scholarly journals Vortioxetine for generalised anxiety disorder in adults

Medwave ◽  
2021 ◽  
Vol 21 (03) ◽  
pp. e8171-e8171
Author(s):  
Nicolás Meza ◽  
Fanny Leyton
Keyword(s):  
Anxiety Disorder ◽  
Adverse Effects ◽  
Systematic Reviews ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Current Treatment ◽  
Response To Treatment ◽  
Generalised Anxiety Disorder ◽  
Psychopharmacological Treatment ◽  
Grade Approach

INTRODUCTION The currently accepted psychopharmacological treatment for generalised anxiety disorder in adults is associated with several adverse effects which threaten its acceptability. In this line, vortioxetine has been proposed as an alternative with less adverse effects in the treatment of this pathology. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including five primary studies, all corresponding to randomized trials evaluating the effectiveness of vortioxetine in adult patients with generalized anxiety disorder without current treatment. We conclude that there is uncertainty whether vortioxetine increases the response to treatment or improves anxious symptoms, because the certainty of the existing evidence has been assessed as very low. Furthermore, vortioxetine may increase nausea (low certainty evidence).

scholarly journals Efficacy and safety of repetitive transcranial magnetic stimulation for generalised anxiety disorder: A meta-analysis

2019 ◽  
Vol 32 (5) ◽  
pp. e100051
Author(s):  
Huiru Cui ◽  
Lijuan Jiang ◽  
Yanyan Wei ◽  
Wei Li ◽  
Hui Li ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Anxiety Disorder ◽  
Adverse Events ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Efficacy And Safety ◽  
Generalised Anxiety Disorder ◽  
Grade Approach

BackgroundPharmacological and conventional non-pharmacological treatments are only moderately effective in treating generalised anxiety disorder (GAD). Recently, repetitive transcranial magnetic stimulation (rTMS) has attracted interest because of its potential therapeutic value.AimTo investigate the efficacy and safety of rTMS treatment for GAD.MethodsLiterature studies published in English or Chinese were screened in 10 electronic databases up to 5 December 2018. The included studies’ bias risk was assessed using Cochrane risk of bias assessment tool. Meta-analysis was performed to compute the standardised mean difference (SMD) and risk ratio (RR) along with its 95% CIs through using RevMan V.5.3. Heterogeneity was inspected by I2 and the χ2 test. We performed subgroup analysis and meta-regression to investigate heterogeneity. We used funnel plot to assess publication bias. We used the GRADE approach to assess the whole quality of evidence.ResultsTwenty-one studies, with a total sample size of 1481, were analysed. The risk of bias in most studies included is moderate, the majority of which are lacking of blinding methods of treatment allocation. The treatment had beneficial effects in the rTMS group compared with the control group in mean anxiety score (SMD=−0.68; 95% CI −0.89 to −0.46). None of the 21 studies included here reported severe adverse events. As for dropout rates, there are no statistically significant differences between the two groups (RR 1.14, 95% CI 0.72 to 1.82) or adverse events (RR 0.95, 95% CI 0.77 to 1.18). No particular influence on the heterogeneity of any variable was observed. The risk of publication bias was low. According to the GRADE approach, the evidence levels of primary outcome (treatment effects) and secondary outcomes (acceptability and safety) were rated as ‘medium’.ConclusionThe use of rTMS combined with medication treatment may have a significant positive anti-anxiety effect on patients with GAD. However, we should interpret the results cautiously due to the relatively high heterogeneity of the meta-analysis. Future high-quality clinical trials are needed to confirm our results.

scholarly journals Atypical antipsychotics for delirium in hospitalized patients

Medwave ◽  
2021 ◽  
Vol 21 (04) ◽  
pp. e8168-e8168
Author(s):  
Daniza Belén Bilicic Ubierna ◽  
Nicolás Cattarinich Schiffrin ◽  
Daniela Coronel Cárdenas ◽  
Rubén Soto Munizaga ◽  
José Miguel Bernucci Piedra
Keyword(s):  
Systematic Reviews ◽  
Atypical Antipsychotics ◽  
Randomized Trials ◽  
Information Sources ◽  
Response Rate ◽  
Meta Analysis ◽  
Low Complexity ◽  
Hospitalized Patients ◽  
Risk Of Mortality ◽  
Grade Approach

