scholarly journals Relative Effectiveness of Cell-Cultured versus Egg-Based Seasonal Influenza Vaccines in Preventing Influenza-Related Outcomes in Subjects 18 Years Old or Older: A Systematic Review and Meta-Analysis

2022 ◽  
Vol 19 (2) ◽  
pp. 818
Author(s):  
Joan Puig-Barberà ◽  
Sonia Tamames-Gómez ◽  
Pedro Plans-Rubio ◽  
José María Eiros-Bouza
Keyword(s):  
Systematic Review ◽  
Seasonal Influenza ◽  
Influenza Season ◽  
Meta Analysis ◽  
Relative Effectiveness ◽  
Vaccine Effectiveness ◽  
Risk Of Bias ◽  
Influenza Vaccines ◽  
Sensitivity Analyses ◽  
Exclusion Criteria

Avian mutations in vaccine strains obtained from embryonated eggs could impair vaccine effectiveness. We performed a systematic review and meta-analysis of the adjusted relative vaccine effectiveness (arVE) of seed cell-cultured influenza vaccines (ccIV) compared to egg-based influenza vaccines (eIV) in preventing laboratory-confirmed influenza related outcomes (IRO) or IRO by clinical codes, in subjects 18 and over. We completed the literature search in January 2021; applied exclusion criteria, evaluated risk of bias of the evidence, and performed heterogeneity, publication bias, qualitative, quantitative and sensitivity analyses. All estimates were computed using a random approach. International Prospective Register of Systematic Reviews, CRD42021228290. We identified 12 publications that reported 26 adjusted arVE results. Five publications reported 13 laboratory confirmed arVE and seven reported 13 code-ascertained arVE. Nine publications with 22 results were at low risk of bias. Heterogeneity was explained by season. We found a significant 11% (8 to 14%) adjusted arVE favoring ccIV in preventing any IRO in the 2017–2018 influenza season. The arVE was 3% (−2% to 7%) in the 2018–2019 influenza season. We found moderate evidence of a significant advantage of the ccIV in preventing IRO, compared to eIV, in a well-matched A(H3N2) predominant season.

Relative Effectiveness of Cell-Cultured versus Egg-Based Seasonal Influenza Vaccines in Preventing Influenza-Related Outcomes in Subjects 18 Years Old or Older: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Joan Puig-Barberà ◽  
Sonia Tamames-Gómez ◽  
Pedro Plans-Rubio ◽  
José María Eirós-Bouza
Keyword(s):  
Systematic Review ◽  
Seasonal Influenza ◽  
Influenza Season ◽  
Meta Analysis ◽  
Relative Effectiveness ◽  
Risk Of Bias ◽  
Influenza Vaccines ◽  
Sensitivity Analyses ◽  
Exclusion Criteria ◽  
Seed Cell

Avian mutations in vaccine strains obtained from embryonated eggs could impair vaccine effec-tiveness. We performed a systematic review and meta-analysis of the adjusted relative vaccine effectiveness (arVE) of seed cell-cultured influenza vaccines (ccIV) compared to egg-based influ-enza vaccines (eIV) in preventing laboratory-confirmed influenza related outcomes (IRO) or IRO by clinical codes, in subjects 18 and over. We completed the literature search in January 2021; ap-plied exclusion criteria, evaluated risk of bias of the evidence, and performed heterogeneity, pub-lication bias, qualitative, quantitative and sensitivity analyses. All estimates were computed us-ing a random approach. International Prospective Register of Systematic Reviews, CRD42021228290. We identified 12 publications that reported 26 adjusted arVE results. Five publications reported 13 laboratory confirmed arVE and seven reported 13 code-ascertained arVE. Nine publications with 22 results were at low risk of bias. Heterogeneity was explained by season and risk of bias. We found a significant 11% (8 to 14%) adjusted arVE favoring ccIV in preventing any IRO in the 2017-2018 influenza season. The arVE was 3% (-01 to 7%) in the 2018-2019 influenza season. We found moderate evidence of a significant advantage of the ccIV in preventing IRO, compared to eIV, in a well-matched A(H3N2) predominant season.

