scholarly journals Incidence of Anterior Uveitis in Patients with Axial Spondyloarthritis Treated with Anti-TNF or Anti-IL17A: A Systematic Review, A Pairwise and Network Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Damien Roche ◽  
Martin Badard ◽  
Laurent Boyer ◽  
Pierre Lafforgue ◽  
Thao Pham
Keyword(s):  
Randomized Controlled Trials ◽  
Anterior Uveitis ◽  
Axial Spondyloarthritis ◽  
De Novo ◽  
Meta Analysis ◽  
Safety Data ◽  
Preventive Treatment ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Asas Criteria

Abstract Background: Anterior uveitis (AU) is the most frequent extra-articular feature of axial spondyloarthritis (axSpA). We aimed to assess and compare the incidence of AU in axSpA patients treated with anti-TNF or anti-IL17A. Methods: We systematically reviewed PubMed, EMBase and Cochrane from inception to May 3, 2020, and searched for placebo-controlled and head-to-head randomized controlled trials (RCTs) assessing anti-TNF monoclonal antibodies (mAb) or soluble receptor fusion protein or anti-IL17A in patients with axSpA according to ASAS criteria and reporting safety data on AU. Data were extracted following a predefined protocol. We did pairwise and network meta-analyses for the primary outcome of AU flares (relapse or de novo) incidence and estimated summary odds ratios (ORs). We assessed the quality of evidence using the Cochrane risk-of-bias 2.0 tool. We ranked treatments according to their effectiveness in preventing AU flare using the P-score.Results: We identified 752 citations and included 33 RCTs, comprising 4544 treated patients (anti-TNF mAb: 2101, etanercept [ETN]: 699, anti-IL17A: 1744) and 2497 placebo-receiving patients. Incidence of uveitis was lower with anti-TNF mAb versus placebo (OR = 0.46; CI95% [0.24; 0.90]) and versus anti-IL17A (OR = 0.34; CI95% [0.12; 0.92]. According to the P-score, the ranking from the most to the least preventive treatment of uveitis flare was as follows: anti-TNF mAb, ETN, placebo, anti-IL17A. Conclusion: In RCTs assessing anti-TNF and anti-IL17A in axSpA, incident uveitis are rare events. However, this network meta-analysis demonstrates that anti-TNF mAb are associated with a lower incidence of uveitis compared to placebo and anti-IL17A.

scholarly journals Incidence of anterior uveitis in patients with axial spondyloarthritis treated with anti-TNF or anti-IL17A: a systematic review, a pairwise and network meta-analysis of randomized controlled trials

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Damien Roche ◽  
Martin Badard ◽  
Laurent Boyer ◽  
Pierre Lafforgue ◽  
Thao Pham
Keyword(s):  
Randomized Controlled Trials ◽  
Anterior Uveitis ◽  
Axial Spondyloarthritis ◽  
De Novo ◽  
Meta Analysis ◽  
Safety Data ◽  
Preventive Treatment ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Asas Criteria

Abstract Background Anterior uveitis (AU) is the most frequent extra-articular feature of axial spondyloarthritis (axSpA). We aimed to assess and compare the incidence of AU in axSpA patients treated with anti-TNF or anti-IL17A. Methods We systematically reviewed PubMed, EMBase, and Cochrane from inception to May 3, 2020, and searched for placebo-controlled and head-to-head randomized controlled trials (RCTs) assessing anti-TNF monoclonal antibodies (mAb) or soluble receptor fusion protein or anti-IL17A in patients with axSpA according to ASAS criteria and reporting safety data on AU. Data were extracted following a predefined protocol. We did pairwise and network meta-analyses for the primary outcome of AU flares (relapse or de novo) incidence and estimated summary odds ratios (ORs). We assessed the quality of evidence using the Cochrane risk-of-bias 2.0 tool. We ranked treatments according to their effectiveness in preventing AU flare using the P-score. Results We identified 752 citations and included 33 RCTs, comprising 4544 treated patients (anti-TNF mAb 2101, etanercept [ETN] 699, anti-IL17A 1744) and 2497 placebo-receiving patients. Incidence of uveitis was lower with anti-TNF mAb versus placebo (OR = 0.46; CI 95% [0.24; 0.90]) and versus anti-IL17A (OR = 0.34; CI 95% [0.12; 0.92]. According to the P-score, the ranking from the most to the least preventive treatment of uveitis flare was as follows: anti-TNF mAb, ETN, placebo, and anti-IL17A. Conclusion In RCTs assessing anti-TNF and anti-IL17A in axSpA, incident uveitis are rare events. However, this network meta-analysis demonstrates that anti-TNF mAb are associated with a lower incidence of uveitis compared to placebo and anti-IL17A.

