scholarly journals The efficacy of combined Albendazole and Praziquantel therapy versus Albendazole monotherapy in treatment of parenchymal neurocysticercosis: A systematic review

2021 ◽  
Vol 10 (2) ◽  
pp. 90-96
Author(s):  
Gaurav Nepal ◽  
Jessica Holly Rehrig ◽  
Rajan Sharma Kandel ◽  
Shaik Tanveer Ahamad ◽  
Bipin Kandel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Meta Analysis ◽  
Dual Therapy ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Radiographic Evaluation ◽  
Treatment Groups ◽  
Significant Difference ◽  
Parasitic Effect

Preliminary studies suggest combined albendazole and praziquantel (ABZ+PZQ) therapy has superior anti-parasitic effect compared to albendazole (ABZ) or praziquantel (PZQ) monotherapy, due to potential pharmacokinetic synergism. We thus present an evidence-based review evaluating the risks and benefits associated with combination ABZ+PZQ therapy compared to standard ABZ monotherapy in the treatment of viable parenchymal Neurocysticercosis (NCC). Our systematic review is based on PRISMA (Preferred Reporting Items for Systematic review and Meta- Analysis) statement. Our primary outcome measure was to compare the efficacy of ABZ+PZQ with ABZ alone for treatment of NCC. Efficacy was determined based on clinical and radiographic evaluation. The secondary outcome measured the incidence of adverse effects in each treatment group. Literature search yielded a total of 120 articles. After excluding duplicates and those not meeting inclusion criteria, five papers were reviewed for data collection. Medication regimens, number of cyst, patient age, and location varied amongst included papers. The combination therapy resulted in significant symptom and cyst resolution in patients with more than two viable parenchymal cysts as compared to monotherapy. The two treatment arms were comparable in treating NCC with low cyst burden. There was no significant difference in the adverse effects between two treatment groups. In individuals with multi-cystic NCC, the patients who received dual therapy had better outcomes than those who received ABZ monotherapy as evidenced by radiographic improvement and reduced seizure episodes. The adverse effect profile in patients receiving dual therapy was similar and comparable to those with monotherapy.

scholarly journals The high risk of malarial recurrence in patients with Plasmodium-mixed infection after treatment with antimalarial drugs: a systematic review and meta-analysis

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Aongart Mahittikorn ◽  
Frederick Ramirez Masangkay ◽  
Kwuntida Uthaisar Kotepui ◽  
Giovanni De Jesus Milanez ◽  
Manas Kotepui
Keyword(s):  
Systematic Review ◽  
Mixed Infection ◽  
Subgroup Analysis ◽  
Initial Treatment ◽  
Meta Analysis ◽  
Antimalarial Drugs ◽  
Secondary Outcome ◽  
Significant Heterogeneity ◽  
Pooled Prevalence ◽  
Significant Difference

Abstract Background Malaria mixed infections are often unrecognized by microscopists in the hospitals, and a delay or failure to treat Plasmodium-mixed infection may lead to aggravated morbidity and increased mortality. The present study aimed to quantify the pooled proportion and risk of malarial recurrences after the treatment of Plasmodium-mixed infection. The results of the study may provide benefits in the management of Plasmodium-mixed infection in co-endemic regions. Methods This systematic review and meta-analysis searched the international Prospective Register of Systematic Reviews (PROSPERO; ID = CRD42020199709), MEDLINE, Web of Science, and Scopus for potentially relevant studies in any language published between January 1, 1936, and July 20, 2020, assessing drug efficacy in patients with Plasmodium-mixed infection. The primary outcome was the pooled prevalence of Plasmodium parasitemia after initiating antimalarial treatment for Plasmodium-mixed infection. The secondary outcome was the pooled risk ratio (RR) of malarial recurrence in Plasmodium-mixed infection compared with those in Plasmodium falciparum and Plasmodium vivax mono-infection. The pooled analyses were calculated by random-effects meta-analysis. After the initial treatment in different days of recurrences (≤ 28 days or > 28 days), the risk of Plasmodium parasitemia was compared in subgroup analysis. Results Out of 5217 screened studies, 11 were included in the meta-analysis, including 4390 patients from six countries. The pooled prevalence of all recurrences of Plasmodium-mixed parasitemia was 30% (95% confidence interval (CI) 16–43; I2: 99.2%; 11 studies). The RR of malarial recurrence within 28 days after the initial treatment (clinical treatment failure) of Plasmodium-mixed parasitemia compared with the treatment of P. falciparum was 1.22 (p: 0.029; 95% CI 1.02–1.47; Cochran Q: 0.93; I2: 0%; six studies), while there was no significant difference in the risk of recurrence 28 days after initial treatment compared with the treatment of P. falciparum (p: 0.696, RR: 1.14; 95% CI 0.59–2.18; Cochran Q < 0.05; I2: 98.2%; four studies). The subgroup analysis of antimalarial drugs showed that significant malarial recurrence within 28 days was observed in patients treated with artemisinin-based combination therapies (ACTs) with no significant heterogeneity (p: 0.028, RR: 1.31; 95% CI 1.03–1.66; Cochran Q: 0.834; I2: 0%). Conclusions The present findings showed a high prevalence of malarial recurrence after the initial treatment of Plasmodium-mixed infection. Moreover, significant malaria recurrence of mixed infection occurred within 28 days after treatment with ACTs. Graphic Abstract

