scholarly journals Antidepressive Effect of Antipsychotics in the Treatment of Schizophrenia: Meta-Regression Analysis of Randomized Placebo-Controlled Trials

2020 ◽  
Author(s):  
Itaru Miura ◽  
Tadashi Nosaka ◽  
Hirooki Yabe ◽  
Katsuhiko Hagi
Keyword(s):  
Depressive Symptoms ◽  
Controlled Trials ◽  
Antidepressive Effect ◽  
Syndrome Scale ◽  
Symptom Domains ◽  
Meta Regression ◽  
Standardized Mean Difference ◽  
Antidepressive Effects ◽  
Meta Regression Analysis ◽  
Negative Syndrome

Abstract Background Antipsychotics improve the positive symptoms of schizophrenia. However, little is known about the extent of antidepressive effects of antipsychotics and their correlation with effects on other symptom domains in schizophrenia. The aim was to investigate whether antidepressive effects of antipsychotics have a significant correlation with the effects on specific symptom domains of schizophrenia. Methods Electronic databases were searched to identify eligible studies that reported antidepressive effects of antipsychotics for the treatment of adult patients with schizophrenia in double-blind, randomized placebo-controlled trials (RCTs). Mean change from baseline in depressive symptoms was meta-analyzed, and the correlation with the effects on other symptom domains was examined through meta-regression analysis. Results Thirty-five RCTs (13 890 patients) were included in this meta-analysis. Overall, antipsychotics showed greater efficacy than placebo in reducing depressive symptoms, with small to medium effect sizes (standardized mean difference = −0.27, 95% confidence interval −0.32 to −0.22, P < .001). All the antipsychotics, except for chlorpromazine, haloperidol, and ziprasidone, were associated with significantly greater decreases in depressive symptoms compared with placebo (standardized mean difference = −0.19 to −0.40). A higher antidepressive effect was significantly correlated with a higher improvement in Positive and Negative Syndrome Scale/Brief Psychiatric Rating Scale total, positive, and negative, and Positive and Negative Syndrome Scale-general psychopathology symptoms (β = .618, P < .001; β = .476, P < .001; β = .689, P < .001; β = .603, P < .001, respectively). Conclusions Second-generation antipsychotics (except for ziprasidone) were associated with small to medium effects sizes on improvement in depressive symptoms among adult patients with schizophrenia. The antidepressive effect of antipsychotics was significantly correlated with improvement in other symptom domains, with the highest correlation observed for improvement in negative symptoms. PROSPERO registration number CRD42019133015

scholarly journals The Prognostic Significance of the Alterations of Cardiovascular Hemodynamics in Patients With Pulmonary Arterial Hypertension: A Meta-regression Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Shih-Hsien Sung ◽  
Wan-Yu Yeh ◽  
Chern-En Chiang ◽  
Chi-Jung Huang ◽  
Wei-Ming Huang ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Pulmonary Arterial Hypertension ◽  
Explanatory Power ◽  
Controlled Trials ◽  
Hemodynamic Changes ◽  
Randomized Controlled ◽  
Clinical Events ◽  
Pulmonary Arterial ◽  
Meta Regression ◽  
Meta Regression Analysis

Abstract Background: Hemodynamic assessment in patients with pulmonary arterial hypertension (PAH) is essential for risk stratification and pharmacological management. However, the prognostic value of the hemodynamic changes after treatment is less well established. Objectives: We investigated the prognostic impacts of the changes in hemodynamic indices, including mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), right atrial pressure (RAP) and cardiac output index (CI). We conducted this systematic review with meta-regression analysis on existing clinical trials.Methods:We searched and identified all relevant randomized controlled trials from multiple databases. An analogous R2 index was used to quantify the proportion of variance explained by each predictor in the association with PAH patients’ prognosis. A total of 20 trials and 3,263 individuals were enrolled. Results:The changes in mPAP, PVR, RAP and CI were all significantly associated with the change in 6MWD (∆6MWD). The change in mPAP was with the highest explanatory power for ∆6MWD (R2 analog=0.739). Additionally, the changes in mPAP, PVR and CI were independently predictive of adverse clinical events. The change in mPAP had the highest explanatory power for the clinical events (R2 analog =0.911). Furthermore, the change in PVR was with the highest explanatory power for total mortality of PAH patients (R2 analog =0.594). Conclusion:Hemodynamic changes after treatment, including mPAP, PVR, CI and RAP, were significantly associated with adverse clinical events or mortality in treated PAH patients. It is recommended that further studies be conducted to evaluate the changes in hemodynamic indices to guide drug titration.Trial registration number: PROSPERO; No.: CRD42019125157; URL: https://www.crd.york.ac.uk/PROSPERO/ (Date of registration: 14/03/2019)

scholarly journals SOFA and mortality endpoints in randomized controlled trials: a systematic review and meta-regression analysis

