Cure Rates of Control Interventions in Randomized Trials for Onychomycosis Treatments: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Aditya K. Gupta ◽  
Maanasa Venkataraman ◽  
Emma M Quinlan ◽  
Mary A Bamimore
Keyword(s):  
Clinical Cure ◽  
Meta Analysis ◽  
Rank Correlation ◽  
Therapeutic Effects ◽  
Cure Rate ◽  
Active Therapy ◽  
Chi Squared ◽  
Arcsine Transformation ◽  
Meta Analyses ◽  
Cure Rates

<p>Background: The efficacy of antifungals for onychomycosis has been determined in randomized controlled trials (RCTs); interestingly their control arms have demonstrated some therapeutic effects. These controls constitute either placebos (inert pills) or vehicles (all but the antifungal component of the creams). The objective of this research was to determine (i) whether RCT controls exhibited statistically-relevant efficacy rates (i.e. beyond the "placebo effect"), (ii) whether oral and topical controls differed in their efficacies, and (iii) if the efficacy rates of the controls correlated with those of the active comparator associated with that control.</p> <p>Methods: RCTs of oral and topical monotherapies for dermatophyte toenail onychomycosis were identified through a systematic literature search. For our meta-analyses of cure rates the double arcsine transformation was used. The N-1 chi squared test was used to determine whether the cure rates significantly differed between topical and oral controls. Correlation was investigated using Kendall rank correlation tests.</p> <p>Results: The pooled mycological, complete, and clinical cure rates of all control interventions (n = 19 trials) were 9%, 1%, and 6%, respectively. The pooled efficacy rates for oral and topical controls were: mycological cure rate, 7% and 12% (p=0.0016); complete cure rate, 1% for both; and clinical cure rate, 4% and 8%, respectively (p=0.0033). For oral RCTs, the respective cure rates of the active therapies were not correlated with controls. However, for topical RCTs, as the mycological and clinical cure rates of the active therapy increased, so did those of the topical vehicle associated with the active therapy in question, and vice versa.</p> <p>Conclusions: The topical vehicle cure rates were often higher than the oral placebo cure rates, likely due to the presence of non-antifungal chemicals (e.g. moisturizers, urea) with antifungal and debriding properties, which are not present in oral controls.</p>

The therapeutic efficacy of intravenous immunoglobulin in anti-neutrophilic cytoplasmic antibody-associated vasculitis: a meta-analysis

Rheumatology ◽  
2019 ◽  
Vol 59 (5) ◽  
pp. 959-967 ◽  
Author(s):  
Takashi Shimizu ◽  
Takayoshi Morita ◽  
Atsushi Kumanogoh
Keyword(s):  
Systematic Review ◽  
Selection Criteria ◽  
Meta Analysis ◽  
Clinical Parameter ◽  
Ivig Treatment ◽  
Therapeutic Effects ◽  
Random Effects Model ◽  
Anca Associated Vasculitis ◽  
Before And After ◽  
Meta Analyses

Abstract Objectives The therapeutic effects of IVIG in patients with ANCA-associated vasculitis (AAV) have not been established so far. This study aims to estimate the effects of IVIG on AAV by conducting a systematic review and meta-analysis. Methods A comprehensive systematic review was conducted in accordance with the guidelines of PRISMA (Preferred Reporting Items for Systematic Reviews And Meta-analyses). PubMed and Google Scholar were used to search for original studies on AAV and collect clinical data before and after IVIG treatment. A meta-analysis of each clinical parameter was performed, and standardized mean difference (SMD) and 95% CI were calculated using the random effects model. Results A total of 220 studies were identified, and nine met the selection criteria for the meta-analysis. IVIG was administered to active AAV patients as an immunomodulatory therapy in the nine studies selected. Significant reductions in BVAS (SMD –1.7; 95% CI [–2.66, –0.73]; P = 0.0006), ANCA (SMD –0.72; 95% CI [–1.13, –0.31]; P = 0.0006) and CRP (SMD –0.92; 95% CI [–1.49, –0.35]; P = 0.002) were noted within 6 months after administration of IVIG. Subgroup analysis in the unmodified immunotherapy population showed reductions in BVAS (SMD –1.39; 95% CI [–2.31, –0.48]; P = 0.003) and CRP (SMD –0.56; 95% CI [–0.93, –0.19]; P = 0.002) within half a month after IVIG treatment. Conclusion IVIG was associated with rapid improvements in disease activity and the related biomarkers in patients with active AAV.

