scholarly journals Efficacy and Safety of Eculizumab in the Treatment of Transplant-Associated Thrombotic Microangiopathy: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Rui Zhang ◽  
Meng Zhou ◽  
Jiaqian Qi ◽  
Wenjing Miao ◽  
Ziyan Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Thrombotic Microangiopathy ◽  
Response Rate ◽  
Meta Analysis ◽  
Complete Response ◽  
Current Evidence ◽  
Efficacy And Safety ◽  
Impaired Liver Function ◽  
Hematopoietic Stem ◽  
Impaired Liver

BackgroundTransplant-associated thrombotic microangiopathy (TA-TMA) is a dangerous and life-threatening complication in patients undergoing hematopoietic stem cell transplantation (HSCT). Eculizumab has been used in the treatment of TA-TMA, and several studies have confirmed the benefit of Eculizumab in patients with TA-TMA. However, the results remain controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of Eculizumab for TA-TMA.Materials and MethodsWe searched PubMed and Embase for studies on the efficacy and safety of Eculizumab in TA-TMA patients. Efficacy outcomes consisted of overall response rate (ORR), complete response rate (CRR), and survival rate at the last follow-up (SR). Safety outcomes were adverse events (AEs), including infection, sepsis, impaired liver function, infusion reactions, and death.ResultsA total of 116 patients from six studies were subjected to meta-analysis. The pooled estimates of ORR, CRR, and SR for TA-TMA patients were 71% (95% CI: 58–82%), 32% (95% CI: 11–56%), and 52% (95% CI: 40–65%), respectively. Only one patient presented with a severe rash, and infection was the most common AEs. The main causes of death were infection and GvHD.ConclusionCurrent evidence suggests that Eculizumab improves SR and ORR in patients with TA-TMA and that Eculizumab is well tolerated. However, the number of studies is limited, and the findings are based mainly on data from observational studies. Higher quality randomized controlled trials and more extensive prospective cohort studies are needed.

ID: 100: A SYSTEMATIC REVIEW AND META-ANALYSIS OF THE RELATIVE EFFICACY AND SAFETY OF TREATMENT REGIMENS FOR HIV-ASSOCIATED CEREBRAL TOXOPLASMOSIS

2016 ◽  
Vol 64 (4) ◽  
pp. 952.3-953
Author(s):  
P Thota ◽  
V Pasupuleti ◽  
D Pellegrino ◽  
VA Benites-Zapata ◽  
A Deshpande ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Current Evidence ◽  
Drug Discontinuation ◽  
Cerebral Toxoplasmosis ◽  
Relative Efficacy ◽  
Efficacy And Safety ◽  
Random Effects Models ◽  
Treatment Regimens ◽  
Radiological Response

AimThe objective of this study was to perform a systematic review and meta-analysis of the literature to evaluate efficacy and safety of therapies for cerebral toxoplasmosis in HIV-infected adults. Pyrimethamine plus sulfadiazine (P-S) combination is considered the mainstay therapy for cerebral toxoplasmosis and pyrimethamine plus clindamycin (P-C) is the most common alternative treatment. Although, trimethoprim-sulfamethoxazole (TMP-SMX) has potential advantages, its use is infrequent.MethodsDesign: Systematic review and meta-analysis. We searched PubMed and 4 other databases to identify randomized controlled trials (RCTs) and cohort studies. Two independent reviewers searched and identified studies and extracted data. Risk ratios (RRs) were pooled across studies using random-effects models.ResultsNine studies were included (5 RCTs, 3 retrospective cohorts, 1 prospective cohort). In comparison to P-S, treatment with P-C or TMP-SMX had similar partial or complete clinical response (P-C: RR 0.87, 95%CI 0.70–1.08; TMP-SMX: RR 0.97, 95%CI 0.78–1.21), radiological response (P-C: RR 0.92, 95%CI 0.82–1.03), skin rash (P-C: RR 0.81, 95%CI 0.56–1.17; TMP-SMX: RR 0.17, 95%CI 0.02–1.29), gastrointestinal impairment (P-C: RR 5.16, 95%CI 0.66–40.11), and drug discontinuation due to adverse events (P-C: RR 0.32, 95%CI 0.07–1.47). Liver impairment was more frequent with P-S than P-C (P-C vs P-S: RR 0.48, 95% CI 0.24–0.97).ConclusionsThe current evidence fails to identify one superior regimen in terms of relative efficacy or safety for the treatment of HIV-associated cerebral toxoplasmosis. Use of TMP-SMX as preferred treatment may be consistent with the available evidence and other real world considerations. Larger comparative studies are needed.

