scholarly journals Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: A system review and meta analysis

2019 ◽  
Author(s):  
Yang Zhou ◽  
Abdul Mannan ◽  
Yuan Han ◽  
He Liu ◽  
Hui-Lian Guan ◽  
...  
Keyword(s):  
Side Effects ◽  
Incidence Rate ◽  
Meta Analysis ◽  
Nausea And Vomiting ◽  
Secondary Outcome ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Study Results ◽  
Postanesthetic Shivering ◽  
Prophylactic Use

Abstract Background Post-anaesthetic shivering is a common complication of anaesthesia which accounts for much discomfort in postoperative patients. The main purpose of this meta analysis is to analyze and evaluate the efficacy and safety of prophylactic use of ketamine for preventing postanesthetic shivering. Methods We searched the following databases: Medline, EMBASE and the Cochrane Central Register of Controlled Trails for randomized controlled trials. The primary outcome being observed was the incidence rate of postanesthetic shivering. The secondary outcome was the sedation score and incidence of the side effects caused by drugs utilized in the study. Results In this meta analysis, we analyzed a total of 16 trials including 1485 patients. Ketamine did reduced the incidence rate of postanesthetic shivering compared with placebo(odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06 to 0.26, P＜0.00001). The observation related to the side effects showed no evident variability regarding the incidence rate of nausea and vomiting. Usage of ketamine was associated with a lower rate of hypotension and bradycardia when compared with placebo. Hallucination was more frequently observed in patients receiving ketamine of higher doses. No significant difference was found in the incidence of postanesthetic shivering for all comparisons between ketamine and other pharmacological interventions. The occurrence of side effects caused by ketamine or other study drugs was similar with an exception of the comparison between ketamine and ondansetron where ketamine lowered the incidence of hypotension but with a relatively higher incidence of postoperative nausea and vomiting. Conclusions Ketamine has a preventive effect on postanesthetic shivering without causing any severe side effects. However, ketamine shows no advantage over other antishivering drugs.

scholarly journals Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: a systematic review and meta analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yang Zhou ◽  
Abdul Mannan ◽  
Yuan Han ◽  
He Liu ◽  
Hui-Lian Guan ◽  
...  
Keyword(s):  
Side Effects ◽  
Incidence Rate ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Central Register ◽  
Postanesthetic Shivering ◽  
Significant Difference ◽  
The Difference ◽  
Prophylactic Use

Abstract Background Postanesthetic shivering is a common complication of anesthesia, which accounts for much discomfort in postoperative patients and may increase postoperative complications in high-risk patients. Due to the lack of high-quality evidence, it is difficult to draw a conclusion about optimal anti-shivering medication. The main purpose of this meta-analysis was to analyze and evaluate the efficacy and safety of prophylactic use of ketamine for preventing postanesthetic shivering. Methods We searched the following databases: Medline, Embase, and the Cochrane Central Register of Controlled Trails for randomized controlled trials. The primary outcome observed was the difference of the incidence rate of postanesthetic shivering between ketamine group and placebo group. The secondary outcomes were the sedation score and incidence of the side effects caused by ketamine and any other drugs utilized in the studies. Results In this meta-analysis, we analyzed a total of 16 trials including 1485 patients. Ketamine reduced the incidence rate of postanesthetic shivering compared to a placebo (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06 to 0.26, P<0.01). Regarding side effects, there was no evident variability of the incidence of nausea and vomiting. Usage of ketamine was associated with a lower rate of hypotension and bradycardia when compared to a placebo. Hallucinations were more frequently observed in patients who received higher doses of ketamine. No significant difference was found in the incidence of postanesthetic shivering with ketamine versus other pharmacological interventions. Conclusions Ketamine can prevent postanesthetic shivering without severe side effects. However, ketamine shows no advantage over other anti-shivering drugs.

scholarly journals Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: A system review and meta analysis

2019 ◽  
Author(s):  
Yang Zhou ◽  
Abdul Mannan ◽  
Yuan Han ◽  
He Liu ◽  
Hui-Lian Guan ◽  
...  
Keyword(s):  
Side Effects ◽  
Incidence Rate ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Central Register ◽  
Postanesthetic Shivering ◽  
Significant Difference ◽  
Risk Patients ◽  
Prophylactic Use

