Effectiveness of drug treatment strategies to prevent asthma exacerbations and increase symptom-free days in asthmatic children: a network meta-analysis

To estimate the association between obesity and poor asthma control or risk of exacerbations in asthmatic children and adolescents, and to assess whether these associations are different by sex.A meta-analysis was performed on unpublished data from three North-European paediatric asthma cohorts (BREATHE, PACMAN (Pharmacogenetics of Asthma medication in Children: Medication with Anti-inflammatory effects) and PAGES (Pediatric Asthma Gene Environment Study)) and 11 previously published studies (cross-sectional and longitudinal studies). Outcomes were poor asthma control (based on asthma symptoms) and exacerbations rates (asthma-related visits to the emergency department, asthma-related hospitalisations or use of oral corticosteroids). Overall pooled estimates of the odds ratios were obtained using fixed- or random-effects models.In a meta-analysis of 46 070 asthmatic children and adolescents, obese children (body mass index ≥95th percentile) compared with non-obese peers had a small but significant increased risk of asthma exacerbations (OR 1.17, 95% CI 1.03–1.34; I2: 54.7%). However, there was no statistically significant association between obesity and poor asthma control (n=4973, OR 1.23, 95% CI 0.99–1.53; I2: 0.0%). After stratification for sex, the differences in odds ratios for girls and boys were similar, yet no longer statistically significant.In asthmatic children, obesity is associated with a minor increased risk of asthma exacerbations but not with poor asthma control. Sex does not appear to modify this risk.

Download Full-text

Vitamin D reduces Exacerbation in Children with Asthma: A Systematic Review and Meta-analysis

Journal of Postgraduate Medicine Education and Research ◽

10.5005/jp-journals-10028-1198 ◽

2016 ◽

Vol 50 (2) ◽

pp. 86-92

Author(s):

Anil Chauhan ◽

Nishant Jaiswal ◽

Manvi Singh ◽

Kiran Kumar Thumburu ◽

Shailender Singh Chauhan ◽

...

Keyword(s):

Systematic Review ◽

Vitamin D ◽

Meta Analysis ◽

Alternative Therapy ◽

Hypovitaminosis D ◽

Asthmatic Children ◽

Asthma Exacerbations ◽

Children With Asthma ◽

Acute Asthma Exacerbation ◽

Impaired Pulmonary Function

ABSTRACT Aim The question whether treatment with vitamin D improves asthma exacerbations in children and adults still needs to be addressed. Background Recent studies in children and adults found a higher prevalence of hypovitaminosis D associated with a higher severity of asthma and impaired pulmonary function. In asthmatic children, patients with vitamin D deficiency demonstrated increased airway hyperresponsiveness and corticosteroid requirements. Results Of 469 records/studies identified through database searching, 5 studies were included in this systematic review. The overall pooled effect showed a significant reduction in acute asthma exacerbation in the vitamin D group (odds ratio 0.45, 95% confidence interval 0.22—0.93). There were no studies that focus on the quality of life. Conclusion This systematic review supports the role of vitamin D in reducing the number of asthma exacerbations in children but not in adults. Clinical significance The present systematic review demonstrates reduction in asthma exacerbations in children. Most of the asthma children are on inhaled corticosteroid, which poses a threat for its side effects. However, vitamin D having multiple functions in body could be used as an alternative therapy in asthmatic children. In adults, more trials are needed wherein the deficient individuals are supplemented with vitamin D and further assessed for asthma exacerbations. There is no harm in supplementation of vitamin D to deficient and insufficient asthmatic individuals. How to cite this article Chauhan A, Singh M, Jaiswal N, Thumburu KK, Agarwal A, Chauhan SS, Dhatwalia S, Bhende MS, Singh M. Vitamin D reduces Exacerbation in Children with Asthma: A Systematic Review and Meta-analysis. J Postgrad Med Edu Res 2016;50(2):86-92.

