First Line Treatments for Newly Diagnosed Primary Immune Thrombocytopenia in Children: A Systematic Review and Network Meta-analysis

Background: The first-line interventions in immune thrombocytopenia (ITP) include intravenous polyclonal immunoglobulins (IVIg), corticosteroids and anti-D immunoglobulin (anti-D). Objective: We aimed to compare the effectiveness and safety of first line treatments for newlydiagnosed primary ITP in children to increase the platelet count. Methods: We searched MEDLINE, EMBASE, LILACS and the Cochrane Central register of Controlled Trials (CENTRAL); and included the clinical trials. We performed the statistical analysis in R. Results: We included 12 studies for meta-analysis. Compared with IVIG 2g/kg, response rates were lower for prednisone 2mg/kg at 72 hours [RR 0.04 (95% CI 0.0 to 0.68)] and at 7 days [RR 0.23 (95% CI 0.08 to 0.67)]; at 48 hours, methylprednisolone 30mg/kg also showed lower response rates [RR 0.72 (95% CI 0.52 to 0.99)]. IVIG 2g/kg and 2.5g/kg had less adverse effects than Anti- D, methylprednisolone and IVIG 0.8g/kg. For rising platelet count, no statistical differences were found at 24 hours or in 7 days; at 48 hours, IVIG 2g/kg showed better results than Anti-D 75μg/kg [MD -58.84 (95% CI -87.02 to -25.66)]. After a month, platelet count with IVIG 2g/kg was higher than Anti-D 50 and 75μg/kg [-82.03 (95% CI -102.60 to -61.46) and -78.77 (95% CI -97.80 to - 59.74), respectively], but lower than methylprednisolone 50mg/kg [MD 118 (95% CI 3.88 to 232.12)]. Conclusion: The total platelet count rises higher in early and late phases with IVIG than Anti-D, but in long term it is higher with methylprednisolone. Additionally, IVIG causes less adverse effects than Anti-D and corticosteroids.

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Ciclosporin or Infliximab as Rescue Therapy in Acute Glucorticosteroid-Refractory Ulcerative Colitis: Systematic Review and Network Meta-Analysis

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa226 ◽

2020 ◽

Author(s):

Brigida Barberio ◽

Christopher J Black ◽

Edoardo V Savarino ◽

Alexander C Ford

Keyword(s):

Ulcerative Colitis ◽

Rescue Therapy ◽

Meta Analysis ◽

Previous Treatment ◽

Response To Therapy ◽

Cochrane Central Register ◽

Serious Adverse Events ◽

Central Register ◽

Meta Analyses

Abstract Background Despite randomized controlled trials [RCTs] and trial-based meta-analyses, the optimal rescue therapy for patients with acute glucorticosteroid-refractory ulcerative colitis [UC], to avoid colectomy and improve long-term outcomes, remains unclear. We conducted a network meta-analysis examining this issue. Methods We searched MEDLINE, EMBASE, EMBASE Classic and the Cochrane central register up to June 2020. We included RCTs comparing ciclosporin and infliximab, either with each other or with placebo, in patients with glucorticosteroid-refractory UC. Results We identified seven RCTs containing 534 patients [415 in head-to-head trials of ciclosporin vs infliximab]. Risk of colectomy at ≤ 1 month was reduced significantly with both treatments, compared with placebo (relative risk [RR] of colectomy with infliximab vs placebo = 0.37; 95% confidence interval [CI] 0.21–0.65, RR with ciclosporin vs placebo = 0.40; 95% CI 0.21–0.77). In terms of colectomy between > 1 month and < 1 year, both drugs ranked equally [P-score 0.75]. Neither treatment was more effective than placebo in reducing the risk of colectomy at ≥ 1 year. Both ciclosporin and infliximab were significantly more efficacious than placebo in achieving a response. Neither treatment was more effective than placebo in inducing remission, nor more likely to cause serious adverse events than placebo. Conclusions Both ciclosporin and infliximab were superior to placebo in terms of response to therapy and avoiding colectomy up to 1 year, with no significant differences in efficacy or safety between the two. Ciclosporin remains a valid option to treat refractory UC patients, especially those who do not respond to previous treatment with infliximab, or as a bridge to other biological therapies.