scholarly journals Relative Effectiveness of Cell-Cultured versus Egg-Based Seasonal Influenza Vaccines in Preventing Influenza-Related Outcomes in Subjects 18 Years Old or Older: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Joan Puig-Barberà ◽  
Sonia Tamames-Gómez ◽  
Pedro Plans-Rubio ◽  
José María Eirós-Bouza
Keyword(s):  
Systematic Review ◽  
Seasonal Influenza ◽  
Influenza Season ◽  
Meta Analysis ◽  
Relative Effectiveness ◽  
Risk Of Bias ◽  
Influenza Vaccines ◽  
Sensitivity Analyses ◽  
Exclusion Criteria ◽  
Seed Cell

Avian mutations in vaccine strains obtained from embryonated eggs could impair vaccine effec-tiveness. We performed a systematic review and meta-analysis of the adjusted relative vaccine effectiveness (arVE) of seed cell-cultured influenza vaccines (ccIV) compared to egg-based influ-enza vaccines (eIV) in preventing laboratory-confirmed influenza related outcomes (IRO) or IRO by clinical codes, in subjects 18 and over. We completed the literature search in January 2021; ap-plied exclusion criteria, evaluated risk of bias of the evidence, and performed heterogeneity, pub-lication bias, qualitative, quantitative and sensitivity analyses. All estimates were computed us-ing a random approach. International Prospective Register of Systematic Reviews, CRD42021228290. We identified 12 publications that reported 26 adjusted arVE results. Five publications reported 13 laboratory confirmed arVE and seven reported 13 code-ascertained arVE. Nine publications with 22 results were at low risk of bias. Heterogeneity was explained by season and risk of bias. We found a significant 11% (8 to 14%) adjusted arVE favoring ccIV in preventing any IRO in the 2017-2018 influenza season. The arVE was 3% (-01 to 7%) in the 2018-2019 influenza season. We found moderate evidence of a significant advantage of the ccIV in preventing IRO, compared to eIV, in a well-matched A(H3N2) predominant season.

scholarly journals Efficacy of zinc as adjunctive pneumonia treatment in children aged 2 to 60 months in low-income and middle-income countries: a systematic review and meta-analysis

2020 ◽  
Vol 4 (1) ◽  
pp. e000662 ◽  
Author(s):  
Nick Brown ◽  
Antti Juhani Kukka ◽  
Andreas Mårtensson
Keyword(s):  
Systematic Review ◽  
Treatment Failure ◽  
Low Income ◽  
Meta Analysis ◽  
Severe Pneumonia ◽  
Risk Of Bias ◽  
Sensitivity Analyses ◽  
Cochrane Library ◽  
Middle Income ◽  
Middle Income Countries

BackgroundDespite advances in vaccination and case management, pneumonia remains the single largest contributor to early child mortality worldwide. Zinc has immune-enhancing properties, but its role in adjunctive treatment of pneumonia in low-income and middle-income countries (LMICs) is controversial and research still active.MethodsSystematic review and meta-analysis of randomised controlled trials of zinc and placebo in pneumonia in children aged 2 to 60 months in LMICs. Databases included MEDLINE, the Cochrane Library, EMBASE, LILACS, SciELO, the WHO portal, Scopus, Google Scholar and ClinicalTrials.gov. Inclusion criteria included accepted signs of pneumonia and clear measure of outcome. Risk of bias was independently assessed by two authors. ORs with 95% CI were used for calculating the pooled estimate of dichotomous outcomes including treatment failure and mortality. Time to recovery was expressed as HRs. Sensitivity analyses considering risk of bias and subgroup analyses for pneumonia severity were performed.ResultsWe identified 11 trials published between 2004 and 2019 fulfilling the a priori defined criteria, 7 from South Asia and 3 from Africa and 1 from South America. Proportional treatment failure was comparable in both zinc and placebo groups when analysed for all patients (OR 0.95 (95% CI 0.80 to 1.14)) and only for those with severe pneumonia (OR 0.93 (95% CI 0.75 to 1.14)). No difference was seen in mortality between zinc and placebo groups (OR 0.64 (95% CI 0.31 to 1.31)). Time to recovery from severe pneumonia did not differ between the treatment and control groups for patients with severe pneumonia (HR 1.01 (95% CI 0.89 to 1.14)). Removal of four studies with high risk of bias made no difference to the conclusions.ConclusionThere is no evidence that adjunctive zinc treatment improves recovery from pneumonia in children in LMICs.Trial registration numberCRD42019141602.