Abstract Background Postanesthetic shivering is a common complication of anesthesia, which accounts for much discomfort in postoperative patients and may increase postoperative complications in high-risk patients. Due to the lack of high-quality evidence, it is difficult to draw a conclusion about optimal anti-shivering medication. The main purpose of this meta-analysis was to analyze and evaluate the efficacy and safety of prophylactic use of ketamine for preventing postanesthetic shivering. Methods We used a systematic approach, also known as meta-analysis, to further address postoperative shivering. We searched the following databases: Medline, EMBASE, and the Cochrane Central Register of Controlled Trails for randomized controlled trials. The primary outcome observed was the incidence rate of postanesthetic shivering. The secondary outcomes were the sedation score and incidence of the side effects caused by drugs utilized in the studies. Results In this meta-analysis, we analyzed a total of 16 trials including 1485 patients. Ketamine reduced the incidence rate of postanesthetic shivering compared to a placebo (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06 to 0.26, P＜0.01). Regarding side effects, there was no evident variability of the incidence of nausea and vomiting. Usage of ketamine was associated with a lower rate of hypotension and bradycardia when compared to a placebo. Hallucinations were more frequently observed in patients who received higher doses of ketamine. No significant difference was found in the incidence of postanesthetic shivering with ketamine versus other pharmacological interventions. Conclusions Ketamine can prevent postanesthetic shivering without severe side effects. However, ketamine shows no advantage over other anti-shivering drugs.

scholarly journals Efficacy and safety of prophylactic use of ketamine for prevention of postanesthetic shivering: A system review and meta analysis

2019 ◽  
Author(s):  
Yang Zhou ◽  
Abdul Mannan ◽  
Yuan Han ◽  
He Liu ◽  
Hui-Lian Guan ◽  
...  
Keyword(s):  
Side Effects ◽  
Incidence Rate ◽  
Meta Analysis ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Central Register ◽  
Postanesthetic Shivering ◽  
Significant Difference ◽  
The Difference ◽  
Prophylactic Use

Abstract Background Postanesthetic shivering is a common complication of anesthesia, which accounts for much discomfort in postoperative patients and may increase postoperative complications in high-risk patients. Due to the lack of high-quality evidence, it is difficult to draw a conclusion about optimal anti-shivering medication. The main purpose of this meta-analysis was to analyze and evaluate the efficacy and safety of prophylactic use of ketamine for preventing postanesthetic shivering. Methods We used a systematic approach, also known as meta-analysis, to further address postoperative shivering. We searched the following databases: Medline, Embase, and the Cochrane Central Register of Controlled Trails for randomized controlled trials. The primary outcome observed was the difference of the incidence rate of postanesthetic shivering between ketamine group and placebo group . The secondary outcomes were the sedation score and incidence of the side effects caused by ketamine and any other drugs utilized in the studies. Results In this meta-analysis, we analyzed a total of 16 trials including 1485 patients. Ketamine reduced the incidence rate of postanesthetic shivering compared to a placebo (odds ratio [OR]: 0.13, 95% confidence interval [CI]: 0.06 to 0.26, P＜0.01). Regarding side effects, there was no evident variability of the incidence of nausea and vomiting. Usage of ketamine was associated with a lower rate of hypotension and bradycardia when compared to a placebo. Hallucinations were more frequently observed in patients who received higher doses of ketamine. No significant difference was found in the incidence of postanesthetic shivering with ketamine versus other pharmacological interventions. Conclusions Ketamine can prevent postanesthetic shivering without severe side effects. However, ketamine shows no advantage over other anti-shivering drugs.

scholarly journals Efficacy and safety of antidepressants for the treatment of back pain and osteoarthritis: systematic review and meta-analysis

BMJ ◽  
2021 ◽  
pp. m4825 ◽  
Author(s):  
Giovanni E Ferreira ◽  
Andrew J McLachlan ◽  
Chung-Wei Christine Lin ◽  
Joshua R Zadro ◽  
Christina Abdel-Shaheed ◽  
...  
Keyword(s):  
Systematic Review ◽  
Back Pain ◽  
Adverse Events ◽  
Meta Analysis ◽  
World Health ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Osteoarthritis Pain