scholarly journals Comparative effectiveness of vitamin D supplementation via buccal spray versus oral supplements on 25(OH)D concentrations: a systematic review

2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Lucy Pritchard ◽  
Mary Hickson ◽  
Stephen Lewis
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Adverse Effects ◽  
Crossover Study ◽  
Comparative Effectiveness ◽  
Meta Analysis ◽  
Systemic Circulation ◽  
Vitamin D Supplementation ◽  
Future Research ◽  
Significant Difference

AbstractVitamin D (vitD) deficiency is the most common nutritional deficiency worldwide. Most patients are treated with oral vitD capsules (either vitD2 or vitD3). A few studies have reported equal efficacy of buccal spray vitD. This is a new formulation that is absorbed via the oral mucosa into the systemic circulation, bypassing the gastrointestinal route. The main objective of this systematic review was to identify RCT evidence for the comparative effectiveness of buccal spray versus oral vitD on serum 25-hydroxyvitaminD [25-OHD] concentrations and any adverse effects of buccal spray vitD. We have published an a priori protocol using Joanna Briggs Institute (JBI) methodology (PROSPERO CRD42018118580). A three-step search strategy to identify RCTs was conducted, which reported serum 25-OHD concentrations from five databases from 2008–2018. Retrieved abstracts were screened; included papers imported into JBI SUMARI and assessed for study quality (GRADE) by two authors. Meta-analysis was planned. Three RCTs met our inclusion criteria. Due to heterogeneity of studies, meta-analysis was not possible. In a RCT crossover study, mean serum 25-OHD concentrations were significantly higher in patients with malabsorption syndrome (n = 20) on 1000IU buccal spray + 117.8%(10.46, 95%CI6.89,14.03ng/ml) vs.1000IU oral vitD3 + 36.02%(3.96, 95%CI2.37, 5.56ng/ml) at 30days (p < 0.0001). Mean serum 25-OHD were also significantly higher in healthy adults (n = 20) on buccal spray + 42.99%(7.995, 95%CI6.86,9.13ng/ml)vs.oral vitD3 + 21.72%(4.06, 95%CI3.41,4.71ng/ml) at 30days (p < 0.0001). In another RCT crossover study, ANCOVA revealed no significant difference in the mean and SD change from baseline total 25-OHD concentrations in adults (n = 22) on 3000IU buccal spray vs. 3000IU oral vitD3 + 44%,26.15 (SD17.85) vs. + 51%,30.38 (SD17.91)nmol/l, respectively;F = 1.044, adjusted r20.493,p = 0.313 at 4 weeks. In a RCT, 800IU buccal spray was equally effective as 750IU oral vitD3 in children with neurodisabilities(n = 24) at 3 months. Both groups had a significant increase in 25-OHD; 11.5 ng/ml(median8–19) to 26.5(13.6–39)ng/ml and 15.5ng/ml(8–20) to 34.5(22–49)ng/ml, respectively (z = 150;p < 0.0001). The overall certainty of evidence was very low to moderate. No adverse effects were reported. The evidence from these studies suggests that 800IU-3000IU doses of buccal spray vitD3 given daily may be an effective alternative as oral vitD3 in obtaining short-term haematological responses in serum 25-OHD concentrations. Buccal spray vitD3 may be a useful alternative for patients with intestinal malabsorption or dysphagia. Future research should compare buccal spray VD3 to intramuscular injections and confirm these findings in well-designed trials.