scholarly journals A Real-World Clinical and Economic Analysis of Cell-derived Quadrivalent Influenza Vaccine Compared to Standard Egg-derived Quadrivalent Influenza Vaccines During the 2019-20 Influenza Season in the United States

2021 ◽  
Author(s):  
Victoria Divino ◽  
Vamshi Ruthwik Anupindi ◽  
Mitch DeKoven ◽  
Joaquin Mould-Quevedo ◽  
Stephen I Pelton ◽  
...  
Keyword(s):  
High Risk ◽  
Influenza Vaccine ◽  
Influenza Season ◽  
The United States ◽  
Vaccine Effectiveness ◽  
Influenza Vaccines ◽  
Sensitivity Analyses ◽  
Administrative Claims ◽  
Adaptive Mutations ◽  
Quadrivalent Influenza Vaccine

Abstract Background Cell-derived influenza vaccines are not subject to egg adaptive mutations that have potential to decrease vaccine effectiveness. This retrospective analysis estimated the relative vaccine effectiveness (rVE) of cell-derived quadrivalent influenza vaccine (IIV4c) compared to standard egg-derived quadrivalent influenza vaccines (IIV4e) among recipients aged 4-64 years in the US during the 2019-20 influenza season. Methods The IQVIA PharMetrics® Plus administrative claims database was utilized. Study outcomes were assessed post-vaccination through the end of the study period (March 7, 2020). Inverse probability of treatment weighting (IPTW) was implemented to adjust for covariate imbalance. Adjusted rVE against influenza-related hospitalizations/emergency room (ER) visits and other clinical outcomes was estimated through IPTW-weighted Poisson regression models for the IIV4c and IIV4e cohorts and for the subgroup with ≥1 high-risk condition. Sensitivity analyses modifying the outcome assessment period as well as a doubly-robust analysis were also conducted. IPTW-weighted generalized linear models were used to estimate predicted annualized all-cause costs. Results The final sample comprised 1,138,969 IIV4c and 3,926,357 IIV4e recipients following IPTW adjustment. IIV4c was more effective in preventing influenza-related hospitalizations/ER visits as well as respiratory-related hospitalizations/ER visits compared to IIV4e. IIV4c was also more effective for the high-risk subgroup and across the sensitivity analyses. IIV4c was also associated with significantly lower annualized all-cause total costs compared to IIV4e (-$467), driven by lower costs for outpatient medical services and inpatient hospitalizations. Conclusions IIV4c was significantly more effective in preventing influenza-related hospitalizations/ER visits compared to IIV4e and was associated with significantly lower all-cause costs.

scholarly journals Efficacy and Safety of Tongxinluo Capsule as Adjunctive Treatment for Unstable Angina Pectoris: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Pengqi Li ◽  
Qiqi Xin ◽  
Jiaqi Hui ◽  
Rong Yuan ◽  
Ya Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Angina Pectoris ◽  
Unstable Angina ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Unstable Angina Pectoris ◽  
Sensitivity Analyses ◽  
Adjunctive Treatment ◽  
Randomized Controlled ◽  
St Segment