Meta-Analysis of Parenteral Clindamycin Dosing Regimens

1995 ◽  
Vol 29 (9) ◽  
pp. 852-858 ◽  
Author(s):  
John P Rovers ◽  
A Lane Ilersich ◽  
Thomas R Einarson
Keyword(s):  
English Language ◽  
Meta Analysis ◽  
Patient Specific ◽  
Success Rates ◽  
Cure Rate ◽  
Data Synthesis ◽  
Study Selection ◽  
Dosing Regimens ◽  
Definition Of ◽  
Cure Rates

Objective: We used meta-analysis to compare clinical cure and success rates for parenteral clindamycin 600 mg q8h or 900 mg q8h therapy to treat adult intraabdominal or female pelvic infections. Data Sources: We located English-language articles describing clindamycin use in humans using MEDLINE, International Pharmaceutical Abstracts, and Embase and from personal and drug information center files, plus all article references. Study Selection: Eligible studies used parenteral clindamycin 600 mg q8h or 900 mg q8h to treat intraabdominal or pelvic infection in at least I aim of a study and provided a definition of clinical outcome. Accepted were comparative trials in adults who were not critically ill or expected to die. Data Synthesis: The DerSimonian and Laird method was used to calculate weighted overall success rates for cure and success (cure plus improved) rates along with 95% confidence intervals for each dosage in intraabdominal and pelvic infections. Regimens were compared with respect to both cure and success rates using the Mann-Whitney U test. Main Results: Twenty-three articles were eligible for inclusion. Abdominal cure rates were 75.6% and 90.5% for clindamycin 600 mg q8h and 900 mg q8h, respectively (p = 0.03); success rates were 89.8% and 92.5%, respectively (p = 0.29). Pelvic cure rates were 82.8% and 89.4%, respectively (p = 0.51); success rates were 87.2% and 89.9%, respectively (p = 0.51). Conclusions: In pelvic infections, a dosage of clindamycin 600 mg q8h appears to be clinically acceptable for all patients. Although clinical outcomes for intraabdominal infections are generally similar for both regimens, the significantly higher cure rate with a dosage of clindamycin 900 mg q8h suggests that dosage recommendations should be patient specific.

scholarly journals Prospective Study of the Wilson Severity-of-Illness Scoring System for Complicated Skin and Skin Structure Infections

2012 ◽  
Vol 57 (1) ◽  
pp. 647-650 ◽  
Author(s):  
George H. Talbot ◽  
Tanya O'Neal ◽  
Anita F. Das ◽  
Dirk Thye
Keyword(s):  
Clinical Cure ◽  
Clinical Cure Rate ◽  
Severity Of Illness ◽  
Cure Rate ◽  
Two Phase ◽  
Ceftaroline Fosamil ◽  
Risk Class ◽  
Skin Structure ◽  
Complicated Skin ◽  
Cure Rates

ABSTRACTWilson et al. (Am. J. Surg.185:369–375, 2003) developed a disease severity classification system for use in complicated skin and skin structure infections (cSSSI). Two phase 3 trials of ceftaroline fosamil in cSSSI provided the opportunity to evaluate the association between Wilson Severity Risk Class and clinical cure rates. Our analyses did not confirm that an association exists between Wilson Severity Risk Class and clinical cure rate and, thus, did not validate its predictive utility.

scholarly journals Efficacy of Different Drugs in Treating Urinary Schistosomiasis: Systematic Review and Network Meta-analysis

2020 ◽  
Author(s):  
Huilong Fang ◽  
Xuli Guo ◽  
Chuwei Tang ◽  
Fuchun Chen ◽  
Ahmed Badr ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Reduction Rate ◽  
P Value ◽  
Cure Rate ◽  
Urinary Schistosomiasis ◽  
Morbidity Control ◽  
Credible Intervals ◽  
Cure Rates ◽  
Egg Reduction Rate ◽  
Indirect Comparisons