Treatment Emergent Sexual Dysfunction Related to Antidepressants: A Meta-analysis

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Chiesa ◽  
A. Serretti ◽  
R. Calati ◽  
D. de Ronchi
Keyword(s):  
Sexual Dysfunction ◽  
Meta Analysis ◽  
Antidepressant Drugs ◽  
Cochrane Collaboration ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Open Label ◽  
Significant Difference ◽  
Total Treatment ◽  
The Cochrane Collaboration

Objective:Sexual dysfunction is an important under-estimated side effect of antidepressant drugs. Patients, in fact, if not directly questioned, tend to scarcely report them. Thus, the aim of the present meta-analysis is to quantify sexual dysfunction caused by antidepressants on the basis of studies where sexual functioning was purposely investigated through direct inquiry and specific questionnaires.Methods:A literature search was conducted using Medline, Isi web of Knowledge and references of selected articles. Selected studies performed on patients without previous sexual dysfunction were entered in the Cochrane Collaboration Review Manager Software (RevMan version 4.2). Our primary outcome measure was the rate of total treatment emergent sexual dysfunction. Our secondary outcome measures were the rates of treatment emergent desire, arousal and orgasm dysfunction.Results:Our analyses indicated significantly higher rates of treatment emergent sexual dysfunction as well as specific phases dysfunction compared to placebo for the following drugs: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, duloxetine, venlafaxine, clomipramine, imipramine and phenelzine, whereas no significant difference with placebo was found for the following antidepressants: amineptine, bupropion, moclobemide, mirtazapine and nefazodone. Nonetheless sufficient evidences (>100 subjects) are available only for bupropion, citalopram, fluoxetine, paroxetine, sertraline and venlafaxine.Discussion:Present evidence on treatment emergent sexual dysfunction caused by antidepressant is sufficiently studied only for few drugs. Furthermore some statistical limiting assumptions, as the inclusion of open label or small studies and the presence of an evident publication bias, could reduce the significativity of our findings. Thus, treatment emergent sexual dysfunction should be more deeply investigated.

scholarly journals Efficacy and safety of bevacizumab in the treatment of adult gliomas: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e048975
Author(s):  
Huan Wang ◽  
Jianxin Guo ◽  
Tianze Wang ◽  
Kai Wang ◽  
Zhuojun Wu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Large Scale ◽  
Meta Analysis ◽  
Progression Free Survival ◽  
Optimal Dose ◽  
Secondary Outcome ◽  
Efficacy And Safety ◽  
Free Survival ◽  
Significant Difference ◽  
Clinical Centre

ObjectiveTo assess the efficacy and safety of bevacizumab (BEV) in patients with glioma.DesignSystematic review and meta-analysis.ParticipantsAdults aged 18 years and above, whose histology was confirmed to be malignant glioma.Primary and secondary outcome measuresThe main indicators included progression-free survival (PFS) rate and overall survival (OS) rate, and the secondary indicators were adverse reactions.ResultsA total of 11 clinical centre trials were included in this study for meta-analysis, including 2392 patients. The results of the meta-analysis showed that the median PFS rate of the BEV group was significantly higher than that of the non-BEV group (p<0.00001). When comparing PFS between two groups, we found that the PFS in the BEV group was higher than that in the non-BEV group at 6 months (OR 3.31, 95% CI 2.74 to 4.00, p<0.00001), 12 months (OR 2.05, 95% CI 1.70 to 2.49, p<0.00001) and 18 months (OR 1.31, 95% CI 1.02 to 1.69, p=0.03). But at 24 months (OR 0.83, 95% CI 0.50 to 1.37, p=0.47), there was no significant difference between the two groups. At 30 months (OR 0.62, 95% CI 0.39 to 0.97, p=0.04), the PFS of the BEV group was lower than that of the non-BEV group. Moreover, The results showed that BEV had no significant effect on improving OS, but the adverse reaction in BEV group was significantly higher than that in non-BEV group.ConclusionThe evidence suggests that BEV can significantly prolong the PFS of patients with glioma within 18 months and shorten the PFS of patients after 30 months. This limitation may be related to the subgroup of patients, the change of recurrence mode, the optimal dose of drug, the increase of hypoxia, the enhancement of invasiveness and so on. Therefore, it is necessary to carry out more samples and higher quality large-scale research in the future.