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Should Finasteride Be Routinely Given Preoperatively for TURP?

ISRN Urology ◽

10.1155/2013/458353 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

O. M. Aboumarzouk ◽

M. Z. Aslam ◽

A. Wedderburn ◽

K. Turner ◽

O. Hughes ◽

...

Keyword(s):

Meta Analysis ◽

Postoperative Bleeding ◽

Controlled Trials ◽

Cochrane Central Register ◽

Vascular Endothelial ◽

Central Register ◽

Language Restriction ◽

Randomised Controlled ◽

Endothelial Growth Factor

Objective. The aim of the review was to compare the use of finasteride to placebo in patients undergoing TURP procedures. Material & Methods. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (1966–November 2011), EMBASE (1980–November 2011), CINAHL, Clinicaltrials.gov, Google Scholar, reference lists of articles, and abstracts from conference proceedings without language restriction for studies comparing finasteride to placebo patients needing TURPs. Results. Four randomised controlled trials were included comparing finasteride to a placebo. A meta-analysis was not conducted due to the disparity present in the results between the studies. Three of the studies found that finasteride could reduce either intra- or postoperative bleeding after TURP. One study found finasteride to significantly lower the microvessel density (MVD) and vascular endothelial growth factor (VEGF). None of the studies reported any long-term complications related to either the medication or the procedure. Conclusion. finasteride reduces bleeding either during or after TURP.

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Response Efficacy of PD-1 and PD-L1 Inhibitors in Clinical Trials: A Systematic Review and Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.562315 ◽

2021 ◽

Vol 11 ◽

Author(s):

Shixue Chen ◽

Zhibo Zhang ◽

Xuan Zheng ◽

Haitao Tao ◽

Sujie Zhang ◽

...

Keyword(s):

Clinical Trials ◽

Checkpoint Inhibitors ◽

Meta Analysis ◽

Subsequent Treatment ◽

Drug Combinations ◽

Cochrane Central Register ◽

First Line ◽

Response Efficacy ◽

Central Register ◽

Cancer Types

BackgroundImmune checkpoint inhibitors targeting the PD-1/PD-L1 pathway have demonstrated promise in treating a variety of advanced cancers; however, little is known regarding their efficacy under various clinical situations, including different cancer types, treatment lines, drug combinations, and therapeutic regimens.MethodsPublished articles and conference abstracts (in English) in PubMed, Embase, the Cochrane Central Register, and Web of Science were searched up to February 10, 2020. The data were analyzed by the meta-analysis program in Stata.ResultsA total of 16,400 patients from 91 clinical trials were included in this meta-analysis. PD-1/PD-L1 inhibitors had a mean ORR of 19.56% (95% CI: 15.09–24.03), a median TTR of 2.05 months (m) (95%CI: 1.85–2.26), and a median DOR of 10.65 m (95%CI: 7.78–13.52). First-line treatment had a higher ORR (36.57% vs. 13.18%) but a shorter DOR (9.00 m vs. 13.42 m) compared to the second-line or subsequent treatment. Immunotherapy combined with chemotherapy (I+C) (46.81% [95%CI: 36.02–57.60]) had a statistically significant higher ORR compared to immunotherapy (I) (17.75% [95%CI: 14.47–21.03]) or immunotherapy combined with immunotherapy (I+O) (12.25% [95%CI: 1.56–22.94]), while I+C (8.09 m [95%CI: 6.86–9.32]) appeared to reduce the DOR compared to I (12.39 m [95%CI: 7.60–17.18]). PD-1 inhibitors were associated with better ORR (21.65% vs. 17.60%) and DOR (11.26 m vs. 10.03 m) compared to PD-L1 inhibitors. There were no significant differences in TTR under different situations.ConclusionsPD-1/PD-L1 inhibitors were promising immunotherapeutic agents to achieve satisfactory response efficacies with different cancer types, treatment lines, drug combinations, and therapeutic regimens. This comprehensive summary of the response efficacy of PD-1/PD-L1 inhibitors serves as a reference for clinicians to make evidence-based decisions.

