aarts ◽  
Joanne Choi ◽  
Paul Brunton
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Adverse Effects ◽  
Botulinum Toxin A ◽  
Meta Analysis ◽  
Common Adverse Effect ◽  
Efficacy And Safety ◽  
Improvement Rate ◽  
Graphical Comparison ◽  
Average Improvement

Abstract Aim: To evaluate efficacy and safety of Botulinum toxinA for improving esthetics in the facial complex and correlating them to the dosage and side effects through a systematic review. Methods: A literature search was performed using PubMed, Medline, Web of Sciences, and Scopus databases. Quality of studies was appraised through the GRADE system. This review follows the ‘Preferred reporting items for systematic review and meta-analysis protocols’ (PRISMA-P) 2015 statement. Efficacy was analyzed through improvement rate and effect sizes. Graphical comparison of efficacy and ocular adverse effects (adverse effects around the eye) at various anatomical locations was made by calculating the average improvement rate and adverse events. Results: Twenty-five studies were included in this systematic review after application of the inclusion criteria. Moderate to severe cases in glabellar, lateral canthal, and forehead regions showed higher improvement rates between 20U to 50U, with an effect lasting up to 120 days. Gender and age seemed to have a direct effect on efficacy. Headaches were the most common adverse effect, followed by injection site bruising; all adverse effects resolved within 3-4 days. Conclusions: Treatment with Botulinum toxinA to enhance esthetics of facial complex is efficient and safe at all recommended dosages. Presence of complexing proteins influenced the efficacy of BoNT-A. undesirable muscular adverse effects around the eyes were more predominant when treating the glabellar region. There was no correlation found between the BoNT-A dosage and side effects, however, an increase in dosage did not always lead to an increase in efficacy.

Risk of infectious, hematological, and gastrointestinal side effects in patients treatedwith ibrutinib: A systematic review and meta-analysis of randomized controlled trials.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18265-e18265
Author(s):  
Myo Zaw ◽  
Kyaw Zin Thein ◽  
Aung Tun ◽  
Lukman Tijani ◽  
Elizabeth Guevara
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Adverse Effects ◽  
Randomized Controlled Trials ◽  
Chemokine Receptors ◽  
Meta Analysis ◽  
Controlled Trials ◽  
High Grade ◽  
Randomized Controlled ◽  
Gastrointestinal Side Effects

e18265 Background: Bruton’s tyrosine kinase (BTK) is essential for signaling of B-cell and chemokine receptors. Ibrutinib targets BTK and has become frontier in many hematologic malignancies. We undertook systematic review and pooled analysis of randomized controlled trials (RCTs) to determine infectious, hematological and gastrointestinal risks associated with ibrutinib. Methods: We performed a comprehensive literature search using MEDLINE, EMBASE databases and meeting abstracts through December 31, 2016. The RCTs that mention infectious, hematological and gastrointestinal side effects as adverse effects were incorporated in the analysis. Mantel-Haenszel method was used to calculate the estimated pooled risk ratio with 95% confidence interval (CI). Results: Four RCTs with a total of 1505 patients were eligible for the analysis. Studies compared Ibrutinib (I) vs ofatumumab, I vs chlorambucil, I+ bendamustine (B)+ rituximab (R) vs placebo + B+ R and I vs temsirolimus were included in the analysis. The relative risks (RR) of all-grade side effects were as follows: infection, 1.34 (95% CI: 1.04 – 1.74; p = 0.02); pneumonia, 1.16 (95% CI: 0.82–1.66; p = 0.38); anemia, 0.77 (95% CI: 0.64 – 0.93; p = 0.007); neutropenia, 0.99 (95% CI: 0.87 – 1.14; p = 0.98); thrombocytopenia, 0.86 (95% CI: 0.71 – 1.04; p = 0.12); diarrhea, 1.74 (95% CI: 1.48 – 2.05; p < 0.0001); nausea, 0.94 (95% CI: 0.80 – 1.10; p = 0.45); and vomiting, 0.98 (95% CI 0.74 – 1.30; p = 0.93). The RR of high-grade adverse effects were as follows: febrile neutropenia, 1.32 (95% CI: 0.84 – 2.08; p = 0.21); infection, 1.20 (95% CI: 0.73 – 1.98; p = 0.45); pneumonia, 1.22 (95% CI: 0.76–1.95; p = 0.39); anemia, 0.48 (95% CI: 0.33 – 0.71; p < 0.0001); neutropenia, 0.99 (95% CI: 0.86 – 1.15; p = 0.94); thrombocytopenia, 0.61 (95% CI: 0.47 – 0.81; p = 0.001); diarrhea, 1.72 (95% CI: 0.88 – 3.34;p = 0.10); nausea, 2.56 (95% CI: 0.59 – 10.99; p = 0.20); and vomiting, 0.42 (95% CI 0.11 – 1.63; p = 0.21). Conclusions: Ibrutinib increased the risk of all-grade diarrhea and infection whereas the risks of all-grade anemia, high-grade anemia and thrombocytopenia were significantly lower in the study arm, favoring ibrutinib.