scholarly journals Neuromodulation techniques for acute and preventive migraine treatment: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Xavier Moisset ◽  
Bruno Pereira ◽  
Daniel Ciampi de Andrade ◽  
Denys Fontaine ◽  
Michel Lantéri-Minet ◽  
...  
Keyword(s):  
Systematic Review ◽  
Randomized Controlled Trials ◽  
Nerve Stimulation ◽  
Acute Treatment ◽  
Meta Analysis ◽  
Preventive Treatment ◽  
Migraine Treatment ◽  
Controlled Trials ◽  
Electrical Nerve Stimulation ◽  
Randomized Controlled

Abstract Background Several neuromodulation methods exists for migraine treatment. The aim of the present study was to perform a systematic review and meta-analysis of randomized controlled trials (RCTs) focusing on migraine treatment using neurostimulation methods. Methods We searched Medline and Embase up to July 1, 2020 for RCTs reporting acute or preventive treatment of migraine with either non-invasive or invasive neurostimulation methods. Two researchers independently assessed the eligibility of the retrieved studies and extracted data. Outcomes for the quantitative synthesis were 2 h pain free for acute treatment and headache days per month for preventive treatment. We performed subgroup analyses by treatment (stimulation method and site of application). Estimates were pooled using random-effects meta-analysis. Results Thirty-eight articles were included in the qualitative analysis (7 acute, 31 preventive) and 34 in the quantitative evaluation (6 acute, 28 preventive). Remote electrical neuromodulation (REN) was effective for acute treatment. Data were insufficient to draw conclusions for any other techniques (single studies). Invasive occipital nerve stimulation (ONS) was effective for migraine prevention, with a large effect size but considerable heterogeneity, whereas supra-orbital transcutaneous electrical nerve stimulation (TENS), percutaneous electrical nerve stimulation (PENS), and high-frequency repetitive transcranial magnetic stimulation (rTMS) over the primary motor cortex (M1) were effective, with small to medium effect sizes. Vagus-nerve stimulation, left prefrontal cortex rTMS, and cathodal transcranial direct current stimulation (tDCS) over the M1 had no significant effect and heterogeneity was high. Conclusion Several neuromodulation methods are of potential interest for migraine management, but the quality of the evidence is very poor. Future large and well-conducted studies are needed and could improve on the present results.

scholarly journals Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257843
Author(s):  
Kae Ling Cheah ◽  
Mohd Noor Norhayati ◽  
Lili Husniati Yaacob ◽  
Razlina Abdul Rahman
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Safety Data ◽  
Anxiety Level ◽  
World Health ◽  
Controlled Trials ◽  
Clinical Trial Registry ◽  
Randomized Controlled