Abstract Objective To investigate the efficacy and safety of antidepressants for back and osteoarthritis pain compared with placebo. Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, CINAHL, International Pharmaceutical Abstracts, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform from inception to 15 November and updated on 12 May 2020. Eligibility criteria for study selection Randomised controlled trials comparing the efficacy or safety, or both of any antidepressant drug with placebo (active or inert) in participants with low back or neck pain, sciatica, or hip or knee osteoarthritis. Data extraction and synthesis Two independent reviewers extracted data. Pain and disability were primary outcomes. Pain and disability scores were converted to a scale of 0 (no pain or disability) to 100 (worst pain or disability). A random effects model was used to calculate weighted mean differences and 95% confidence intervals. Safety (any adverse event, serious adverse events, and proportion of participants who withdrew from trials owing to adverse events) was a secondary outcome. Risk of bias was assessed with the Cochrane Collaboration’s tool and certainty of evidence with the grading of recommendations assessment, development and evaluation (GRADE) framework. Results 33 trials (5318 participants) were included. Moderate certainty evidence showed that serotonin-noradrenaline reuptake inhibitors (SNRIs) reduced back pain (mean difference −5.30, 95% confidence interval −7.31 to −3.30) at 3-13 weeks and low certainty evidence that SNRIs reduced osteoarthritis pain (−9.72, −12.75 to −6.69) at 3-13 weeks. Very low certainty evidence showed that SNRIs reduced sciatica at two weeks or less (−18.60, −31.87 to −5.33) but not at 3-13 weeks (−17.50, −42.90 to 7.89). Low to very low certainty evidence showed that tricyclic antidepressants (TCAs) did not reduce sciatica at two weeks or less (−7.55, −18.25 to 3.15) but did at 3-13 weeks (−15.95, −31.52 to −0.39) and 3-12 months (−27.0, −36.11 to −17.89). Moderate certainty evidence showed that SNRIs reduced disability from back pain at 3-13 weeks (−3.55, −5.22 to −1.88) and disability due to osteoarthritis at two weeks or less (−5.10, −7.31 to −2.89), with low certainty evidence at 3-13 weeks (−6.07, −8.13 to −4.02). TCAs and other antidepressants did not reduce pain or disability from back pain. Conclusion Moderate certainty evidence shows that the effect of SNRIs on pain and disability scores is small and not clinically important for back pain, but a clinically important effect cannot be excluded for osteoarthritis. TCAs and SNRIs might be effective for sciatica, but the certainty of evidence ranged from low to very low. Systematic review registration PROSPERO CRD42020158521.

scholarly journals Comparative efficacy and safety of different regimens of ranibizumab for neovascular age-related macular degeneration: a network meta-analysis of randomised controlled trials

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e040906
Author(s):  
Xinyu Zhao ◽  
Lihui Meng ◽  
Youxin Chen
Keyword(s):  
Adverse Events ◽  
Macular Degeneration ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Age Related Macular Degeneration ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Age Related ◽  
Randomised Controlled