scholarly journals Senna alata (akapulko) Extract versus Topical Antifungals for Treatment of Superficial Fungal Skin Infections: a Systematic Review and Meta-analysis

2020 ◽  
Vol 54 (1) ◽  
Author(s):  
Erin Jane L. Tababa ◽  
Rowena Natividad S. Flores-Genuino ◽  
Charissa Mia D. Salud-Gnilo
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Data Extraction ◽  
Meta Analysis ◽  
Sodium Thiosulfate ◽  
Skin Infections ◽  
Efficacy And Safety ◽  
Mycologic Cure ◽  
Meta Analyses ◽  
Senna Alata

Objective. The study aimed to assess the efficacy and safety of Senna alata (akapulko) plant extracts compared with topical antifungals in the treatment of superficial fungal skin infections. Methods. A systematic review and meta-analysis of randomized controlled trials that studied patients with diagnosed cutaneous tinea or dermatophytosis (excluding hair and nail), tinea versicolor, or cutaneous candidiasis, via microscopy or culture, and compared the efficacy and safety of S. alata (akapulko) extract versus topical antifungals. Two authors independently screened titles and abstracts of merged search results from electronic databases (The Cochrane Skin Group Specialized Register, CENTRAL, MEDLINE, EMBASE (January 1990 to December 2011), Health Research and Development Information Network (HERDIN), and reference lists of articles), assessed eligibility, assessed the risk of bias using the domains in the Cochrane Risk Bias tool and collected data using a pretested Data extraction form (DEF). Meta-analyses were performed when feasible. Results. We included seven RCTs in the review. There is low certainty of evidence that S. alata 50% lotion is as efficacious as sodium thiosulfate 25% lotion (RR 0.91, 95% CI, 0.79 to 1.04; 4 RCTs, n=216; p=0.15; I2=52%) and high quality evidence that S. alata cream is as efficacious as ketoconazole (RR 0.95, 95% CI, 0.82 to 1.09; 1 RCT, n=40; p=0.44) and terbinafine cream (RR 0.93, 95% CI, 0.86 to 1.01; 1 RCT, n=150; p=0.09) in mycologic cure. For adverse effects, there is very low certainty of evidence of increased harm with S. alata 50% lotion compared to sodium thiosulfate 25% lotion (RR 1.26, 95% CI, 0.46, 3.44; 2 RCTs, n=120; p=0.65; I2=19%). Adverse effects were few and mild. Conclusion. S. Alata 50% lotion may be as efficacious as sodium thiosulfate 25% lotion and is as efficacious as ketoconazole 2% and terbinafine 1% creams. There is insufficient evidence to compare the safety of S. alata 50% lotion with sodium thiosulfate 25% lotion

scholarly journals Efficacy and Safety of Levetiracetam vs. Phenobarbital for Neonatal Seizures: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Meng-Yuan Qiao ◽  
Hong-Tao Cui ◽  
Ling-Zhi Zhao ◽  
Jing-Kun Miao ◽  
Qi-Xiong Chen
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Antiepileptic Drug ◽  
Respiratory Depression ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Efficacy And Safety ◽  
Neonatal Seizures ◽  
First Line ◽  
Neurodevelopmental Outcomes