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Efficacy of Dexamethasone for Acute Primary Immune Thrombocytopenia Compared to Prednisolone: A Systematic Review and Meta-analysis

TH Open ◽

10.1055/s-0037-1604168 ◽

2017 ◽

Vol 01 (02) ◽

pp. e73-e81

Author(s):

Yasuyuki Arai ◽

Hiroyuki Matsui ◽

Tomoyasu Jo ◽

Tadakazu Kondo ◽

Akifumi Takaori-Kondo

Keyword(s):

Systematic Review ◽

Immune Thrombocytopenia ◽

Meta Analysis ◽

Initial Therapy ◽

First Line Therapy ◽

Significant Difference ◽

Primary Immune Thrombocytopenia ◽

Acute Itp ◽

Therapy Studies

AbstractCorticosteroids have been established as first-line therapy in acute primary immune thrombocytopenia (ITP), and the clinical guidelines recommend either dexamethasone (Dex) or prednisolone (PSL). The types and dosages of corticosteroids, however, have not yet been determined, because previous randomized control trials (RCTs) comparing Dex and PSL showed controversial results in terms of efficacy. To understand and interpret all available evidence, we conducted a systematic review and meta-analysis of RCTs. The main outcome measure was the incidence of sustained response (SR; platelet count >30 × 109/L for 6 months without concomitant treatments after the completion of the final therapies). Eight RCTs (totaling 704 patients) were included in this study. The incidence of SR showed no significant difference, while it was significantly higher in the Dex arm when used with posttherapy (more than one course of Dex or tapering corticosteroids added; risk ratio [RR], 1.82; 95% confidence interval [CI], 1.38–2.41; p < 0.01). A single course of Dex showed no significant difference. The overall response (platelet >30 × 109/L) at day 28 was significantly improved in the Dex arm (RR, 1.11; 95% CI, 1.01–1.22; p = 0.03) and Dex with posttherapy suppressed long-term relapse (RR of nonevent, 1.32; 95% CI, 1.10–1.59; p < 0.01). There were significantly fewer adverse events in the Dex arm (RR, 0.45; 95% CI, 0.37–0.55; p < 0.01). Use of Dex with posttherapy instead of PSL may be more beneficial as the initial therapy. Studies comparing Dex with other new strategies are essential to determine the most suitable therapeutic regimens for acute ITP.

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Comparison between nab-paclitaxel and solvent-based taxanes as neoadjuvant therapy in breast cancer: a systematic review and meta-analysis

BMC Cancer ◽

10.1186/s12885-021-07831-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Miao Liu ◽

Siyao Liu ◽

Liu Yang ◽

Shu Wang

Keyword(s):