Smaller size is more suitable for pharmacotherapy among undersized abdominal aortic aneurysm: a systematic review and meta-analysis

2021 ◽  
pp. 1358863X2110616
Author(s):  
Takuro Shirasu ◽  
Hisato Takagi ◽  
Jun Yasuhara ◽  
Toshiki Kuno ◽  
K Craig Kent ◽  
...  
Keyword(s):  
Systematic Review ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Meta Analysis ◽  
Unmet Need ◽  
Secondary Outcome ◽  
Annual Growth Rate ◽  
Abdominal Aortic ◽  
Significant Difference ◽  
Baseline Diameter

Background: Pharmacotherapy for undersized abdominal aortic aneurysm (AAA) is a clinical unmet need. Randomized controlled trials (RCTs) have failed to show effectiveness despite countless promising data in preclinical studies. We aimed to identify the population with undersized AAAs (30–54 mm) who potentially benefit from pharmacotherapy. Methods: In accordance with the PRISMA statement, we conducted a systematic review and meta-analysis of placebo-controlled RCTs. The primary outcome was mean difference (MD) in annual growth rate (< 0 favors pharmacotherapy), and the secondary outcome was aneurysm-related events (diameters ⩾ 55 mm, ruptures, or referral to surgery). Results: Our search strategy identified eight RCTs (six trials on antibiotics [ABx], two on renin-angiotensin system inhibitors [RAS-I]) with a total of 1325 patients. The mean of baseline diameters ranged from 33.1 mm to 43.1 mm. Neither ABx nor RAS-I showed significant differences in MD. Multivariable random-effects restricted maximum likelihood meta-regression revealed a statistically significant linear relationship between baseline diameter and MD (coefficient 0.15 [95% CI 0.0011, 0.30], p = 0.049) but not for the follow-up period ( p = 0.28) and duration of treatment ( p = 0.11). In line with this result, ABx with baseline diameter < 40 mm significantly reduced MD (−1.03 mm/year [95% CI −1.64, −0.42], p = 0.001) and a borderline significant difference in aneurysm-related events (HR 0.53 [95% CI 0.28, 1.00], p = 0.05), whereas the other groups ⩾ 40 mm never demonstrated effectiveness. Fixed-effect models did not change the results. No evidence of publication bias was detected. Conclusion: Undersized AAAs < 40 mm can potentially benefit from pharmacotherapy. Future RCTs should consider preferentially including undersized AAA with smaller diameters.

scholarly journals Coblation versus Bipolar Diathermy Hemostasis in Pediatric Tonsillectomy Patients: Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Mohammad Karam ◽  
Ahmad Abul ◽  
Abdulwahab Althuwaini ◽  
Talal Alenezi ◽  
Ali Aljadi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Outcome Measures ◽  
Pediatric Patients ◽  
Meta Analysis ◽  
Operation Time ◽  
Secondary Outcome ◽  
Intraoperative Bleeding ◽  
Post Operative Pain ◽  
Delayed Hemorrhage ◽  
Significant Difference