Objective To determine the effect of Ashwagandha extract on sleep. Methods A comprehensive search was conducted in CENTRAL, MEDLINE, SCOPUS, Google Scholars, World Health Organization Trials Portal, ClinicalTrials.gov, Clinical Trial Registry of India, and AYUSH Research Portal for all appropriate trials. Randomized controlled trials that examined the effect of Ashwagandha extract versus placebo on sleep in human participants 18 years old and above were considered. Two authors independently read all trials and independently extracted all relevant data. The primary outcomes were sleep quantity and sleep quality. The secondary outcomes were mental alertness on rising, anxiety level, and quality of life. Results A total of five randomized controlled trials containing 400 participants were analyzed. Ashwagandha extract exhibited a small but significant effect on overall sleep (Standardized Mean Difference -0.59; 95% Confidence Interval -0.75 to -0.42; I2 =  62%). The effects on sleep were more prominent in the subgroup of adults diagnosed with insomnia, treatment dosage ≥600 mg/day, and treatment duration ≥8 weeks. Ashwagandha extract was also found to improve mental alertness on rising and anxiety level, but no significant effect on quality of life. No serious side effects were reported. Conclusion Ashwagandha extract appears to has a beneficial effect in improving sleep in adults. However, data on the serious adverse effects of Ashwagandha extract are limited, and more safety data would be needed to assess whether it would be safe for long-term use.

scholarly journals A network meta-analysis of randomized controlled trials comparing treatment modalities for de novo superficial femoral artery occlusive lesions

2017 ◽  
Vol 65 (1) ◽  
pp. 234-245.e11 ◽  
Author(s):  
Constantine N. Antonopoulos ◽  
Spyridon N. Mylonas ◽  
Konstantinos G. Moulakakis ◽  
Theodoros N. Sergentanis ◽  
George S. Sfyroeras ◽  
...  
Keyword(s):  
Randomized Controlled Trials ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
De Novo ◽  
Meta Analysis ◽  
Treatment Modalities ◽  
Controlled Trials ◽  
Randomized Controlled

scholarly journals Drug-Coated Balloon for De Novo Coronary Artery Lesions: A Systematic Review and Trial Sequential Meta-analysis of Randomized Controlled Trials

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Wei Liu ◽  
Min Zhang ◽  
Guangping Chen ◽  
Zongzhuang Li ◽  
Fang Wei
Keyword(s):  
Systematic Review ◽  
Coronary Artery ◽  
Randomized Controlled Trials ◽  
De Novo ◽  
Meta Analysis ◽  
Bleeding Risk ◽  
Controlled Trials ◽  
Coronary Artery Lesions ◽  
Randomized Controlled ◽  
Drug Coated Balloon

Objective. To investigate the efficacy of drug-coated balloon (DCB) treatment for de novo coronary artery lesions in randomized controlled trials (RCTs). Background. DCB was an effective therapy for patients with in-stent restenosis. However, the efficacy of DCB in patients with de novo coronary artery lesions is still unknown. Methods. Eligible studies were searched on PubMed, Web of Science, EMBASE, and Cochrane Library Database. Systematic review and meta-analyses of RCTs were performed comparing DCB with non-DCB devices (such as plain old balloon angioplasty (POBA), bare-metal stents (BMS), or drug-eluting stents (DES)) for the treatment of de novo lesions. Trial sequential meta-analysis (TSA) was performed to assess the false positive and false negative errors. Results. A total of 2,137 patients enrolled in 12 RCTs were analyzed. Overall, no significant difference in target lesion revascularization (TLR) was found, but there were numerically lower rates after DCB treatment at 6 to 12 months follow-up (RR: 0.69; 95% CI: 0.47 to 1.01; P=0.06; TSA-adjusted CI: 0.41 to 1.16). TSA showed that at least 1,000 more randomized patients are needed to conclude the effect on TLR. A subgroup analysis from high bleeding risk patients revealed that DCB treatment was associated with lower rate of TLR (RR: 0.10; 95% CI: 0.01 to 0.78; P=0.03). The systematic review illustrated that the rate of bailout stenting was lower and decreased gradually. Conclusions. DCB treatment was associated with a trend toward lower TLR when compared with controls. For patients at bleeding risk, DCB treatment was superior to BMS in TLR.

scholarly journals Long term outcomes of Everolimus therapy in de novo liver transplantation: a systematic review and meta-analysis of randomized controlled trials