ObjectiveTo give a comprehensive efficacy and safety ranking of different therapeutic regimens of ranibizumab for neovascular age-related macular degeneration (nAMD).DesignA systematic review and network meta-analysis.MethodsThe PubMed, Embase, Cochrane Central Register of Controlled Trials, and other clinical trial registries were searched up to 1 October 2019 to identify related randomised controlled trials (RCT) of different regimens of ranibizumab for nAMD. The primary efficacy outcome was the changes of best-corrected visual acuity (BCVA) at 1 year, the primary safety outcome was the incidence of severe ocular adverse events. Secondary outcomes such as changes of central retinal thickness (CRT) were evaluated. We estimated the standardised mean difference (SMD), ORs, 95% CIs, the surface under the cumulative ranking curves and the mean ranks for each outcome using network meta-analyses with random effects by Stata 14.0.ResultsWe identified 26 RCTs involving 10 821 patients with nAMD randomly assigned to 21 different therapeutic regimens of ranibizumab or sham treatment. Ranibizumab 0.5 mg (treat and extend, T&E) is most effective in terms of changes of BCVA (letters, SMD=21.41, 95% CI 19.86 to 22.95) and three or more lines of BCVA improvement (OR=2.83, 95% CI 1.27 to 4.38). However, it could not significantly reduce retreatment times compared with monthly injection (SMD=−0.94, 95% CI −2.26 to 0.39). Ranibizumab 0.5 mg (3+pro re nata)+non-steroidal anti-inflammatory drugs (NSAIDs) is most effective in reducing CRT and port delivery system of ranibizumab (100 mg/mL) could reduce the number of retreatment most significantly. All regimes have no more risk of severe ocular complications (including vitreous haemorrhage, rhegmatogenous retinal detachment, endophthalmitis, retinal tear and retinal pigment epithelium tear) or cardiocerebral vascular complications.ConclusionsRanibizumab 0.5 mg (T&E) is most effective in improving the visual outcome. The administration of topical NSAIDs could achieve additional efficacy in CRT reduction and visual improvement. Both interventions had acceptable risks of adverse events.

scholarly journals Iris-Claw Intraocular Lens: Anterior Chamber or Retropupillary Implantation? A Systematic Review and Meta-Analysis

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 785
Author(s):  
I-Chia Liang ◽  
Yun-Hsiang Chang ◽  
Adrián Hernández Hernández Martínez ◽  
Chi-Feng Hung
Keyword(s):  
Anterior Chamber ◽  
Intraocular Lens ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Randomized Controlled ◽  
Cell Counts ◽  
Iop Elevation ◽  
Iris Claw

Background and Objectives: Iris-claw intraocular lens (ICIOL) could be implanted in the anterior chamber (AC) or retropupillary (RP) in eyes lacking capsular and/or zonular support. Several studies have focused on comparing the efficacy and complications of these two techniques and we designed this research to review the published literatures. Materials and Methods: Peer-reviewed studies were collected through network databases (PubMed, Scopus, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) and analyzed. The primary outcome was the standardized mean differences (SMDs) of pre- and post-operative corrected distant visual acuity (CDVA). The secondary outcome was the SMDs of pre- and post-operative intraocular pressure (IOP), endothelial cell counts (ECC), and the odds ratios (ORs) of post-operative IOP elevation and cystoid macular edema (CME). Comprehensive Meta-Analysis software was utilized to conduct statistical analysis. Results: Six studies (one randomized controlled trial and five retrospective case series) were relevant and included a total of 516 eyes (255 and 261 eyes in the AC ICIOL and RP ICIOL groups, respectively). The quantitative analysis showed no significant differences in CDVA (SMD: 0.164, 95% confidence interval (CI): −0.171 to 0.500), ECC (SMD: −0.011, 95% CI: −0.195 to 0.173), and IOP elevation events (OR: 0.797, 95% CI: 0.459 to 1.383). Lesser IOP reduction (SMD: 0.257, 95%CI: 0.023 to 0.490) and a relative increase in the incidence of CME (OR:2.315, 95% CI: 0.950 to 5.637) were observed in the AC ICIOL group compared with RP ICIOL group. Conclusions: Our meta-analysis indicated that AC and RP ICIOL seem to have equivalent visual outcomes. RP ICIOL may perform slightly better with more IOP reduction and lesser CME. More randomized controlled trials, which have higher patient participation and more outcomes are needed to confirm our conclusions.

scholarly journals Efficacy and safety of anti-epidermal growth factor receptor agents for the treatment of oesophageal cancer: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e046352
Author(s):  
Lijuan Zhang ◽  
Yanli Song ◽  
Nan Jiang ◽  
Yaqi Huang ◽  
Bo Dong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Growth Factor ◽  
Outcome Measures ◽  
Oesophageal Cancer ◽  
Meta Analysis ◽  
Growth Factor Receptor ◽  
Cochrane Library ◽  
Secondary Outcome ◽  
Efficacy And Safety ◽  
Positive Effects