Objective To compare the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Methods A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines and an electronic search of information was conducted to identify all Randomized Controlled Trials (RCTs) comparing the outcomes of coblation versus bipolar in pediatric patients undergoing tonsillectomy. Intraoperative bleeding, reactionary hemorrhage, delayed hemorrhage and post-operative pain were primary outcome measures. Secondary outcome measures included return to normal diet, effects on tonsillar bed, operation time and administration of analgesia. Fixed and random effects models were used for the analysis. Results Seven studies enrolling 1328 patients were identified. There was a significant difference between coblation and bipolar groups in terms of delayed hemorrhage (Odds Ratio [OR] = 0.25, P = 0.0007) and post-operative pain (standardized mean difference [MD] = -2.13, P = 0.0007). Intraoperative bleeding (MD = -43.26, P = 0.11) and reactionary hemorrhage did not show any significant difference. For secondary outcomes, coblation group had improved outcomes in terms of administration of analgesia, diet and tonsillar tissue recovery and thermal damage. No significant difference was reported in terms of operation time. Conclusions Coblation is a superior option when compared to bipolar technique for pediatric patients undergoing tonsillectomy as it improves post-operative pain and delayed hemorrhage and does not worsen intraoperative bleeding and reactionary hemorrhage.

Systematic Review and Meta-analysis: Effectiveness of Corticosteroids in Treating Adults With Acute Vestibular Neuritis

2021 ◽  
pp. 019459982098291
Author(s):  
Kai-Jing Leong ◽  
Timothy Lau ◽  
Vicky Stewart ◽  
Elisa F. D. Canetti
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Meta Analysis ◽  
Complete Recovery ◽  
Vestibular Neuritis ◽  
Canal Paresis ◽  
Vestibular Tests ◽  
Significant Difference ◽  
Objective Outcomes

Objectives To determine whether steroids are effective in treating adults with acute vestibular neuritis. Data Sources PubMed, Embase, CINAHL, Cochrane CENTRAL, Web of Science, CAB Abstract, ICTRP, LILACS, PEDRO, ClinicalTrials.Gov, Google Scholar, NARIC, and OT Seeker. Review Methods A systematic review was undertaken for articles reporting subjective and/or objective outcomes of corticosteroids in adults with acute vestibular neuritis between December 2010 and October 2019. Reports of patient recovery from clinical vestibular outcomes at various time points and adverse effects from corticosteroids were of interest. Statistical analysis included qualitative and quantitative assessments. A limited meta-analysis of the data was performed through a random effects model. Results Eight studies met the criteria, and 6 were included in the meta-analysis. No significant differences between the groups (corticosteroid vs placebo, corticosteroid vs vestibular exercise, or corticosteroid vs combination of vestibular exercise and corticosteroid) were reported in the proportion of patients with complete recovery at 1, 6, and 12 months. The corticosteroid group had significantly better caloric recover at 1 month (95% CI, –16.33 to –0.32); however, there was no significant difference to the overall effect between the groups across 12 months. Subjective recovery did not differ between the groups. Five of the 8 studies reported on adverse effects from corticosteroids. Conclusion There is insufficient evidence to support the use of corticosteroids in managing acute vestibular neuritis in adults. At present, corticosteroids appear to have short-term benefits in canal paresis but no long-term benefits in canal paresis and symptomatic recovery. Future studies should consider including a wider variety of clinical vestibular tests and frequent acute follow-ups to monitor the effects of corticosteroids.

scholarly journals The Efficacy of Fish Oil in Preventing Coronary Heart Disease: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Gaohong Wu ◽  
Haifeng Geng ◽  
Yue Jiang ◽  
Wei Song ◽  
Xueping Zhu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Fish Oil ◽  
Meta Analysis ◽  
Secondary Outcome ◽  
Control Group ◽  
Randomized Controlled ◽  
Significant Difference

To evaluate the efficacy of fish oil for protection against coronary heart disease (CHD), we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the use of fish oil for protection against CHD. We retrieved relevant articles published from January 1966 to January 2020 by searching the PubMed, EMBASE, Cochrane CENTRAL, and Web of Science databases. RCTs of fish oil in preventing CHD were selected. The study quality was evaluated using the Cochrane Risk of Bias tool with RevMan 5.3 software. The first selection involved 350 citations. After screening and evaluation of suitability, 19 RCTs adjusted for clustering were included in the meta-analysis. All selected manuscripts considered that fish oil was effective in preventing CHD, secondary outcome measures included angina, sepsis and death. Compared with the control group, fish oil may confer significant protection against CHD (odds ratio = 0.84; 95% confidence interval: 0.72–0.98). There was no significant difference in the incidence of secondary outcomes between the observation group and the control group (P &gt; 0.05). The above results show that fish oil plays an important role in reducing CHD and cardiovascular events. However, because of the suboptimal quality of the studies included into the meta-analysis, these results do not justify adding fish oils systematically to the heavy pharmaceutical assortment already recommended in CHD patients.