scholarly journals Efficacy and Safety of CGRP Monoclonal Antibodies for the Prevention of Migraine Compared with Placebo: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Xiaojing Yi ◽  
Yun Chen ◽  
Kun Chen ◽  
Mo Liu ◽  
Jiale Yi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Monoclonal Antibodies ◽  
Adverse Events ◽  
Injection Site ◽  
Response Rate ◽  
Meta Analysis ◽  
Upper Respiratory Tract ◽  
Efficacy And Safety ◽  
Upper Respiratory ◽  
Secondary Outcomes

Abstract Background: Calcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are a novel class of drugs for migraine that includes erenumab, fremanezumab, galcanezumab and eptinezumab. In clinical trials, CGRP mAbs have been reported to show good efficacy in the prevention of episodic migraines or chronic migraines. Our aim was to evaluate the efficacy and safety of CGRP monoclonal antibodies in this study.Methods: We systematically searched for randomized controlled trials in the PubMed, Embase, ClinicalTrials.gov, and Cochrane Library databases. The primary outcome was overall mean change from baseline to end of treatment in the number of monthly migraine headache days (MMHDs). The secondary outcomes included 50% response rate, in the number of monthly headache days (MHDs), in the number of monthly headache hours (MHHs), and in the number of monthly acute migraine-specific medication days (MSMDs). The safety outcomes were evaluated in terms of reported adverse events. Results: Eighteen studies including 11,099 patients were included in the meta-analysis. The meta-analysis showed that CGRP mAbs exhibited a significant benefit in reducing the number of MMHDs compared to placebo (Episodic migraine: Std. MD -0.42, 95% CI -0.47 to -0.36; Chronic migraine: Std. MD -0.28, 95% CI -0.35 to -0.21). Similarly, CGRP mAbs were superior to placebo in the secondary outcomes of 50% response rate, MHDs, MHHs, and MSMDs. With respect to safety, serious adverse events and withdrawal due to adverse events were not significantly associated with CGRP mAbs. Fremanezumab was associated with a significantly higher incidence of any adverse event compared with placebo (RR 1.10, 95% CI 1.03 to 1.17). Galcanezumab was associated with significantly higher treatment-emergent adverse events compared with placebo (RR 1.11, 95% CI 1.04 to 1.17). Constipation and injection site pain were significantly higher with erenumab than placebo. Injection site erythema and injection site induration were significantly higher with fremanezumab than placebo. Upper respiratory tract infection, injection site erythema, injection site pruritus and injection site reaction were significantly higher with galcanezumab than placebo. Conclusions: This study confirms that CGRP mAbs are effective as preventive treatments for episodic migraines and chronic migraines. Adverse reactions at the injection site were associated with erenumab, fremanezumab and galcanezumab therapy. Constipation was more common with erenumab. The risk of upper respiratory tract infection was higher with galcanezumab.Systematic review registration: Our PROSPERO protocol registration number: CRD42019125928. Registered 26 November 2019.

scholarly journals Efficacy and Safety of Moxibustion for Postherpetic Neuralgia: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Qiqi Wu ◽  
Hantong Hu ◽  
Dexiong Han ◽  
Hong Gao
Keyword(s):  
Systematic Review ◽  
Herbal Medicine ◽  
Adverse Events ◽  
Postherpetic Neuralgia ◽  
Outcome Measure ◽  
Meta Analysis ◽  
Current Evidence ◽  
Cochrane Library ◽  
Efficacy Rate ◽  
Efficacy And Safety

Background: Postherpetic neuralgia (PHN) is one of the most common complications of herpes zoster (HZ), and there is still a lack of effective therapies. An increasing number of studies have found that compared to traditional therapy, moxibustion treatment is beneficial for the treatment of PHN, although current evidence remains inconclusive. This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to evaluate the efficacy and safety of moxibustion for PHN.Methods: We conducted a broad literature review of a range of databases from inception to December 2020, including the Cochrane Library, PubMed, EMBASE, Web of Science, Clinical Trails, China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP), China Biomedical Network Information, and Wanfang databases. We included RCTs that compared moxibustion to pharmacological therapies, herbal medicine, or no treatment for treating PHN. The main outcome measure was efficacy rate and Visual Analog Scale (VAS); the secondary outcome measure was adverse events. Data accumulation and synthesis included meta-analysis, publication bias, sensitivity analysis, risk-of-bias assessment, and adverse events.Results: We included 13 RCTs involving 798 patients. Compared with the controls (pharmacological therapies, herbal medicine, or no treatment), moxibustion achieved a significantly higher efficacy rate (odds ratio [OR]: 3.65; 95% [confidence interval]: [2.32, 5.72]; P < 0.00001). Subgroup analysis of the distinct moxibustion modalities showed that both Zhuang medicine medicated thread and thunder-fire moxibustions obtained higher clinical efficacy than the control group. Compared with the controls, moxibustion resulted in significantly lower scores on the VAS (Weighted Mean Difference (MD) = −1.79; 95% CI: [−2.26, −1.33]; P < 0.00001). However, there was no significant difference in terms of safety between moxibustion and the controls (OR = 0.33; 95% CI [0.06, 1.77]; P = 0.19).Conclusion: Due to the lack of methodological quality as well as the significant heterogeneity of the included studies, it remains difficult to draw a firm conclusion on the efficacy and safety of moxibustion for the treatment of PHN. Future high-quality studies are urgently needed.