Download Full-text

Outcomes associated with modern treatment paradigms in connective tissue disease (CTD)-associated pulmonary arterial hypertension (PAH): a meta-analysis of randomized controlled trials (RCTs)

European Heart Journal ◽

10.1093/ehjci/ehaa946.2282 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V McLaughlin ◽

C Zhao ◽

J.G Coghlan ◽

L.S Chung ◽

S.C Mathai ◽

...

Keyword(s):

Drug Treatment ◽

Treatment Effect ◽

Meta Analysis ◽

Response To Treatment ◽

Funding Source ◽

Class Iii ◽

Inclusion Criteria ◽

Private Company ◽

Mortality Event

Abstract Background CTD-PAH has historically represented a PAH subtype with poor prognosis. New therapies, as well as combination therapy approaches targeting multiple pathways have been approved for PAH based on RCTs. CTD-PAH patients comprise a subgroup of the RCT populations and efficacy analyses are based on subgroup analyses which can be less reliable than the overall analysis. We conducted a meta-analysis of RCTs of approved PAH therapies to evaluate outcomes of patients with CTD-PAH. Purpose To use meta-analysis to determine response to treatment in patients with CTD-PAH. Methods The PubMed and EMBASE databases were searched for English-only articles published between January 1, 2000 and November 25, 2019. Inclusion criteria were multicenter RCTs that enrolled adults with WHO group 1 pulmonary hypertension (PAH); enrollment in 2000 or later; long-term clinical morbidity and/or mortality event or 6-minute walk distance (6MWD) as an efficacy endpoint reported for ≥30 patients with CTD-PAH; and evaluation of a US Food and Drug Administration-approved PAH therapy. The primary outcomes were treatment effect as measured by the study time to first morbidity or morality event and change in 6MWD from baseline to between 3–6 months, per the data provided in each article. Results from individual studies were combined using a random-effects model for overall study population (PAH patients) and the subgroup of CTD-PAH patients. Results Ten RCTs (N=4329 PAH patients; n=1263 (29%) with CTD-PAH) met inclusion criteria and were included in the meta-analysis. At baseline, PAH patients had a mean age of 50 years, approximately 78% were female, and approximately 58% had functional class III or IV disease. These characteristics were balanced between treatment and control groups. Baseline 6MWD was 356 m for the overall population and 337 m for patients with CTD-PAH. Five RCTs (N=3172; n=941 with CTD-PAH [30%]) reported hazard ratios (HRs) for time to a morbidity or mortality event by drug treatment and PAH etiology: overall population HR=0.63 (95% confidence interval [CI], 0.56–0.72; P<0.001); CTD-PAH population HR=0.64 (95% CI, 0.51–0.80; P<0.001) (Figure). Nine RCTs reported mean change with drug treatment from baseline to 3 to 6 months in 6MWD for PAH and CTD patients: 33.9 m (95% CI, 21.9–45.9; P<0.001) in the overall population; 20.2 m (95% CI, 10.8–29.7; P<0.001) in CTD-PAH patients. Conclusions The improvement in 6MWD in patients with CTD-PAH is smaller than in those with other types of PAH, perhaps reflecting comorbidities and CTD-induced mobility constraints, independent of their cardiopulmonary capacity. Data from long term clinical morbidity/mortality endpoint studies in this large group of patients with CTD-PAH demonstrate that these patients derive significant benefit from currently available PAH therapies which, in many patients, comprised the addition of a drug targeting a second or third pathway involved in the pathophysiology of PAH. Treatment effect on morbidity/mortality Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Actelion Pharmaceuticals US, Inc.

Download Full-text

ADRB2 Haplotypes and Asthma Exacerbations in Children and Young Adults: An Individual Participant Data Meta‐Analysis

Clinical & Experimental Allergy ◽

10.1111/cea.13965 ◽

2021 ◽

Author(s):

Leila Karimi ◽

Susanne J. Vijverberg ◽

Marjolein Engelkes ◽

Natalia Hernandez‐Pacheco ◽

Niloufar Farzan ◽

...