scholarly journals Atazanavir / ritonavir versus Lopinavir / ritonavir-based combined antiretroviral therapy (cART) for HIV-1 infection: a systematic review and meta-analysis

2020 ◽  
Vol 20 (1) ◽  
pp. 91-101 ◽  
Author(s):  
Bereket Molla Tigabu ◽  
Feleke Doyore Agide ◽  
Minoo Mohraz ◽  
Shekoufeh Nikfar
Keyword(s):  
Systematic Review ◽  
Viral Suppression ◽  
Adverse Drug Events ◽  
Meta Analysis ◽  
Fixed Effect Model ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Hiv 1 ◽  
Overall Risk

Background: This systematic review and meta-analysis was conducted to evaluate the safety and effectiveness of Atazanavir/ritonavir over lopinavir/ritonavir in human immunodeficiency virus-1 (HIV-1) infection. Methods: Clinical trials with a head-to-head comparison of atazanavir/ritonavir and lopinavir/ritonavir in HIV-1 were included. Electronic databases: PubMed/Medline CENTRAL, Embase, Scopus, and Web of Science were searched. Viral suppression below 50 copies/ml at the longest follow-up period was the primary outcome measure. Grade 2-4 treatment-related adverse drug events, lipid profile changes and grade 3-4 bilirubin elevations were used as secondary outcome measures. Results: A total of nine articles from seven trials with 1938 HIV-1 patients were included in the current study. Atazanavir/ritonavir has 13% lower overall risk of failure to suppress the virus level < 50 copies/ml than lopinavir/ritonavir in fixed effect model (pooled RR: 0.87; CI: 0.78, 0.96; P=0.006). The overall risk of hyperbilirubinemia is very high for atazanavir/ritonavir than lopinavir/ritonavir in the random effects model (pooled RR: 45.03; CI: 16.03, 126.47; P< 0.0001). Conclusion: Atazanavir/ritonavir has a better viral suppression at lower risk of lipid abnormality than lopinavir/ritonavir. The risk and development of hyperbilirubinemia from atazanavir-based regimens should be taken into consideration both at the time of pre- scribing and patient follow-up. Keywords: Atazanavir; Atazanavir/ritonavir; lopinavir/ritonavir; viral suppression.

Fulvestrant in the treatment of advanced breast cancer: A systematic review and meta-analysis of randomized controlled trials

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1087-1087
Author(s):  
D. Mauri ◽  
A. Valachis ◽  
N. P. Polyzos ◽  
D. Mavroudis ◽  
V. Georgoulias ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Overall Survival ◽  
Meta Analysis ◽  
Objective Response ◽  
Secondary Outcome ◽  
Tolerability Profile ◽  
Time To Progression ◽  
Good Tolerability ◽  
Significant Difference

1087 Background: The purpose of the study was to compare efficacy and tolerability of fulvestrant with aromatase inhibitors and tamoxifen that actually represent the standard of care in hormonesensitive breast cancer. Methods: Systematic review and meta-analysis of available trials. Primary outcomes were overall survival, time to progression, clinical outcome, and objective response. Secondary outcome was the tolerability profile of the drugs. Results: Four trials were identified with 2,125 eligible patients. There was no statistically significant difference between fulvestrant and other hormonal agents in terms of overall survival (pooled HR: 1.047, 95% CI: 0.688 to 1.592), time to progression (pooled HR: 0.994, 95% CI: 0.691 to 1.431), clinical benefit (pooled OR: 1.044, 95% CI: 0.828 to 1.315), or objective response rate (pooled OR: 0.949, 95% CI: 0.736 to 1.224). A higher incidence of joint disorders (pooled OR: 0.621, 95% CI: 0.424 to 0.909; p = 0.014) was noted in patients receiving hormonal agents other than fulvestrant. Conclusions: Fulvestrant was similar to other hormonal agents with respect to efficacy measures, with good tolerability profile. No significant financial relationships to disclose.

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