Abstract Background: Praziquantel is the current pillar for morbidity control of schistosomiasis. Artesunate and its derivatives, widely used for malaria treatment, also display antischistosomal activities. This review compares the efficacy of three drugs, namely praziquantel (PZQ), artesunate, and metrifonate in urinary schistosomiasis. Methods: Databases were searched for articles comparing the effectiveness of any of the three drugs to other medications or controls in urinary schistosomiasis in children aged 18 or less. Stata software was opted to generate the network meta-analysis. Efficacy (Cure rate and egg reduction rate) was the main outcome measure. Pairwise and network meta-analysis were used to report Odds Ratios (ORs) with either 95% confidence interval (CI) for direct comparisons or 95% credible intervals (CrI) for indirect comparisons. Results: The SUCRA plot for cure rate revealed that PZQ (SUCRA= 40.4%) was the fourth effective drug after albendazole 400mg (SUCRA= 71.5), metrifonate 5 mg (SUCRA= 62.2%), and metrifonate 10 mg (SUCRA= 59.7). PZQ was only superior to metrifonate 7.5 mg. ORs were PZQ 40 mg (OR 0.48; 95% CI -3.55 to 4.51; p-value 0.816), artesunate 6 mg (OR 0.06; 95% CI -5.67 to 5.79; p-value 0.983), metrifonate 5 mg (OR -1.65; 95% CI -7.52 to 4.21; p-value 0.581), metrifonate 10 mg (OR -1.76; 95% CI -8.86 to 5.34; p-value 0.628), and metrifonate 7.5 mg (OR -2.40; 95% CI -9.78 to 4.98; p-value 0.524). A similar plot for egg reduction rate showed an exclusive superiority of PZQ 40 mg (SUCRA= 94.4%), followed by metrifonate 10mg (SUCRA= 82.3%) and niridazole 25mg plus metrifonate 10mg (SUCRA= 48.6%). Conclusions: Our network analysis revealed that PZQ 40 mg was the most efficient drug in reducing egg count, whereas albendazole 400mg showed the highest cure rates.

scholarly journals Comparing Several Treatments with Antibiotics for CommunityAcquired Pneumonia: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Fusheng Bai ◽  
Xinming Li
Keyword(s):  
Randomized Controlled Trials ◽  
Subgroup Analysis ◽  
Clinical Cure ◽  
Clinical Cure Rate ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Clinical Effects ◽  
Cure Rate ◽  
Ceftaroline Fosamil ◽  
Randomized Controlled

Background: We aimed to review relevant randomized controlled trials to assess the relative clinical effects of antibiotic treatment of patients with community-acquired pneumonia (CAP). Methods: In this meta-analysis, we identified relevant studies from PubMed, Cochrane, and Embase using appropriate keywords. Key pertinent sources in the literature were also reviewed and all articles published through Oct 2019 were considered for inclusion. For each study, we assessed the risk ratios (RRs) or mean difference combined with the 95% confidence interval (CI) to assess and synthesize outcomes. Results: Overall, 36 studies were consistent with the meta-analysis, involving 17,076 patients. There was no significant difference in the mortality after subgroup analysis: individualized treatment vs. standard treatment; β-lactams plus macrolides vs. β-lactam and/or fluoroquinolone; ceftaroline fosamil vs. ceftriaxone; combination therapy vs. monotherapy or high-dose vs. low-dose. The drug-related adverse event incidence was significantly higher in the ceftriaxone group than in the other drug groups (P<0.05) and also higher in the tigecyline group than in the levofloxacin group (P<0.05). Compared with ceftriaxone, ceftaroline fosamil significantly increased the clinical cure rate at the test-of-cure (TOC) visit in the clinically evaluable population, modified intent-to-treat efficacy (MITTE) population, microbiologically evaluable (ME) population and the microbiological MITTE (mMITTE) population (all P<0.05). Compared with ceftriaxone, ceftaroline fosamil significantly increased the clinical cure rate at the TOC visit in the mMITTE population of Gram positiveStreptococcus pneumoniae (P<0.05) and multidrug-resistant S. pneumoniae (P<0.05). Conclusion: There was a limited number of included studies in the subgroup analysis, but it will still be necessary to conduct more high-quality randomized controlled trials to confirm the clinical efficacy of different antibiotics used to treat CAP.

scholarly journals TaiChi and Qigong for Depressive Symptoms in Patients with Chronic Heart Failure: A Systematic Review with Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Wei Jiang ◽  
Shaojun Liao ◽  
Xiankun Chen ◽  
Cecilia Stålsby Lundborg ◽  
Gaetano Marrone ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Depressive Symptoms ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Therapeutic Effects ◽  
Cochrane Central Register ◽  
China National Knowledge Infrastructure ◽  
Beneficial Effects ◽  
Meta Analyses