Breast Cancer ◽

Neoadjuvant Therapy ◽

Meta Analysis ◽

Metastatic Breast ◽

Complete Response ◽

Cochrane Central Register ◽

Ki 67 ◽

Term Survival ◽

Central Register

Abstract Background To compare the efficacy and safety of nanoparticle albumin-bound paclitaxel (nab-paclitaxel) and solvent-based taxanes (sb-taxanes) as neoadjuvant therapy in the treatment of breast cancer. Methods We systematically searched the PubMed, Embase, and Cochrane Central Register databases. Randomized controlled trials (RCTs) and cohort studies, published in English, about the comparison between nab-paclitaxel and sb-taxanes as neoadjuvant therapy in patients with breast cancer were searched up to September 2019. Results The primary outcome was the proportion of patients with pathological complete response (pCR, defined as ypT0 ypN0 or ypT0/is ypN0). Other main outcomes included long-term survival and adverse events (AEs). Seven studies (five RCTs and two cohorts) and 2949 patients were included. Neoadjuvant nab-paclitaxel improved pCR compared with sb-taxanes (ypT0 ypN0: OR = 1.52, 95%CI: 1.27–1.83, P < 0.001; ypT0/is ypN0: OR = 1.40, 95%CI: 1.17–1.68, P < 0.001). The benefits of nab-paclitaxel on pCR were persistent in HER2-negative, hormone receptor (HR)-positive breast cancer (OR = 1.53, 95%CI: 1.07–2.19, P = 0.020), triple-negative breast cancer (weekly/every 2 weeks regimen; OR = 2.95, 95%CI: 1.54–5.67, P < 0.001), and tumors with Ki-67 > 20% (OR = 1.63, 95%CI: 1.26–2.12, P < 0.001). Patients treated with nab-paclitaxel had better event-free survival (EFS; HR = 0.69, 95%CI: 0.57–0.85, P < 0.001) than with sb-taxanes. There were no differences in most of grade > 3 AEs between nab-paclitaxel and sb-taxanes (all P > 0.05), besides of any grade hypersensitivity (OR = 0.29, 95%CI: 0.11–0.72, P = 0.008), any grade (OR = 2.10, 95%CI: 1.37–3.23, P = 0.001) and grade > 3 (OR = 4.01, 95%CI: 2.51–6.41, P < 0.001) neuropathy. Conclusion Nab-paclitaxel is effective for the treatment of non-metastatic breast cancer in the neoadjuvant setting. Nab-paclitaxel could improve pCR rate and EFS compared with sb-taxanes and with reasonable toxicities.

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Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis

European Respiratory Journal ◽

10.1183/13993003.01153-2017 ◽

2017 ◽

Vol 50 (5) ◽

pp. 1701153 ◽

Cited By ~ 35

Author(s):

Cindy A. Verberkt ◽

Marieke H.J. van den Beuken-van Everdingen ◽

Jos M.G.A. Schols ◽

Sushma Datla ◽

Carmen D. Dirksen ◽

...

Keyword(s):

Adverse Effects ◽

Advanced Disease ◽

Single Case ◽

Meta Analysis ◽

Carbon Dioxide Tension ◽

Cochrane Central Register ◽

Inclusion Criteria ◽

Central Register ◽

Study Population

Previous studies have shown that opioids can reduce chronic breathlessness in advanced disease. However, physicians remain reluctant to prescribe opioids for these patients, commonly due to fear of respiratory adverse effects. The aim of this study was to systematically review reported respiratory adverse effects of opioids in patients with advanced disease and chronic breathlessness.PubMed, Embase, the Cochrane Central Register of Controlled Trials, CINAHL, ClinicalTrials.gov and the reference lists of relevant systematic reviews were searched. Two independent researchers screened against predefined inclusion criteria and extracted data. Meta-analysis was conducted where possible.We included 63 out of 1990 articles, describing 67 studies. Meta-analysis showed an increase in carbon dioxide tension (0.27 kPa, 95% CI 0.08–0.45 kPa,) and no significant change in oxygen tension and oxygen saturation (both p>0.05). Nonserious respiratory depression (definition variable/not stated) was described in four out of 1064 patients. One cancer patient pretreated with morphine for pain needed temporary respiratory support following nebulised morphine for breathlessness (single case study).We found no evidence of significant or clinically relevant respiratory adverse effects of opioids for chronic breathlessness. Heterogeneity of design and study population, and low study quality are limitations. Larger studies designed to detect respiratory adverse effects are needed.