Introduction For the pharmacotherapy of delirium in elderly adults who are hospitalized, atypical antipsychotics are used. Currently, there is insufficient evidence on the effectiveness of this treatment in low complexity units. Methods We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE/PubMed, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach. Results and conclusions We identified 13 systematic reviews that included three randomized trials. We concluded that the use of atypical antipsychotics in hospitalized patients likely increases the risk of mortality compared to placebo and could decrease the response rate associated with reducing the risk of adverse effects. Furthermore, using atypical antipsychotics probably results in low or no difference in the severity of delirium.

scholarly journals Radiosurgery for brain oligometastases in lung cancer

Medwave ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. e8184-e8184
Author(s):  
Gabriela Antúnez ◽  
Tomás Merino
Keyword(s):  
Lung Cancer ◽  
Systematic Reviews ◽  
Poor Prognosis ◽  
Randomized Trials ◽  
Information Sources ◽  
Meta Analysis ◽  
Whole Brain Radiation ◽  
Therapeutic Alternatives ◽  
Brain Radiation ◽  
Grade Approach

INTRODUCTION Brain metastases are a common problem in oncology patients, especially in lung cancer. The usual treatment for cerebral oligometastases is whole brain radiation therapy. Given the persistent poor prognosis of this disease, other therapeutic alternatives such as stereotactic radiosurgery have been considered. However, there is no clarity regarding the effectiveness of its addition. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified 17 systematic reviews including seven studies overall, of which four were randomized trials. All trials assessed patients with brain oligometastases, but none of them included exclusively lung cancer population. We concluded that it is not possible to clearly establish whether radiosurgery decreases neurological functionality, cognitive impairment, mortality or serious adverse effects, as the certainty of the existing evidence has been assessed as very low.

scholarly journals Safety of Human Papillomavirus 9-Valent Vaccine: A Meta-Analysis of Randomized Trials

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Ana Paula Ferreira Costa ◽  
Ricardo Ney Oliveira Cobucci ◽  
Janine Medeiros da Silva ◽  
Paulo Henrique da Costa Lima ◽  
Paulo César Giraldo ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Human Papillomavirus ◽  
Adverse Effects ◽  
Randomized Trials ◽  
Web Of Science ◽  
Meta Analysis ◽  
Developed Countries ◽  
Electronic Data ◽  
Tetravalent Vaccine ◽  
Significant Difference

Vaccination against human papillomavirus (HPV) has been progressively implemented in most developed countries for approximately 10 years. In order to increase the protection of the vaccines, a 9-valent vaccine (HPV9) was developed, which provides protection against nine types of the virus. Studies evaluating its safety are rare. Thus, we performed a meta-analysis of three clinical trials assessing adverse effects on women randomly vaccinated with HPV9 or tetravalent vaccine (HPV4), with the objective of analyzing whether the HPV9 is as safe as HPV4. An electronic data search was performed through the PubMed, Embase, Scopus, Web of Science, and SciELO databases. The studies selected 27,465 women who received one of the two vaccines. Pain (OR 1.72; 95% CI 1.62–1.82) and erythema (OR 1.29; 95% CI 1.21–1.36) occurred significantly more in the HPV9 group. However, there was no significant difference between the groups for the following adverse effects: headache (OR 1.07; 95% CI 0.99–1.15), dizziness (OR 1.09; 95% CI 0.93–1.27), and fatigue (OR 1.09; 95% CI 0.91–1.30), and the occurrence of serious events related to vaccination was similarly rare among those vaccinated. Therefore, our findings demonstrate that HPV9 in female patients is as safe as the tetravalent vaccine.

scholarly journals Palliative chemotherapy for advanced gallbladder cancer

Medwave ◽  
2021 ◽  
Vol 21 (03) ◽  
pp. e8046-e8046
Author(s):  
Gonzalo A Bravo-Soto ◽  
Rocío Brañes ◽  
José Peña ◽  
Bruno Nervi
Keyword(s):  
Gallbladder Cancer ◽  
Systematic Reviews ◽  
Palliative Chemotherapy ◽  
Meta Analysis ◽  
Methodological Errors ◽  
Advanced Gallbladder Cancer ◽  
Therapeutic Alternatives ◽  
New Evidence ◽  
Grade Approach ◽  
Common Malignancy

INTRODUCTION Gallbladder cancer is the most common malignancy of the biliary tract. Given the lack of therapeutic alternatives for advanced stage patients studies have suggested that palliative chemotherapy could benefit these patients. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis, and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified two systematic reviews including two studies overall, of which one was a randomized trial. We concluded that palliative chemotherapy may increase survival in advanced gallbladder cancer patients. However, palliative chemotherapy probably increases adverse effects. In addition, it is essential to carry out a new systematic review, since methodological errors were identified in the analysis and there is new evidence that has not been included in the previous reviews

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