Background. Depression is a debilitating comorbidity of heart failure (HF) that needs assessment and management. Along with mind-body exercise to deal with HF with depression, the use of TaiChi and/or Qigong practices (TQPs) has increased. Therefore, this systematic review assesses the effects of TQPs on depression among patients with HF. Methods. Randomized controlled trials (RCTs) that examined the effect of TQPs on depression in patients with HF were searched by five databases (PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, CINAHL, and China National Knowledge Infrastructure (CNKI)). With standardized mean difference (SMD) and 95% confidence intervals (95% CI), random-effects meta-analyses of the effect of TQPs on depressive symptoms were performed. Results. Of eight included RCTs, seven (481 patients) provided data for the meta-analysis. The pooling revealed that TQPs contribute to depression remission in HF (SMD −0.66; 95% CI −0.98 to −0.33, P < 0.0001 ; I2 = 64%). Its antidepressive effect was not influenced by intervention duration or exercise setting, but rather by ejection fraction subtype, depressive severity, and depression instruments. The beneficial effects were preserved when the study with the largest effect was removed. Conclusion. This study suggests that TQPs might be a good strategy for alleviating depressive symptoms in patients with HF. And rigorous-design RCTs, which focus on the identified research gaps, are needed to further establish the therapeutic effects of TQPs for depression in HF.

scholarly journals Ceftaroline Efficacy and Safety in Treatment of Complicated Skin and Soft Tissue Infection: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

2019 ◽  
Vol 8 (6) ◽  
pp. 776 ◽  
Author(s):  
Shao-Huan Lan ◽  
Shen-Peng Chang ◽  
Chih-Cheng Lai ◽  
Li-Chin Lu ◽  
Chien-Ming Chao
Keyword(s):  
Randomized Controlled Trials ◽  
Clinical Cure ◽  
Clinical Cure Rate ◽  
Meta Analysis ◽  
Adult Patients ◽  
Controlled Trials ◽  
Efficacy And Safety ◽  
Cure Rate ◽  
Randomized Controlled ◽  
Complicated Skin

This study aims to assess the clinical efficacy and safety of ceftaroline for the treatment of complicated skin and skin structure infections (cSSSIs) in adult patients through meta-analysis. PubMed, Embase, ClinicalTrials.gov, and Cochrane databases were searched up to April 2019. Only randomized controlled trials (RCTs) that evaluated ceftaroline and other comparators for treating cSSSIs in adult patients were included. The primary outcome was the clinical cure rate, whereas the secondary outcomes were clinical failure rate, microbiological eradication rate, relapse rate, and risk of an adverse event (AE). Five RCTs were included. Overall, ceftaroline had a clinical cure rate similar to comparators in the treatment of cSSSIs in the modified intent-to-treat population (risk ratio (RR), 1.00; 95% confidence interval (CI), 0.97–1.04; I2 = 0%) and in the clinically evaluable population (RR, 1.00; 95% CI, 0.97–1.03; I2 = 0%). In addition, no significant difference was observed between ceftaroline and comparators for the treatment of infection with Staphylococcus aureus (RR, 1.01; 95% CI, 0.98–1.05; I2 = 0%), methicillin-resistant S. aureus (RR, 0.99; 95% CI, 0.94–1.05; I2 = 0%), methicillin-susceptible S. aureus (RR, 1.01; 95% CI, 0.96–1.06; I2 = 26%), Streptococcus spp. (RR, 1.07; 95% CI, 0.92–1.24; I2 = 73%), and Gram-negative bacteria (RR, 0.94; 95% CI, 0.83–1.08; I2 = 0%). Furthermore, ceftaroline had a similar rate of microbiological eradication (92.2% vs. 92.6%, RR, 1.00; 95% CI, 0.97–1.03; I2 = 9%) and relapse (6.9% vs. 9.1%, RR, 0.48; 95% CI, 0.14–1.74; I2 = 0%) as comparators. Finally, the risks of treatment-emergent AEs (RR, 0.96; 95% CI, 0.88–1.05; I2 = 0%), serious AEs (RR, 1.03; 95% CI, 0.63–1.68; I2 = 0%), and discontinuation of study drug due to an AE (RR, 0.86; 95% CI, 0.50–1.49; I2 = 34%) did not differ significantly between ceftaroline and comparators. In conclusion, the clinical efficacy of ceftaroline is as high as that of comparators in the treatment of cSSSIs in adult patients, and this antibiotic is well tolerated like the comparators.

scholarly journals Role of Probiotics in Helicobacter pylori Eradication: Lessons from a Study of Lactobacillus reuteri Strains DSM 17938 and ATCC PTA 6475 (Gastrus®) and a Proton-Pump Inhibitor