Background: Neonatal seizures are a common neurological emergency in newborns. Phenobarbital (PB) is the first-line antiepileptic drug (AED). However, PB has some side effects, such as hypotension and respiratory depression, and it can accelerate neuronal apoptosis in the immature brain. Levetiracetam (LEV), a new antiepileptic drug, has been used as a second-line drug for the treatment of neonatal seizures. Compared with PB, LEV has many advantages, including a low incidence of side effects and better neurodevelopmental outcomes. However, there are only a few systematic reviews of LEV for the treatment of neonatal seizures.Objective: To evaluate the efficacy and safety of LEV for neonatal seizures and to compare the efficacy, side effects, and neurological outcomes between LEV and PB in the treatment of neonatal seizures.Methods: The keywords LEV, PB, and neonatal seizure were searched in the MEDLINE, Cochrane Library, Web of Science, EMBASE, clinicaltrials.gov, and China National Knowledge Internet (CNKI) databases with a last update in July 2021 to collect high-quality studies. We collected studies studying the efficacy or safety of LEV and PB in the treatment of neonatal seizures applying strict inclusion and exclusion criteria. The data were extracted and outcome measures, including efficacy, side effect rate, neurological score, and mortality rate, were analyzed with RevMan 5.3 software.Results: Ten articles were finally included in the meta-analysis. The meta-analysis showed that there was no difference in efficacy between LEV and PB in the treatment of neonatal seizures. Compared with PB, the incidence of side effects of LEV was lower. The incidence of hypotension and respiratory depression in the LEV group was significantly lower than that in the PB group. In terms of long-term neurodevelopmental outcomes, there was no significant difference in the Bayley Scales of Infant Development (BSID) scores between LEV and PB.Conclusion: PB is still the first-line AED recommended by the WHO for the treatment of neonatal seizures. The new AEDs LEV may not have better efficacy than PB. At the same time, LEV is associated with better neurodevelopment outcomes and a lower risk of adverse effects. In addition, continuous EEG monitoring should be used to diagnose neonatal seizures to evaluate the severity of the seizures, remission, and drug efficacy.Systematic Review Registration: PROSPERO, identifier: CRD42021279029.

scholarly journals Efficacy and Safety of COVID-19 Vaccines: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 467
Author(s):  
Ali Pormohammad ◽  
Mohammad Zarei ◽  
Saied Ghorbani ◽  
Mehdi Mohammadi ◽  
Mohammad Hossein Razizadeh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Side Effects ◽  
Immune Responses ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Receptor Binding Domain ◽  
Efficacy And Safety ◽  
Vectored Vaccine ◽  
Local Side

The current study systematically reviewed, summarized and meta-analyzed the clinical features of the vaccines in clinical trials to provide a better estimate of their efficacy, side effects and immunogenicity. All relevant publications were systematically searched and collected from major databases up to 12 March 2021. A total of 25 RCTs (123 datasets), 58,889 cases that received the COVID-19 vaccine and 46,638 controls who received placebo were included in the meta-analysis. In total, mRNA-based and adenovirus-vectored COVID-19 vaccines had 94.6% (95% CI 0.936–0.954) and 80.2% (95% CI 0.96.4–0.92.7) efficacy in phase II/III RCTs, respectively. Efficacy of the adenovirus-vectored vaccine after the first (97.6%; 95% CI 0.939–0.997) and second (98.2%; 95% CI 0.980–0.984) doses was the highest against receptor-binding domain (RBD) antigen after 3 weeks of injections. The mRNA-based vaccines had the highest level of side effects reported except for diarrhea and arthralgia. Aluminum-adjuvanted vaccines had the lowest systemic and local side effects between vaccines’ adjuvant or without adjuvant, except for injection site redness. The adenovirus-vectored and mRNA-based vaccines for COVID-19 showed the highest efficacy after first and second doses, respectively. The mRNA-based vaccines had higher side effects. Remarkably few experienced extreme adverse effects and all stimulated robust immune responses.

scholarly journals Comparison of the Efficacy of Melasma Treatments: A Network Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Yi Liu ◽  
Shanshan Wu ◽  
Haixuan Wu ◽  
Xuelei Liang ◽  
Dechao Guo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Tranexamic Acid ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Therapeutic Index ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Randomized Controlled

