Meta-analysis: the efficacy and safety of combined treatment with ARB and ACEI on diabetic nephropathy

Objective. To perform a systematic evaluation of the efficacy and safety of combined treatment of Shenmai injection and chemotherapy for lung cancer. Methods. A literature search for randomized controlled trials (RCTs) describing the treatment of lung cancer by Shenmai injection and chemotherapy or chemotherapy alone was performed using the PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Value In Paper (VIP), China BioMed, and Wanfang databases. The databases were searched for entries published before September 1, 2019. Results. Thirty-seven RCTs, comprising a total of 2808 cases, were included in the present meta-analysis. Of these, 1428 cases were treated by Shenmai injection plus chemotherapy, and 1380 cases were treated only by chemotherapy. The results of meta-analysis showed that the combined treatment (Shenmai injection plus chemotherapy) increased the short-term efficacy of treatment (relative risk [RR] = 1.183, 95% confidence interval [CI] = 1.043–1.343, P < 0.01 ) and improved patients’ quality of life (RR = 1.514, 95%CI = 1.211–1.891, P < 0.01 ) compared with chemotherapy alone. With regard to the adverse effects, the combined treatment markedly reduced the incidence of white blood cell (WBC) reduction (RR = 0.846, 95%CI = 0.760–0.941, P < 0.01 ), platelet reduction (RR = 0.462, 95% CI = 0.330–0.649, P < 0.01 ), and hemoglobin reduction (RR = 0.462, 95% CI = 0.330–0.649, P < 0.01 ) and alleviated drug-induced liver injury (RR = 0.677, 95%CI = 0.463–0.990, P < 0.05 ). However, it did not offer a significant protective effect (RR = 0.725, 95%CI = 0.358–1.468, P < 0.05 ). The effect of the combined treatment on the occurrence of vomiting was considerable (RR = 0.889, 95%CI = 0.794–0.996, P < 0.05 ), and the combined treatment markedly increased the immunity of patients with lung cancer. Conclusion. The combined treatment of Shenmai injection plus chemotherapy enhanced the short-term efficacy of chemotherapy, improved the patient quality of life, alleviated the adverse effects of chemotherapeutics, and increased the patient immunity. These results should be confirmed by large-scale, high-quality RCTs.

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Efficacy and safety of Huangkui capsule for diabetic nephropathy A protocol for systematic review and meta-analysis

10.37766/inplasy2021.6.0057 ◽

2021 ◽

Author(s):

Wenrong An ◽

Yanqin Huang ◽

Shouqiang Chen ◽

Tao Teng ◽

Juan Liu ◽

...

Keyword(s):

Systematic Review ◽

Diabetic Nephropathy ◽

Meta Analysis ◽

Efficacy And Safety

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Efficacy and safety of Shenkang Injection as adjuvant therapy in patients with diabetic nephropathy: a protocol for systematic review and meta-analysis

10.37766/inplasy2020.11.0014 ◽

2020 ◽

Author(s):

Yanping Wang ◽

Mingzhu Li ◽

Sheng Xu ◽

Chenyun Li ◽

Yuanyuan Cai ◽

...

Keyword(s):

Systematic Review ◽

Diabetic Nephropathy ◽

Adjuvant Therapy ◽

Meta Analysis ◽

Efficacy And Safety

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Efficacy and safety of iguratimod combined with methotrexate vs. methotrexate alone in rheumatoid arthritis

Zeitschrift für Rheumatologie ◽

10.1007/s00393-020-00944-7 ◽

2020 ◽

Author(s):

L.-J. Chen ◽

Y.-J. Zhou ◽

Z.-H. Wen ◽

F. Tian ◽

J.-Y. Li

Keyword(s):

Rheumatoid Arthritis ◽

Meta Analysis ◽

Statistical Significance ◽

Combined Treatment ◽

Cochrane Collaboration ◽

Biomedical Literature ◽

Cochrane Library ◽

Efficacy And Safety ◽

American College Of Rheumatology ◽

The Cochrane Collaboration

AbstractThe current systematic review and meta-analysis aims to evaluate the efficacy and safety of iguratimod (IGU) combined with methotrexate (MTX) versus MTX alone in rheumatoid arthritis (RA). Two independent investigators searched for original randomized controlled trials (RCTs) related to the combination of IGU and MTX in RA published before November 1, 2019, in PubMed, Cochrane Library, Embase, the China National Knowledge Infrastructure (CNKI), the Chinese Biomedical Literature Database (CBM), and WanFang Data. Additionally, we searched clinical trial registry websites. We assessed the methodological quality of the included trials using the Cochrane Collaboration tool and the seven-point Jadad scale. Statistical analyses were performed using Review Manager (RevMan) 5.3 (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). Meta-regression and publication bias analyses were performed using Stata version 14 software (StataCorp., College Station, TX, USA). A total of 7 RCTs consisting of 665 participants, with 368 participants in the active arm and 297 in the placebo arm, were included in the meta-analysis. The American College of Rheumatology (ACR) value was better in the IGU + MTX group than in the MTX alone group, with a pooled relative risk (RR) for ACR20 (American College of Rheumatology 20% improvement criteria), ACR50, and ACR70 of 1.40 (95% CI, 1.13–1.74), 2.09 (95% CI, 1.67–2.61), and 2.24 (95% CI, 1.53–3.28), respectively. The results of the meta-analysis demonstrated that there was no statistical significance in adverse events (1.06 (95% CI, 0.92–1.23)). The combined treatment is an effective, safe, and economical treatment option for patients who do not respond well to methotrexate alone or for patients who cannot afford expensive biologics that have no confirmed efficacy.