Critical Care ◽  
2017 ◽  
Vol 21 (1) ◽  
Author(s):  
Harm-Jan de Grooth ◽  
Irma L. Geenen ◽  
Armand R. Girbes ◽  
Jean-Louis Vincent ◽  
Jean-Jacques Parienti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Meta Regression ◽  
Meta Regression Analysis

scholarly journals Optimal duration of prone positioning in patients with acute respiratory distress syndrome: a protocol for a systematic review and meta-regression analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021408 ◽  
Author(s):  
Tetsuro Kamo ◽  
Yoshitaka Aoki ◽  
Tatsuma Fukuda ◽  
Kiyoyasu Kurahashi ◽  
Hideto Yasuda ◽  
...  
Keyword(s):  
Systematic Review ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Prone Positioning ◽  
Short Term ◽  
Optimal Duration ◽  
Short Term Mortality ◽  
Meta Regression ◽  
Meta Regression Analysis

IntroductionSeveral systematic reviews and meta-analyses have demonstrated that prolonged (≥16 hours) prone positioning can reduce the mortality associated with acute respiratory distress syndrome (ARDS). However, the effectiveness and optimal duration of prone positioning was not fully evaluated. To fill these gaps, we will first investigate the effectiveness of prone positioning compared with the conventional management of patients with ARDS, regarding outcomes using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Second, if statistical heterogeneity in effectiveness with regard to short-term mortality (intensive care unit death or ≤30-day mortality) is shown, we will conduct a meta-regression analysis to explore the association between duration and effectiveness, and determine the optimal duration of prone positioning.Method and analysisRelevant studies are collected using PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials and the WHO International Clinical Trials Platform Search Portal. Randomised controlled trials comparing prone and supine positioning in adults with ARDS will be included in the meta-analysis. Two independent investigators will screen trials obtained by search eligibility and extract data from selected studies to standardised data recording forms. For each selected trial, the risk of bias and quality of evidence will be evaluated using the GRADE system. Meta-regression analyses will be performed to identify the most important factors associated with short-term mortality, and subgroup analysis will be used to analyse the following: duration of mechanical ventilation in the prone position per day, patient severity, tidal volume and cause of ARDS. If heterogeneity or inconsistency among the studies is detected, subgroup analysis will be conducted on factors that may cause heterogeneity.Ethics and disseminationThis study requires no ethical approval. The results obtained from this systematic review and meta-analysis will be disseminated through international conference presentations and publication in a peer-reviewed journal.PROSPERO registration numberCRD42017078340.

scholarly journals The prognostic significance of the alterations of pulmonary hemodynamics in patients with pulmonary arterial hypertension: a meta-regression analysis of randomized controlled trials

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Shih-Hsien Sung ◽  
Wan-Yu Yeh ◽  
Chern-En Chiang ◽  
Chi-Jung Huang ◽  
Wei-Ming Huang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Explanatory Power ◽  
Controlled Trials ◽  
Hemodynamic Changes ◽  
Randomized Controlled ◽  
Clinical Events ◽  
Pulmonary Arterial ◽  
Meta Regression ◽  
Meta Regression Analysis

Abstract Background Hemodynamic assessment in patients with pulmonary arterial hypertension (PAH) is essential for risk stratification and pharmacological management. However, the prognostic value of the hemodynamic changes after treatment is less well established. Objectives We investigated the prognostic impacts of the changes in hemodynamic indices, including mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), right atrial pressure (RAP), and cardiac output index (CI). We conducted this systematic review with meta-regression analysis on existing clinical trials. Methods We searched and identified all relevant randomized controlled trials from multiple databases. An analogous R2 index was used to quantify the proportion of variance explained by each predictor in the association with PAH patients’ prognosis. A total of 21 trials and 3306 individuals were enrolled. Results The changes in mPAP, PVR, RAP, and CI were all significantly associated with the change in 6MWD (∆6MWD). The change in mPAP was with the highest explanatory power for ∆6MWD (R2 analog = 0.740). Additionally, the changes in mPAP, PVR, and CI were independently predictive of adverse clinical events. The change in mPAP had the highest explanatory power for the clinical events (R2 analog = 0.911). Furthermore, the change in PVR was with the highest explanatory power for total mortality of PAH patients (R2 analog = 0.612). Conclusion Hemodynamic changes after treatment, including mPAP, PVR, CI, and RAP, were significantly associated with adverse clinical events or mortality in treated PAH patients. It is recommended that further studies be conducted to evaluate the changes in hemodynamic indices to guide drug titration. Systematic review registration PROSPERO CRD42019125157

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