ObjectivesDespite remarkable advances in the treatment of oesophageal cancer (OC), the role of antiepidermal growth factor receptor (anti-EGFR) agents in treating OC remains controversial. Herein, a systematic review and meta-analysis were conducted to elucidate the efficacy and safety of anti-EGFR agents in patients with OC.DesignMeta-analysis of randomised controlled trials (RCTs) identified by searching the PubMed, Embase, Web of Science, ClinicalTrials.gov, Cochrane Library, Chinese Biology Medicine, China National Knowledge Infrastructure and Wanfang Data Knowledge Service Platform databases from inception to December 2019. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.SettingRCTs from any country and healthcare setting.ParticipantsPatients with OC.InterventionsCombination therapy with anti-EGFR agents and conventional treatments versus conventional treatments alone in patients with OC.Primary and secondary outcome measuresOverall survival (OS) and progression-free survival (PFS) were primary outcome measures, and objective response rate (ORR), disease control rate (DCR) and treatment toxicities were secondary outcome measures.ResultsIn total, 25 RCTs comprising 3406 patients with OC were included. Overall, anti-EGFR treatment significantly improved the OS (HR: 0.81, 95% CI 0.74 to 0.89, p<0.00001), ORR (relative risk (RR): 1.33, 95% CI 1.16 to 1.52, p<0.0001) and DCR (RR: 1.22, 95% CI 1.11 to 1.34, p<0.0001) but not PFS (HR: 0.91, 95% CI 0.76 to 1.08, p=0.26). Anti-EGFR treatment was significantly associated with higher incidences of myelosuppression, diarrhoea, acne-like rash and hypomagnesaemia.ConclusionsOverall, anti-EGFR agents have positive effects on OS, the ORR and DCR in OC. However, considering the high incidence of adverse effects, such as myelosuppression, diarrhoea, acne-like rashes and hypomagnesaemia, careful monitoring of patients with OC is recommended during anti-EGFR treatment.Trial registration numberCRD42020169230.

scholarly journals Intravenous dexmedetomidine during spinal anaesthesia for caesarean section: A meta-analysis of randomized trials

2017 ◽  
Vol 45 (3) ◽  
pp. 924-932 ◽  
Author(s):  
Zeqing Bao ◽  
Chengmao Zhou ◽  
Xianxue Wang ◽  
Yu Zhu
Keyword(s):  
Caesarean Section ◽  
Spinal Anaesthesia ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Relevant Literature ◽  
Nausea And Vomiting ◽  
Cochrane Library ◽  
Control Group ◽  
Efficacy And Safety ◽  
The Cochrane Library

Objective To evaluate the efficacy and safety of spinal anaesthesia using dexmedetomidine for caesarean section. Methods PubMed, The Cochrane Library, and CNKI were searched for relevant literature. Results The incidence of nausea and vomiting in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.21, 95% CI: 0.12–0.35, P < 0.00001). No difference was found in the incidence of pruritus between the two groups (OR = 1.21, 95% CI: 0.36–4.09, P = 0.76).The dexmedetomidine group had a higher incidence of bradycardia than did the control group (OR = 2.20, 95% CI: 1.02–4.77, P = 0.05). The incidence of shivering in the dexmedetomidine group was significantly lower than that in the control group (OR = 0.20, 95% CI: 0.13–0.32, P < 0.00001). The incidence of hypotension was not different between the two groups (OR = 0.88, 95% CI: 0.49–1.56, P = 0.65). Conclusion Dexmedetomidine can decrease the incidence of nausea, vomiting, bradycardia, and shivering with spinal anaesthesia during caesarean section.

scholarly journals Efficacy and Safety of Bilastine in the Treatment of Allergic Rhinitis: A Systematic Review and Meta-analysis

2022 ◽  
Vol 12 ◽  
Author(s):  
Aranjit Singh Randhawa ◽  
Norhayati Mohd Noor ◽  
Mohd Khairi Md Daud ◽  
Baharudin Abdullah
Keyword(s):  
Allergic Rhinitis ◽  
Symptom Score ◽  
Meta Analysis ◽  
Nasal Symptom ◽  
Comparable Efficacy ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Efficacy And Safety ◽  
Quality Of Evidence

