scholarly journals Screening for hepatocellular carcinoma in chronic liver disease: A systematic review and meta-analysis of randomized controlled trials comparing screening methodologies

2021 ◽  
Author(s):  
James O'Connell
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Randomized Controlled Trials ◽  
Chronic Liver Disease ◽  
Alpha Fetoprotein ◽  
Chronic Liver ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Significant Difference ◽  
All Cause Mortality

Abstract BackgroundHepatocellular carcinoma (HCC) is the 5th most prevalent cancer and the second most common cause of cancer-related mortality worldwide. HCC is often asymptomatic until an advanced stage. Current guidelines recommend ultrasound surveillance with or without measurement of serum alpha-fetoprotein. Our objective was to determine if screening for HCC is beneficial or harmful in patients with chronic liver disease. Primary outcomes were all-cause mortality and quality of life. Secondary outcomes were mortality due to HCC, the number of cases of HCC detected and adverse events.MethodsThis is a systematic review and meta-analysis of data from randomized controlled trials. To be included trials had to randomize patients to either an HCC screening group or non-screening group, randomize patients to different screening frequencies or randomize patients to different screening methods. All published reports of randomized trials on screening for HCC were eligible for inclusion, irrespective of the language of publication. Studies had to include patients with chronic liver disease. Data extraction and analysis were performed independently by two reviewers.ResultsWhen screening with six-monthly alpha-fetoprotein and ultrasound abdomen was compared to no screening there was no evidence of difference in HCC related mortality when adjusted for clustering across a range of intracluster correlation coefficients (Intracluster coefficient (ICC) 0.02, odds ratio (OR) 0.60, 95% confidence interval (CI) 0.31-1.15). Screening with six-monthly alpha-fetoprotein when compared to a single alpha-fetoprotein check did not result in a statistically significant difference in all-cause mortality (OR 1.02, 95% confidence interval (CI) 0.65-1.60), mortality due to HCC (OR 1.01, 95% CI 0.57-1.78) or the number of HCC detected (OR 1.11 95% CI 0.64-1.92). There was no evidence of difference in all-cause mortality (OR 0.81, 95% CI 0.26-2.53), mortality due to hepatocellular carcinoma (OR 0.81, 95% CI 0.26-2.53) or the number of patients with HCC detected (OR 1.09 95% CI 0.40-2.99) when twice-a-year ultrasound was compared with annual CT. There was no statistically significant difference when screening more frequently was compared to less frequently in terms of all-cause mortality (OR 0.86, 95% CI 0.56-1.32), mortality due to hepatocellular carcinoma (OR 1.42, 95% CI 0.55-3.64) and the number of cases of hepatocellular carcinoma detected (OR 0.90 95% CI 0.47-1.71).ConclusionsThere is currently insufficient evidence from randomized controlled trials to support the routine screening for HCC in patients with chronic liver disease.

scholarly journals Intravenous Colistin Monotherapy versus Combination Therapy against Carbapenem-Resistant Gram-Negative Bacteria Infections: Meta-Analysis of Randomized Controlled Trials

2018 ◽  
Vol 7 (8) ◽  
pp. 208 ◽  
Author(s):  
I-Ling Cheng ◽  
Yu-Hung Chen ◽  
Chih-Cheng Lai ◽  
Hung-Jen Tang
Keyword(s):  
Combination Therapy ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Randomized Controlled ◽  
Carbapenem Resistant ◽  
Significant Difference ◽  
All Cause Mortality

This meta-analysis aims to compare intravenous colistin monotherapy and colistin-based combination therapy against carbapenem-resistant gram-negative bacteria (GNB) infections. PubMed, Embase, and Cochrane databases were searched up to July 2018. Only randomized controlled trials (RCTs) evaluating colistin alone and colistin-based combination therapy in the treatment of carbapenem-resistant GNB infections were included. The primary outcome was all-cause mortality. Five RCTs including 791 patients were included. Overall, colistin monotherapy was associated with a risk ratio (RR) of 1.03 (95% confidence interval (CI), 0.89–1.20, I2 = 0%) for all-cause mortality compared with colistin-based combination therapy. The non-significant difference was also detected in infection-related mortality (RR, 1.23, 95% CI, 0.91–1.67, I2 = 0%) and microbiologic response (RR, 0.86, 95% CI, 0.72–1.04, I2 = 62%). In addition, no significant difference was observed in the subgroup analysis—high or low dose, with or without a loading dose, carbapenem-resistant Acinetobacter baumannii infections, and in combination with rifampicin. Finally, colistin monotherapy was not associated with lower nephrotoxicity than colistin combination therapy (RR, 0.98; 95% CI, 0.84–1.21, I2 = 0%). Based on the analysis of the five RCTs, no differences were found between colistin monotherapy and colistin-based combination therapy against carbapenem-resistant GNB infections, especially for A. baumannii infections.