Keyword(s):

Young Adults ◽

Meta Analysis ◽

Individual Participant Data ◽

Asthma Exacerbations ◽

Individual Participant ◽

Children And Young Adults

Download Full-text

Prevalence and Impact of Atrial Fibrillation in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10112490 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2490

Author(s):

Giulio Francesco Romiti ◽

Bernadette Corica ◽

Gregory Y. H. Lip ◽

Marco Proietti

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Meta Analysis ◽

Geographical Location ◽

Treatment Strategies ◽

Cardiovascular Complications ◽

Risk Of Death ◽

All Cause Mortality ◽

High Degree ◽

Degree Of Heterogeneity

Background: In patients with COVID-19, cardiovascular complications are common and associated with poor prognosis. Among these, an association between atrial fibrillation (AF) and COVID-19 has been described; however, the extent of this relationship is unclear. The aim of this study is to investigate the epidemiology of AF in COVID-19 patients and its impact on all-cause mortality. Methods: A systematic review and meta-analysis were performed and reported according to PRISMA guidelines, and a protocol for this study was registered on PROSPERO (CRD42021227950). PubMed and EMBASE were systematically searched for relevant studies. A random-effects model was used to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). Results: Overall, 31 studies were included in the analysis, with a total number of 187,716 COVID-19 patients. The prevalence of AF was found to be as high as 8% of patients with COVID-19 (95% CI: 6.3–10.2%, 95% prediction intervals (PI): 2.0–27.1%), with a high degree of heterogeneity between studies; a multiple meta-regression model including geographical location, age, hypertension, and diabetes showed that these factors accounted for more than a third of the heterogeneity. AF COVID-19 patients were less likely to be female but more likely older, hypertensive, and with a critical status than those without AF. Patients with AF showed a significant increase in the risk of all-cause mortality (OR: 3.97, 95% CI: 2.76–5.71), with a high degree of heterogeneity. A sensitivity analysis focusing on new-onset AF showed the consistency of these results. Conclusions: Among COVID-19 patients, AF is found in 8% of patients. AF COVID-19 patients are older, more hypertensive, and more likely to have a critical status. In COVID-19 patients, AF is associated with a 4-fold higher risk of death. Further studies are needed to define the best treatment strategies to improve the prognosis of AF COVID-19 patients.

Download Full-text

Comprehensive Comparisons among Inotropic Agents on Mortality and Risk of Renal Dysfunction in Patients Who Underwent Cardiac Surgery: A Network Meta-Analysis of Randomized Controlled Trials

Journal of Clinical Medicine ◽

10.3390/jcm10051032 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1032

Author(s):

Wei-Cheng Chen ◽

Meng-Hsuan Lin ◽

Chieh-Lung Chen ◽

Ying-Chieh Chen ◽

Chih-Yu Chen ◽

...

Keyword(s):

Cardiac Surgery ◽

Randomized Controlled Trials ◽

Renal Dysfunction ◽

Systolic Function ◽

Meta Analysis ◽

Treatment Strategies ◽

Controlled Trials ◽

Protective Effects ◽

Renal Protection ◽

Randomized Controlled

Several kinds of inotropes have been used in critically ill patients to improve hemodynamics and renal dysfunction after cardiac surgery; however, the treatment strategies for reducing mortality and increasing renal protection in patients who underwent cardiac surgery remain controversial. Therefore, we performed a comprehensive network meta-analysis to overcome the lack of head-to-head comparisons. A systematic database was searched up to 31 December 2020, for randomized controlled trials that compared different inotropes on mortality outcomes and renal protective effects after cardiac surgery. A total of 29 trials were included and a frequentist network meta-analysis was performed. Inconsistency analyses, publication bias, and subgroup analyses were also conducted. Compared with placebo, use of levosimendan significantly decreased the risks of mortality (odds ratio (OR): 0.74; 95% confidence interval (CI): 0.56–0.97) and risk of acute renal injury (OR: 0.61; 95% CI: 0.45–0.82), especially in low systolic function patients. Use of levosimendan also ranked the best treatment based on the P-score (90.1%), followed by placebo (64.5%), milrinone (49.6%), dopamine (49.5%), dobutamine (29.1%), and fenoldopam (17.0%). Taking all the available data into consideration, levosimendan was a safe renal-protective choice for the treatment of patients undergoing cardiac surgery, especially for those with low systolic function.