Bilastine is a non-sedating second generation H1 oral antihistamine (OAH) for treating allergic rhinitis (AR) patients. The effect of bilastine has not previously been evaluated in a meta-analysis. The aim of this review was to determine the efficacy and safety of bilastine in treating AR. An electronic literature search was performed using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Science Direct and Google Scholar up to March 2021. Randomized controlled trials comparing bilastine with placebo and standard pharmacotherapy were included. The included studies must have diagnosis of AR established by clinicians and the outcomes must have a minimum of 2 weeks of follow-up period. The primary outcomes assessed were total symptom score (TSS), nasal symptom score (NSS) and non-nasal symptom score (NNSS). The secondary outcomes were discomfort due to rhinitis, quality of life (QOL) and adverse events. The risk of bias and quality of evidence for all studies were appraised. The meta-analysis was done using Review Manager 5.3 software based on the random-effects model. The search identified 135 records after removal of duplicates. Following screening and review of the records, fifteen full-text articles were assessed for eligibility. Five trials involving 3,329 patients met the inclusion criteria. Bilastine was superior to placebo in improving TSS, NSS, NNSS, rhinitis discomfort score and QOL but has comparable efficacy with other OAHs in TSS, NSS, NNS, rhinitis discomfort score and QOL. There was no difference in adverse effects when bilastine was compared against placebo and other OAHs except for somnolence. Bilastine has fewer incidence of somnolence compared to cetirizine. The overall quality of evidence ranged from moderate to high quality. Bilastine is effective and safe in treating the overall symptoms of AR with comparable efficacy and safety with other OAHs except somnolence. Whilst bilastine has similar efficacy to cetirizine, somnolence is notably less in bilastine.

scholarly journals Warm Needle Acupuncture in Primary Osteoporosis Management: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 36 (4) ◽  
pp. 215-221 ◽  
Author(s):  
Ding Luo ◽  
Yue Liu ◽  
Yanan Wu ◽  
Rui Ma ◽  
Lin Wang ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Conventional Medicine ◽  
Meta Analysis ◽  
Lumbar Vertebrae ◽  
Secondary Outcome ◽  
Primary Osteoporosis ◽  
Cochrane Central Register ◽  
Greater Trochanter ◽  
Vas Scores ◽  
Needle Acupuncture

Background Warm needle acupuncture (WNA) is commonly used in primary osteoporosis (OP) management in China. The evidence of its effectiveness needs to be systematically reviewed. Objective The aim of the meta-analysis was to evaluate whether using WNA alone or combined with conventional medicine benefits primary OP. Methods PubMed, Embase, the Cochrane Central Register, Medline, China National Knowledge Infrastructure, Wanfang and VIP databases were searched from their inception through 30 June 2016. RCTs applying WNA independently or as an adjunct to conventional medicine, compared with conventional medicine alone, were included. Primary outcomes were bone mineral density (BMD) of the lumbar vertebrae, femoral neck, Ward's triangle and greater trochanter. The secondary outcome was chronic pain measured by VAS score. Meta-analysis was conducted using RevMan V.5.3 software. Results Nine RCTs involving 572 participants were included. When WNA was used as an adjunct to conventional medicine, meta-analysis revealed a statistical difference in favour of increasing BMD of the lumbar vertebrae (mean difference (MD)=0.06, 95% CI 0.03 to 0.08, P<0.001). WNA increased BMD of the femoral neck (MD 0.14, 95% CI 0.08 to 0.21, P<0.001) and greater trochanter (MD 0.09, 95% CI 0.04 to 0.15, P<0.001) when used alone, and additionally decreased VAS scores (MD=−1.10, 95% CI −1.14 to −1.06, P<0.001) when used as an adjunct to conventional medicine. However, the safety of WNA was not specifically reported. Conclusions WNA may have beneficial effects on BMD and VAS scores of patients with primary OP. However, all included trials were at high risk of bias and of low quality. Further rigorous studies are needed to determine the effectiveness of WNA for primary OP treatment.

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