Background: Melasma is an acquired pigmentation disorder with challenges in treatment because of its refractory nature and high risk of recurrence.Objectives: This study aimed to compare the efficacy and side effects of 14 common therapies for melasma using a systematic review and network meta-analysis (NMA).Methods: The PubMed, Embase, and Cochrane Library databases were searched till December 2020 using the melasma area and severity index as a therapeutic index. A total of 59 randomized controlled trials (RCTs) met the inclusion criteria and were selected.Results: The ranking of relative efficacy compared with placebo in descending order was Q-switched Nd:Yag 1,064-nm laser (QSND), intense pulsed light, ablative fractional laser (AFL), triple combined cream (TCC), topical vitamin C, oral tranexamic acid (oTA), peeling, azelaic acid, microneedles (MNs), topical tranexamic acid (tTA), tretinoin, picosecond laser, hydroquinone (HQ), and non-AFL. Moreover, QSND was more effective than HQ and tTA against melasma. The ranking of percentage (%) of side effects in ascending order for each of 14 therapies with more than 80 participants was tretinoin (10.1%), oTA (17.6%), HQ (18.2%), AFL (20.0%), QSND (21.5%), TCC (25.7%), tTA (36.75%), peeling (38.0%), and MN (52.3%). Taking both efficacy and safety into consideration, TCC was found to be the most favorable selection among the topical drugs for melasma. QSND and AFL were still the best ways to treat melasma among photoelectric devices. oTA as system administration was a promising way recommended for melasma. Among 31 studies, 87% (27/31) studies showed that the efficacy of combination therapies is superior to that of single therapy. The quality of evidence in this study was generally high because of nearly 50% of split-face RCTs.Conclusions: Based on the published studies, this NMA indicated that QSND, AFL, TCC, and oTA would be the preferred ways to treat melasma for dermatologists. However, more attention should be paid to the efficacy and safety simultaneously during the clinical application. Most of the results were in line with those of the previous studies, but a large number of RCTs should be included for validation or update.Systematic Review Registration: identifier: CRD42021239203.

scholarly journals Efficacy and Safety of Acotiamide for the Treatment of Functional Dyspepsia: Systematic Review and Meta-Analysis

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Guoguang Xiao ◽  
Xiaoping Xie ◽  
Juan Fan ◽  
Jianjun Deng ◽  
Shan Tan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Distress Syndrome ◽  
Epigastric Pain ◽  
Meta Analysis ◽  
Pain Syndrome ◽  
Efficacy And Safety ◽  
Confidential Interval ◽  
Epigastric Pain Syndrome ◽  
Subgroup Analyses

Background.There are no treatments with established efficacy for this disorder so far.Aim.To systematically review the efficacy of acotiamide in the treatment of patients with FD.Methods.We searched main electronic databases through November 2013. RCTs evaluating the efficacy of acotiamide versus placebo in FD patients were included. Pooled risk ratio (RR) with 95% confidential interval (CI) was calculated.Results.Six publications including seven RCTs were eligible for inclusion. The summary RR of overall improvement of FD symptoms in patients receiving acotiamide versus placebo was 1.29 (95% CI, 1.19–1.40,P<0.00001;I2=15%). Acotiamide improved the symptoms of patients with postprandial distress syndrome (PDS) (RR, 1.29; 95% CI, 1.09–1.53,P=0.003;I2=0%), and the summary RR for patients with epigastric pain syndrome (EPS) was 0.92 (95% CI, 0.76–1.11,P=0.39;I2=0%). Acotiamide showed a significantly beneficial effect on the elimination of some individual FD symptoms compared with placebo. Adverse events were not significantly different between acotiamide and placebo groups. Subgroup analyses suggested that acotiamide 100 mg three times daily (tid) showed consistent efficacy not only for the overall improvement but also for the elimination of some individual symptoms in FD patients.Conclusions.Acotiamide has the potential to improve the symptoms of patients with FD, particularly of patients with PDS, without major adverse effects. The dosage of acotiamide 100 mg tid might be the appropriate dose in the treatment of FD.

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