Tongxinluo capsule (TXLC) is a commonly used Chinese medicine for unstable angina pectoris (UA). This article aimed to clarify the safety and efficacy of TXLC as an adjunctive treatment for UA. Two reviewers searched 7 databases from inception to August 2021, and performed literature screening and information extraction independently. The meta-analysis was implemented after evaluating the methodological quality of each randomized controlled trial (RCT) by the Cochrane Risk of Bias tool. Sensitivity analyses were conducted for testing the stability of the results, and the Begg and Egger tests were performed for any potential publication bias. After eligibility assessment, 42 RCTs with a total of 5,421 participants were included. Evidence showed that TXLC reduced the rate of cardiovascular events [RR = 0.29, 95% CI (0.19, 0.45), p < 0.00001, I2 = 0%] {including cardiovascular mortality [RR = 0.16, 95% CI (0.03, 0.88), p = 0.03, I2 = 20%], the incidence of acute myocardial infarction [RR = 0.27, 95% CI (0.13, 0.57), p = 0.0006, I2 = 0%] and the occurrence of revascularization [RR = 0.28, 95% CI (0.15,0.54), p = 0.0001, I2 = 0%]}, all-cause mortality [RR = 0.25, 95% CI (0.06, 0.99), p = 0.05, I2 = 19%], recurrence of angina [RR = 0.25, 95% CI (0.11, 0.61), p = 0.002, I2 = 0%], the number of ST-segment depression [MD = −0.45, 95% CI (−0.69, −0.20), p = 0.0005, I2 = 0%], the summation of ST-segment depression [MD = −0.70, 95% CI (−1.08, −0.32), p = 0.0003, I2 = 70%] and the hypersensitive C-reactive protein level [MD = −2.86, 95% CI (−3.73, −1.99), p < 0.00001, I2 = 86%], increased the nitric oxide level [MD = 11.67, 95% CI (8.33, 15.02), p < 0.00001, I2 = 33%], improved the electrocardiogram change [RR = 1.23, 95% CI (1.16, 1.30), p < 0.00001, I2 = 0%] and the clinical efficacy in UA [RR = 1.26, 95% CI (1.21, 1.32), p < 0.00001, I2 = 24%], and relieved the symptoms of angina pectoris {including chest pain or tightness [RR = 1.13, 95% CI (0.97, 1.32), p = 0.12, I2 = 30%], palpitations [RR = 1.47, 95% CI (1.18, 1.84), p = 0.0007, I2 = 0%], shortness of breath [RR = 1.53, 95% CI (1.24, 1.88), p < 0.0001, I2 = 0%], and asthenia [RR = 1.69, 95% CI (0.83, 3.43), p = 0.15, I2 = 90%]}. The most common adverse effect was gastrointestinal symptoms which could be relieved and eliminated through dose reduction, medication time adjustment and symptomatic remedy. Collectively, TXLC was effective and considerably safe for UA. However, due to the unavoidable risk of bias, these results must be interpreted with caution and further verified by large-scale and high-quality RCTs.Systematic Review Registration:www.crd.york.ac.uk/PROSPERO/, identifier CRD42021232771.

scholarly journals PREVALENCE THRESHOLDS THAT SHOULD BE APPLIED IN SCHISTOSOMIASIS MASS DRUG ADMINISTRATION PRGROGRAMMES: SYSTEMATIC REVIEW AND META-ANALYSIS

2021 ◽  
Author(s):  
Anthony Danso-Appiah ◽  
Amadou Djirmay Garba ◽  
Nathan C Lo ◽  
Massimiliano Orso ◽  
Kwadwo Owusu Akuffo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Drug Administration ◽  
Mass Drug Administration ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Sensitivity Analyses ◽  
School Age Children ◽  
School Age ◽  
Intensity Of Infection ◽  
Global Prevalence