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Vitamin D Supplementation and Mortality in Older Adults: A Systematic Review and Meta-Analysis

Innovation in Aging ◽

10.1093/geroni/igaa057.781 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 242-242

Author(s):

Yunli Zhao ◽

Shuli Jia ◽

Meiling Ge ◽

Birong Dong

Keyword(s):

Older Adults ◽

Vitamin D ◽

Meta Analysis ◽

Pooled Analysis ◽

Vitamin D Supplementation ◽

Cochrane Central Register ◽

Central Register ◽

All Cause Mortality ◽

Pooled Sample

Abstract Web of Science, Embase, Medline and Cochrane Central Register of Controlled Trails from their inception to 14 January 2020 were searched in this review. We included randomized controlled trials (RCTs), which compared vitamin D supplementation versus placebo or no intervention and reported mortality as one of outcomes in older adults. Two review authors extracted data independently. Fifty-one articles were included in the analysis, which generated a total pooled sample of 89,977 people and 9813 deaths. These trials were pooled in a meta-analysis, and the outcomes were expressed as risk ratios (RRs) and 95% confidence Intervals (CIs). Across all studies, vitamin D supplementation was not associated with all-cause mortality (RR 0.98, 95%CI 0.92 to 1.04, P=0.48, I2=14%; 89,977 participants; data from 51 trails). Vitamin D supplementation was significantly decreased cancer mortality ( RR 0.85, 95% CI 0.74 to 0.97, P= 0.02, I2=0%; 34364 participants; data from 6 trails). A subgroup analysis showed the associations between the length of vitamin D supplementation more than 3 years and all-cause mortality were statistically significance (RR 0.93, 95%CI 0.88 to 0.98, p = 0.01, I2=0%; 49336 participants; data from 17 trails). Subgroup analyses by vitamin D status, forms of vitamin D (vitamin D3, vitamin D2, alfacalcidol or calcitriol), dose showed no association with all-cause mortality. The evidence from pooled analysis of 51 RCTs undertaken in older adults shows vitamin D supplementation was not associated with all-cause mortality. More long-term trails are need to know weather vitamin D supplementation can decrease all-cause mortality in older adults.

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Immediate Effect of Fan Therapy in Terminal Cancer With Dyspnea at Rest: A Meta-Analysis

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909119873626 ◽

2019 ◽

Vol 37 (4) ◽

pp. 294-299 ◽

Cited By ~ 2

Author(s):

Jun Kako ◽

Masamitsu Kobayashi ◽

Yasufumi Oosono ◽

Kohei Kajiwara ◽

Mika Miyashita

Keyword(s):

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Terminal Cancer ◽

Cochrane Central Register ◽

Patients With Cancer ◽

Central Register ◽

Nonmalignant Disease ◽

The Cochrane Library

Background: Dyspnea is a common distressing symptom in patients with malignant and nonmalignant diseases. Fan therapy, which uses a fan to blow air toward the patient’s face, can alleviate dyspnea; however, its efficacy remains unclear. Aim: To examine the immediate efficacy of fan therapy for alleviation of dyspnea at rest. Design: Meta-analysis. Data sources: We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE EBSCO, CINAHL EBSCO, and Scopus from January 1, 1987, to August 21, 2018 (PROSPERO-CRD42018108610). In addition, we hand-searched studies and used the similar articles feature on PubMed to search for articles. Randomized controlled trials comparing the effects of fan therapy with placebo or other interventions to alleviate dyspnea at rest, in which patients were aged ≥18 years, were eligible for inclusion in the review. We excluded articles on long-term intervention involving fan therapy and complex intervention (including fan therapy). The risk of bias assessment was conducted using the Cochrane tool, and the meta-analysis was performed using RevMan version 5.3. Results: We identified a total of 218 studies; 2 met our criteria for inclusion in the meta-analysis. Fan therapy significantly improved dyspnea at rest in terminally ill patients with cancer compared to control groups (mean difference: −1.31, 95% confidence interval: −1.79 to −0.83, P < .001). There were no studies that met the inclusion criteria regarding fan therapy for patients with nonmalignant disease. Conclusions: This meta-analysis demonstrated that fan therapy may be an effective intervention for dyspnea at rest in patients with terminal cancer.

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