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Efficacy and safety of Bailing capsules in the treatment of type 2 diabetic nephropathy: a meta-analysis

Annals of Palliative Medicine ◽

10.21037/apm-20-1799 ◽

2020 ◽

Vol 9 (6) ◽

pp. 3885-3898

Author(s):

Xiaohua Sheng ◽

Yang Dong ◽

Dongsheng Cheng ◽

Niansong Wang ◽

Yongping Guo

Keyword(s):

Diabetic Nephropathy ◽

Meta Analysis ◽

Efficacy And Safety ◽

Type 2 Diabetic

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Efficacy and Safety of Tripterygium Glycoside in the Treatment of Diabetic Nephropathy: A Systematic Review and Meta-Analysis Based on the Duration of Medication

Frontiers in Endocrinology ◽

10.3389/fendo.2021.656621 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yizhen Li ◽

Runpei Miao ◽

Yixing Liu ◽

Jiawei Zhang ◽

Zhili Dou ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trial ◽

Diabetic Nephropathy ◽

Adverse Events ◽

Treatment Duration ◽

Meta Analysis ◽

Efficacy And Safety ◽

Severe Adverse Events ◽

Blood Creatinine

AimThe aim of this study was to assess the clinical efficacy and safety of Tripterygium-derived glycosides (TG) after 3-month and 6-month of treatments of diabetic nephropathy (DN) and to resolve the conflict between medicine guidance and clinical practice for TG application.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials involving TG application in treating DN. We extensively searched PubMed, Cochrane Library, CNKI, VIP, Wan-Fang, CBM, Chinese Clinical Trial Registry, and WHO International Clinical Trial Registration Platform till November 2020, along with grey literature for diabetes and all other relevant publications to gather eligible studies. Based on the preset inclusion and exclusion criteria, document screening, quality assessment of methodology, and data extraction was conducted by two researchers independently. The methodological quality was assessed by the Cochrane risk test from the Cochrane Handbook 5.2, and then analyses were performed by Review Manager 5.3 (Rev Man 5.3). The quality of output evidence was classified by GRADE.ResultsThirty-one eligible studies (2764 patients) were included for this meta-analysis. Our study results showed a comparable significant decrease in the 24 h-UTP and blood creatinine levels in DN patients from both 3-month and 6-month TG treatment groups, compared with the routine symptomatic treatment alone. To the contrary of the findings from the included studies, our results showed that the occurrence of serious adverse reaction events was significantly higher in the TG treated group with 6 months of treatment duration compared to that of 3 months of the treatment course. However, the total AR ratio was slightly varied while increasing the percent of severe adverse events. GRADE assessment indicated that the quality of evidence investigating TG-induced adverse reactions was moderate and that for 24 h-UTP and blood creatinine indicators were considerably low.ConclusionCombinatorial treatment regimen including TG can significantly decrease the pathological indicators for DN progression, while it can also simultaneously predispose the patient to a higher risk for developing severe adverse events, as the medicine guidance indicates. Notably, even in 3-month of course duration smaller percent of severe adverse events can get to a fatal high percent and is likely to increase proportionally as the TG treatment continues. This suggests that TG-mediated DN treatment duration should be optimized to even less than 3 continuous months to avoid adverse event onset-associated further medical complications in DN patients. In clinical practice, serious attention should be paid to these severe side-effects even in a course normally considered safe, and importantly more high-quality studies are urgently warranted to obtain detailed insights into the balance between the efficacy and safety profiles of TG application in treating DN.

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Efficacy of tripterygium glycosides combined with ARB on diabetic nephropathy: a meta-analysis

Bioscience Reports ◽

10.1042/bsr20202391 ◽

2020 ◽

Vol 40 (11) ◽

Author(s):

Xue Wu ◽

Youye Huang ◽

Yao Zhang ◽

Chunling He ◽

Yongli Zhao ◽

...

Keyword(s):

Diabetic Nephropathy ◽

Meta Analysis ◽

Combined Treatment ◽

Mean Difference ◽

Biomedical Literature ◽

Controlled Trials ◽

Angiotensin Ii Receptor Blocker ◽

Cochrane Central Register ◽

Significant Difference ◽

Tripterygium Glycosides

Abstract The purpose of this meta-analysis was to evaluate the beneficial and adverse effects of tripterygium glycosides (TGs) combined with angiotensin II receptor blocker (ARB) on diabetic nephropathy (DN). We searched for randomized controlled trials (RCTs) in PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data, Chinese Biomedical Literature Database, China Science and Technology Journal Database up to June 2017. Weighted mean difference (WMD) and standardized mean difference (SMD) were used for continuous variables and all variables were expressed by 95% confidence interval (CI). Twenty-three studies with 1810 DN patients were included in this meta-analysis. TG combined with ARB statistically significantly improved 24-h urinary total protein (24-h UTP) (SMD = −1.46; 95% CI = −1.84 to −1.09; P<0.00001), urinary albumin excretion rate (UAER) (SMD = −6.9; 95% CI = −9.65 to −4.14, P<0.00001), serum creatinine (SCr) (WMD = −7.65.14; 95% CI = −12.99 to −2.31; P=0.005) and albumin (Alb) (WMD = 5.7; 95% CI = 4.44 to 6.96; P<0.00001) more than did ARB alone. TG combined with ARB statistically significantly affected the level of serum glutamic pyruvic transaminase (SGPT) (WMD = 1.08; 95% CI = 0.04 to 2.12, P=0.04) more than did ARB alone. Compared with ARB alone, TG combined with ARB showed no significant difference in improving blood urea nitrogen (BUN) and hemoglobin A1c (HbA1c). Minor side effects from the combined treatment were observed and mainly focused on the abnormal liver function. TG combined with ARB offers a novel concept in treating DN, more high-quality RCTs are needed for better understanding and applying the combined treatment in DN.

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