Background WHO-recommended prevalence thresholds for deciding schistosomiasis mass drug administration (MDA) are based on anecdotal evidence and unclear. Objectives This systematic review and meta-analysis commissioned by the WHO, as part of its new schistosomiasis evidence-based guideline development, was to generate a single and global prevalence threshold that should be applied in MDA programmes. Methods We searched several databases from 1979 to 31st March 2021 without language restriction. Two reviewers selected studies, extracted data and assessed the risk of bias using relevant risk of bias tools and resolved disagreements through discussion. The review followed the PRISMA guidelines. Data were analysed and presented as prevalence reduction (PR) and relative risk (RR) for dichotomous outcomes or mean difference for continuous outcomes with their 95% confidence intervals (CIs). Meta-regression of observations on prevalence rates and intensity of infection of MDA programmes and sensitivity analyses to assess the robustness of the results to the risk of bias components were performed. Evidence on benefits, harms, values, preferences, compliance, acceptability, equity and feasibility were also assessed. The overall level of evidence was graded using GRADE. Results Out of 1,232 studies retrieved, 38 studies met our inclusion criteria and 34 studies were included in the meta-analysis. No direct relation was observed between prevalence and intensity of infection. Praziquantel reduced prevalence of S. haematobium in school age children (SAC) at 12 months (RR 0.38, 95% CI 0.28 to 0.52; 8 studies, n=37,868); at 24 months (RR 0.30; 95% CI 0.30 to 0.52; 7 studies; n=37107); at 36 months (RR 0.39, 95% CI 0.21 to 0.71; 5 studies, n=28,146). There was no significant reduction in prevalence at 48 months (2 studies, n=10,954). For S. mansoni, there were reductions in prevalence at 12 months (RR 0.56, 95% CI 0.46 to 0.69; 14 studies, n=86,073); 24 months (RR 0.46; 95% CI 0.32 to 0.66; 14 studies; n=83,721);36 months (RR 0.44, 95% CI 0.33 to 0.58; 7 studies, n=70,933) and at 48 months (RR 0.25, 95% CI 0.11 to 0.59; 5 studies; n=27,483). Further analyses were performed from a series of created prevalence thresholds of 5%, 10%, 15%, 20%, 30% and ≥40% which showed differences in effect of MDA when each of the thresholds was applied. For annual MDA of school age children (SAC), school-based treatment (SBT) appears to perform better than community-wide treatment (CWT) in terms of prevalence reduction. For the different schistosome species, the model suggests, using the same prevalence threshold, it will take shorter time to reach elimination for S. haematobium than S. mansoni; annual MDA using SBT approach for S. haematobium will require about 10 years to achieve elimination whereas it will take over 10 years to around 15 years to achieve elimination for S. mansoni. Conclusion The evidence presented in this systematic review suggests that 10% prevalence should be used as the global prevalence threshold for implementing MDA in endemic countries.

scholarly journals Who benefits from guided internet-based interventions? A systematic review of predictors and moderators of treatment outcome

2021 ◽  
Author(s):  
Katrin Haller ◽  
Pauline Becker ◽  
Helen Niemeyer ◽  
Johanna Boettcher
Keyword(s):  
Systematic Review ◽  
Treatment Outcome ◽  
Interrater Reliability ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Exclusion Criteria ◽  
Ovid Medline ◽  
Rigorous Research ◽  
And Gender ◽  
Treatment Credibility

Objective: To our knowledge, no systematic review or meta-analysis has been conducted on all predictors or moderators of treatment outcome across diagnoses in guided internet-based interventions (IBIs) for adults. We aimed to aggregate the results of relevant studies and identify research gaps. Methods: After duplicate removal, 1615 articles, identified by searching the databases PsycInfo, Ovid Medline, and Pubmed and through snowballing, were screened following detailed in- and exclusion criteria in April and May 2021. Risk of bias (QUIPS) and intra- and interrater reliability for screening and risk of bias were assessed. Variables were grouped and categorized, then synthesized using vote counting based on direction of effect. Results: N=50 articles were included in the review. Seventy-seven predictors or moderators were generated, of which adherence, baseline symptoms, education, age, and gender were most frequently assessed. Adherence, treatment credibility, working alliance, and baseline scores emerged as conclusive predictors/moderators. Results for other variables were mainly inconsistent or inconclusive. Conclusion: Our review highlights that it is currently difficult to predict, across diagnoses, who will benefit from guided IBIs. Further rigorous research is needed to identify predictors and moderators based on a sufficient number of studies. PROSPERO registration: CRD42021242305.