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Maria Pina Dore ◽  
Stefano Bibbò ◽  
Giovanni Mario Pes ◽  
Ruggero Francavilla ◽  
David Y. Graham
Keyword(s):  
Helicobacter Pylori ◽  
Lactobacillus Reuteri ◽  
Eradication Therapy ◽  
Cure Rate ◽  
Double Blind ◽  
Antibiotics Use ◽  
Incremental Improvement ◽  
H Pylori ◽  
Meta Analyses ◽  
Cure Rates

Background. Meta-analyses involving >4000 subjects with probiotics added to antimicrobial Helicobacter pylori eradication therapy have reported a mean increase in the eradication rate of 12 to 14%. It is unclear how to translate that result into clinical practice. Aim. To evaluate whether administration of Lactobacillus reuteri plus a PPI without antibiotics would eradicate H. pylori infections. Methods. This was a double-blind placebo-controlled randomized 2-site study of L. reuteri (Gastrus®) at a dose of 2 × 108 CFU, 7 times per day, or matching placebo plus 20 mg pantoprazole b.i.d. for 4 weeks. Cure was defined by negative 13C-UBT, 4 weeks after therapy. Sample size required ≥50% cure rates for using probiotics as a clinically useful monotherapy. Results. Recruitment was halted after 56 subjects because of the low cure rate; there were 8 dropouts; 48 subjects completed therapy (71% women, average age 49 years). The cure rates per protocol were 3/24 (12.5%; 95% CI 2.6–32%) with L. reuteri vs. 1/24 (4.1%) with placebo. Side effects (most often diarrhea) occurred infrequently (in 5/28 vs. 3/28; active vs. placebo therapy) (P=0.53). Conclusion. L. reuteri plus a PPI therapy was unable to provide a clinically important rate of H. pylori eradication. The cure rate albeit low (12.5%) was essentially identical to that achieved when probiotics were added to antibiotic therapy. The incremental improvement was additive and independent of antimicrobial resistance or antibiotics use. Probiotics can reliably increase the cure rate to ≥90% only in regimens achieving cure rates of ∼80%. This trial is registered with NCT03404440.

Surotomycin (A Novel Cyclic Lipopeptide) vs. Vancomycin for the Treatment of Clostridioides difficile Infection: A Systematic Review and Meta-analysis

2019 ◽  
Vol 14 (3) ◽  
pp. 166-174 ◽  
Author(s):  
Aziz Muhammad ◽  
Desai Madhav ◽  
Fatima Rawish ◽  
Thoguluva C. Viveksandeep ◽  
Eid Albert ◽  
...  
Keyword(s):  
Clinical Cure ◽  
Meta Analysis ◽  
Promising Alternative ◽  
Cyclic Lipopeptide ◽  
Treatment And Prevention ◽  
Clostridioides Difficile ◽  
Specific Strain ◽  
Clostridioides Difficile Infection ◽  
Cure Rates

Background: Current guidelines recommend the use of vancomycin for the initial treatment of moderate to severe Clostridioides difficile Infection (CDI). Surotomycin, a novel antibiotic, has been utilized for the management of CDI with variable results. Methods: A systematic literature search was performed using the following electronic databases [Medline, Embase, google scholar and Cochrane] for eligible studies. Randomized controlled trials comparing Surotomycin with Vancomycin for the CDI treatment were included. Demographic variables and outcomes (CDI resolution, CDI recurrence, B1/NAP1/027-specific strain treatment, B1/NAP1/027-strain recurrence, death not related to treatment) were analyzed. The primary outcome was clinical cure rate defined as the resolution of CDI at the end of the 10-day drug course. Results: Three RCTs met the inclusion criteria with a total of 1280 patients with CDI who received either surotomycin 250 mg twice daily (642 patients) or vancomycin 125 mg four times daily (638 patients). Clinical cure rates after 10 days of treatment with either surotomycin or vancomycin were not significantly different (pooled OR: 0.89, 95% CI 0.66-1.18, p=0.41). Sustained clinical response at clinical follow-up and the overall recurrence of CDI were also not significantly different between the two groups – pooled OR 1.15 (95% CI 0.89-1.50, p=0.29) and pooled OR 0.74 (95%CI 0.52- 1.04, p=0.08), respectively. With regards to the NAP1/BI/027 strain, patients in the surotomycin group had significantly lower rates of recurrence compared to vancomycin (pooled OR 0.35, 95% CI 0.19-0.63, p<0.01). Conclusion: Surotomycin is non-inferior to vancomycin and offers a promising alternative for the treatment and prevention of C. diff infection.

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