scholarly journals Anti-MRSA Cephalosporin versus Vancomycin-Based Treatment for Acute Bacterial Skin and Skin Structure Infection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 1020
Author(s):  
Ching-Yi Chen ◽  
Wang-Chun Chen ◽  
Chih-Cheng Lai ◽  
Tzu-Ping Shih ◽  
Hung-Jen Tang
Keyword(s):  
Systematic Review ◽  
Clinical Response ◽  
Clinical Efficacy ◽  
Response Rate ◽  
Meta Analysis ◽  
Clinical Response Rate ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Skin Structure ◽  
Randomized Controlled

This systematic review and meta-analysis of randomized controlled trials (RCTs) compared the clinical efficacy and safety of anti-MRSA cephalosporin and vancomycin-based treatment in treating acute bacterial skin and skin structure infections (ABSSSIs). PubMed, Embase, Cochrane Central Register of Controlled Trials, Turning Research into Practice, and ClinicalTrials.gov databases were searched for relevant articles from inception to 15 June 2020. RCTs comparing the clinical efficacy and safety of anti-MRSA cephalosporin with those of vancomycin-based regimens in treating adult patients with ABSSSIs were included. The primary and secondary outcomes were clinical response at the test-of-cure assessments and risk of adverse events (AEs), respectively. Eight RCTs were enrolled. The clinical response rate was not significantly different between anti-MRSA cephalosporin and vancomycin-based treatments (odds ratio [OR], 1.05; 95% CI, 0.90–1.23; I2 = 0%). Except for major cutaneous abscesses in which anti-MRSA cephalosporin-based treatment was associated with a lower clinical response rate than vancomycin-based treatment (OR, 0.62; 95% CI, 0.40–0.97; I2 = 0%), other subgroup analyses according to the type of cephalosporin (ceftaroline or ceftobiprole), type of infection, and different pathogens did not show significant differences in clinical response. Anti-MRSA cephalosporin-based treatment was only associated with a higher risk of nausea than vancomycin-based treatment (OR, 1.41; 95% CI, 1.07–1.85; I2 = 0%). In treating ABSSSIs, the clinical efficacy of anti-MRSA cephalosporin is comparable to that of vancomycin-based treatment, except in major cutaneous abscesses. In addition to nausea, anti-MRSA cephalosporin was as tolerable as vancomycin-based treatment.

scholarly journals Chimeric Antigen Receptor T-cell (CAR T) Therapy for Hematologic and Solid Malignancies: Efficacy and Safety—A Systematic Review with Meta-Analysis

Cancers ◽  
2019 ◽  
Vol 11 (1) ◽  
pp. 47 ◽  
Author(s):  
Wen-Liang Yu ◽  
Zi-Chun Hua
Keyword(s):  
T Cells ◽  
Response Rate ◽  
Meta Analysis ◽  
Complete Response ◽  
Hematologic Malignancies ◽  
Common Side Effect ◽  
Future Research ◽  
Efficacy And Safety ◽  
Tumor Patients ◽  
Car T

Chimeric antigen receptors T cells (CAR T) had been used for treating various tumor patients in clinic, and owned an incredible efficacy in part of malignancies. However, CAR T therapy remains controversial due to doubts about its efficacy and safety in the clinical treatment of various malignancies. A total of 997 tumor patients from 52 studies were included in this review. Eligible studies were searched and reviewed from the databases of PubMed, Web of Science, Wanfang and Clinicaltrials.gov. Then meta-analysis and subgroup analysis were used to investigate the overall response rate (ORR), complete response rate (CRR), common side effect rate (CSER) and relapse rate (RR) of CAR T therapy for patients in clinical researches, respectively. The results further confirmed that CAR T therapy had a higher response rate for hematologic malignancies. More importantly, CAR T therapy had a higher CSER in patients with hematologic malignancies, and it had a similar RR in patients with different malignancies. Cell cultured without the addition of IL-2 and total administration less than 108 cells were recommended. This study offers a reference for future research regarding the application in solid and hematologic malignancies, side effects and relapse, and even the production processes of CAR T cells.

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