scholarly journals Robotic versus open urological oncological surgery: study protocol of a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e036609
Author(s):  
Giovanni E Cacciamani ◽  
Karanvir Gill ◽  
Inderbir S Gill
Keyword(s):  
Systematic Review ◽  
Open Surgery ◽  
Meta Analysis ◽  
Case Series ◽  
Risk Of Bias ◽  
Sensitivity Analyses ◽  
National Database ◽  
Oncological Surgery ◽  
Control Series ◽  
Open Versus

IntroductionMinimally invasive surgery in urology has grown considerably in application since its initial description in the early 1990s. Herein, we present the protocol for a systematic review and meta-analysis comparing open versus robotic urological oncological surgery for various clinically relevant outcomes, as well as to assess their comparative penetrance over the past 20 years (2000–2020).Methods and analysisWe will document the penetrance of robotic versus open surgery in the urological oncological field using a national database.Second, we will perform a systematic review and meta-analysis of all published full-text English and non-English language articles from Pubmed, Scopus and Web of Science search engines on surgical treatment of localised prostate, bladder, kidney and testis cancer published between 1st January 2000 to 10th January 2020. We will focus on the highest-volume urological oncological surgeries, namely, radical prostatectomy, radical cystectomy, partial nephrectomy, radical nephrectomy and retroperitoneal lymph node dissection. Study inclusion criteria will comprise clinical trials and prospective and retrospective studies (cohort or case–control series) comparing robotic versus open surgery. Exclusion criteria will comprise meta-analyses, multiple papers with overalapping study-periods, studies analysing national databases and case series describing only one approach (robotic or open). Risk of bias for included studies will be assessed by the appropriate Cochrane risk of bias tool. Principal outcomes assessed will include perioperative, functional, oncological survival and financial outcomes of open versus robotic uro-oncological surgery. Sensitivity analyses will be performed to correlate outcomes of interest with key baseline characteristics and surrogates of surgical expertise.Ethics and disseminationThis comprehensive systematic review and meta-analysis will provide rigorous, consolidated information on contemporary outcomes and trends of open versus robotic urological oncological surgery based on all the available literature. These aggregate data will help physicians better advise patients seeking surgical care for urological cancers.PROSPERO registration numberCRD42017064958.

scholarly journals Quality of life in cancer patients treated with mistletoe: a systematic review and meta-analysis

2019 ◽  
Author(s):  
Martin Loef ◽  
Harald Walach
Keyword(s):  
Quality Of Life ◽  
Systematic Review ◽  
Cancer Patients ◽  
Positive Impact ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Sensitivity Analyses ◽  
Data Sets ◽  
Mistletoe Extracts

AbstractBackgroundMistletoe extracts are used as an adjunct therapy for cancer patients, but there is dissent as to whether this therapy has a positive impact on quality of life (QoL).MethodsWe conducted a systematic review searching in several databases (Medline, Embase, CENTRAL, CINAHL, PsycInfo, Science Citation Index, clinicaltrials.gov, opengrey.org) by combining terms that cover the fields of “neoplasm”, “quality of life” and “mistletoe”. We included prospective controlled trials that compared mistletoe extracts with a control in cancer patients and reported QoL or related dimensions. The quality of the studies was assessed with the Cochrane Risk of Bias tool version 2.We conducted a quantitative meta-analysis.ResultsWe included 26 publications with 30 data sets. The studies were heterogeneous. The pooled standardized mean difference (random effects model) for global QoL after treatment with mistletoe extracts vs. control was d = 0.61 (95% CI 0.41-0.81; p<0,00001). The effect was stronger for younger patients, with longer treatment, in studies with lower risk of bias, in randomized and blinded studies. Sensitivity analyses support the validity of the finding. 50% of the QoL subdomains (e.g. pain, nausea) show a significant improvement after mistletoe treatment. Most studies have a high risk of bias or at least raise some concern.ConclusionMistletoe extracts produce a significant, medium-sized effect on QoL in cancer. Risk of bias in the analyzed studies is likely due to the specific type of treatment, which is difficult to blind; yet this risk is unlikely to affect the outcome.PROSPERO registration numberCRD42019137704

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