2019 ◽  
Author(s):  
Bzeizi Khalid ◽  
Smith Richard ◽  
Benmousa Ali ◽  
Dama Madhukar M.V.SC ◽  
Aba-Alkhail Faisal ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Randomized Controlled Trials ◽  
De Novo ◽  
Meta Analysis ◽  
Calcineurin Inhibitors ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Combination Regimen ◽  
Randomized Controlled ◽  
Number Of Patients

ABSTRACTBackgroundRisk of nephrotoxicity in liver transplant patients on calcineurin inhibitors (CnIs) is a concern. Several controlled trials reported benefit of Everolimus (EVR) in minimizing this risk when combined with a reduced CnIs dose.ObjectiveTo systematically review the efficacy and safety of EVR, alone or with reduced CnI dose, as compared to CnI alone post liver transplantation.MethodsWe searched MEDLINE, Scopus and the Cochrane Library for randomized controlled trials (RCTs) comparing EVR and CnI based regimens post liver transplanation. Assessment of studies and data extraction was undertaken independently.ResultsEight studies were selected describing 769 patients. Cockcroft-Gault GFR (CG-GFR) was significantly higher at one (p=0.05), 3 & 5 years (p=0.030) in patients receiving EVR as compared to those receiving CnI therapy. The composite end point of efficacy failure was similar between the two arms after 1, 3 & 5 years of study. Higher number of patients discontinued EVR due to adverse effects in one year, however no difference was noted after 3 & 5 years. A higher rates of proteinuria, peripheral edema and incisional hernia were noted in patients on EVR.ConclusionThe analysis confirms non-inferiority of EVR and reduced CnI combination. Patients on the combination regimen had better renal function compared to standard CnI therapy.

scholarly journals Galcanezumab in migraine prevention: a systematic review and meta-analysis of randomized controlled trials

2020 ◽  
Vol 13 ◽  
pp. 175628642091808 ◽  
Author(s):  
Panagiotis Gklinos ◽  
Dimos D. Mitsikostas
Keyword(s):  
Clinical Trials ◽  
Adverse Event ◽  
Randomized Controlled Trials ◽  
Meta Analysis ◽  
Preventive Treatment ◽  
Phase Iii ◽  
Controlled Trials ◽  
Migraine Prevention ◽  
Randomized Controlled ◽  
The Mean

Background: Galcanezumab, along with three other monoclonal antibodies targeting the calcitonin gene-related peptide (CGRP) pathway, represents the latest disease-specific and mechanism-based treatment for the prophylaxis of migraine. Galcanezumab shares data also for the prophylaxis of cluster headache. Objective: To provide a pooled safety and efficacy analysis of all phase III randomized controlled trials of galcanezumab in the preventive therapy of migraine. Methods: A computer-based literature search was conducted on MEDLINE and the US National Institutes of Health Clinical Trials Registry for phase III randomized controlled trials of galcanezumab in migraine prevention. The primary outcome was the mean change in monthly migraine days (MMDs). The proportions of patients who reported at least one adverse event (AE), at least one serious adverse event (SAE) or withdrew from the study were used as safety outcomes. Results: Two trials were included in the efficacy meta-analysis and three in the safety meta-analysis. Migraine preventive treatment with subcutaneous galcanezumab, at both 120 mg and 240 mg dosages, was associated with a significantly greater reduction in the mean number of MMDs versus placebo (120 mg, MD = –1.98, 95% CI = –2.33 to –1.63; p < 0.0001) or (240 mg, MD = –1.86, 95% CI = –2.20 to –1.53; p < 0.0001). Galcanezumab was found to be more efficacious in all key secondary outcomes as well. Regarding safety, most of the adverse events were mild to moderate, while drop-out rates and serious adverse events were low. Conclusions: Galcanezumab is an efficacious and well-tolerated preventive treatment for migraine. Larger clinical trials with longer follow-up periods need to be conducted in order to provide more safety data of the above-mentioned drug.

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