Download Full-text

Comparative efficacy and safety of drug treatment for premature ejaculation: A systemic review and Bayesian network meta‐analysis

Andrologia ◽

10.1111/and.13806 ◽

2020 ◽

Vol 52 (11) ◽

Author(s):

Hanchao Liu ◽

Mingxiao Zhang ◽

Mingchuan Huang ◽

Hongcai Cai ◽

Yadong Zhang ◽

...

Keyword(s):

Drug Treatment ◽

Bayesian Network ◽

Premature Ejaculation ◽

Meta Analysis ◽

Systemic Review ◽

Efficacy And Safety ◽

Comparative Efficacy

Download Full-text

Meta-Analysis: Effect of Long-Acting β-Agonists on Severe Asthma Exacerbations and Asthma-Related Deaths

Annals of Internal Medicine ◽

10.7326/0003-4819-144-12-200606200-00126 ◽

2006 ◽

Vol 144 (12) ◽

pp. 904 ◽

Cited By ~ 330

Author(s):

Shelley R. Salpeter ◽

Nicholas S. Buckley ◽

Thomas M. Ormiston ◽

Edwin E. Salpeter

Keyword(s):

Severe Asthma ◽

Meta Analysis ◽

Asthma Exacerbations ◽

Long Acting

Download Full-text

Therapeutic Effect of Mesenchymal Stem Cells on Sjögren's Syndrome: Systematic Review and a Preclinical Meta-Analysis

10.21203/rs.3.rs-325228/v1 ◽

2021 ◽

Author(s):

Yan Liu ◽

Yi Xiong Chen ◽

Nancy Olsen ◽

Wael Jarjour ◽

Yan Lu ◽

...

Keyword(s):

Stem Cells ◽

Mesenchymal Stem Cells ◽

Sjögren’S Syndrome ◽

Sjögren's Syndrome ◽

Meta Analysis ◽

Treatment Strategies ◽

Sjogren’S Syndrome ◽

Sjogren's Syndrome ◽

Therapeutic Effects ◽

Sjögren‘S Syndrome

Abstract BackgroundEvidence to support Mesenchymal stem cells (MSCs) treatment in Sjögren's syndrome (SS) has been verified. This study aims to evaluate the effectiveness of heterogeneous MSCs therapies, identify optimal experimental parameters and explore possible underlying mechanisms in animal models of SS.MethodsLiterature searches were performed in PubMed, Web of Science and EMBASE. Effect sizes of SS treatments with MSCs were extracted and analyzed by two authors independently.ResultsA total of 13 studies and 20 treatment arms met the inclusion criteria. When compared with the controls, MSCs treatment resulted in lower level of histological score (SMD= -2.208; 95%CI= -3.129, -1.286; P<0.001) accompanied by an improved trend of salivary flow rate (SFR) (SMD = 1.726; 95%CI= 1.340, 2.113; P <0.001) and Schirmer's test results (SMD= 3.379; 95% CI= 2.141, 4.618; P<0.001). In MSCs groups, levels of autoantibodies decreased to varying degrees. Treg cells were increased and Th17 cells were decreased in both lymph nodes and spleens. Additionally, IL-6 reduction and IL-10 elevation were found in local lesional tissues. Furthermore, TNF-α level dropped either in sera or glands. Notably, the cell injection frequency and routes may be two important factors affecting the effect of MSCs therapy.ConclusionTo the best of our knowledge, this is the first meta-analysis to quantitatively evaluate MSCs therapeutic effects on SS. Our research emphasizes optimizing MSC treatment strategies to achieve better outcomes, thereby providing a valuable reference for clinical application.

Download Full-text