Abstract 325: Prasugrel vs Ticagrelor for Dapt Therapy in Patients With Acs Undergoing Pci; A Systematic Review and Meta-analysis of Randomized Controlled Trials

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Ahmad Al-Abdouh ◽  
Mahmoud Amr ◽  
Nazir Savji ◽  
Di Zhao ◽  
Rani K Hasan ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Stent Thrombosis ◽  
Major Bleeding ◽  
Cardiovascular Mortality ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Coronary Syndrome ◽  
Randomized Controlled ◽  
Significant Difference ◽  
All Cause Mortality

Introduction: Dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor added to aspirin is considered the standard of care for patients with acute coronary syndrome (ACS) undergoing percutaneous intervention (PCI). Prasugrel and ticagrelor are commonly used P2Y12 inhibitors. However, few head-to-head randomized controlled trials have been performed to directly compare the efficacy and safety of these two agents when used in patients with ACS undergoing PCI. Methods: We searched PubMed/MEDLINE and Cochrane library. The primary endpoint was major adverse cardiovascular events (MACE). Secondary outcomes were all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stent thrombosis, major bleeding, and all bleeding event. Estimates were calculated as random effects risk ratios (RRs) with 95% confidence intervals (CI). Results: Six trials with 6807 patients were included [ FIGURE ]. There were no significant differences in MACE (RR 0.93; 95% CI [0.72-1.20]; p = 0.59; I 2 = 26%), all-cause mortality (RR 0.92; 95% CI [0.73-1.17]; p = 0.51; I 2 = 0%),cardiovascular mortality (RR 0.99; 95% CI [0.75-1.31]; p = 0.96; I 2 = 0%), MI (RR 0.87; 95% CI [0.60-1.27]; p = 0.48; I 2 = 27%), stent thrombosis (RR 0.64; 95% CI [0.39-1.04]; p = 0.07; I 2 = 0%), major bleeding (RR 0.94; 95% CI [0.70-1.26]; p = 0.68; I 2 = 6%), and all bleeding events (RR 0.92; 95% CI [0.77-1.09]; p = 0.32; I 2 = 0%) when ticagrelor was compared to prasugrel. Conclusion: There are no significant difference of MACE, all-cause mortality, cardiovascular mortality, MI, stent thrombosis, and bleeding between prasugrel and ticagrelor for DAPT in PCI for ACS based current clinical trial data. However, the most recently published and largest of these trials suggests a reduction in MACE. More such comparisons are warranted to inform clinical practice.

scholarly journals sGC Stimulators for Heart Failure: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Xueli Shi ◽  
Xuejing Yu ◽  
Jinhui Wang ◽  
Jianzhong Zhou
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trials ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Serious Adverse Events ◽  
Randomized Controlled ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Sgc Stimulators

Abstract Background Oral sGC stimulators are novel treatments for heart failure (HF). Since individual studies are limited to confirm the efficacy and safety of sGC stimulators in patients with HF, we provide a meta-analysis based on published clinical randomized controlled trials. Methods Embase, PubMed, Cochrane and Medline were applied to search for randomized controlled trials (published before March 29, 2020 without language restrictions) by comparing oral sGC stimulators to placebos. Main endpoints were efficacy outcomes, including all-cause mortality, incidence of cardiovascular-events related death or hospitalization, alterations of EQ-5D index, and N-terminal (NT)-pro hormone BNP(NT-proBNP); and safety outcomes included incidence of serious adverse events (SAEs), symptomatic hypotension and syncope. Results Six trials were enrolled (N=6255 participants), sGC stimulators yielded a lower incidence of cardiovascular-events related death or hospitalization (OR=0.88, 95% CI=0.79 to 0.98), an improvement in EQ-5D scores (SMD=0.44, 95% CI=0.24 to 0.63), and a lower relative risk of SAEs (OR=0.90, 95% CI=0.81 to 1.00) compared with placebos. Furthermore, NT-proBNP was decreased by riociguat (SMD=-0.79, 95% CI=-1.10 to -0.49), but not by vericiguat (SMD=0.04, 95% CI=-0.18 to 0.25). There was no significant difference in all-cause mortality (OR=0.95, 95% CI=0.83 to 1.09), incidence of symptomatic hypotension (OR=1.15, 95% CI=0.95 to 1.40) and syncope (OR=1.15, 95% CI=0.87 to 1.53) between sGC stimulators and placebos. Conclusion Oral sGC stimulators may be beneficial for HF with a good tolerance, further studies are also needed to establish the optimal approach in clinical practice.

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