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Rheumatology International Sep 2015To evaluate the efficacy of current treatments for the Raynaud phenomenon (RP) in patients with systemic sclerosis (SSc), a systematic literature search was performed... (Review)
Review
To evaluate the efficacy of current treatments for the Raynaud phenomenon (RP) in patients with systemic sclerosis (SSc), a systematic literature search was performed using Medline, EMBASE, and Cochrane Central Register of Controlled Trials (from 1961 to October 2011). We included meta-analyses, systematic reviews, clinical trials, and high-quality cohort studies published in English or Spanish. Patient populations had to include adults diagnosed with limited cutaneous or diffuse SSc who had associated RP and/or digital ulcers under pharmacological treatment. Efficacy of treatments was evaluated based on: number of RP episodes, RP severity, episode-free time, ulcer improvement/healing, and appearance of new ulcers. We used the Jadad scale of methodological quality to evaluate the quality of randomized clinical trials, and the 2009 Oxford Centre for Evidence-Based Medicine classification for other studies. Of a total of 1617 studies identified, only 27 fulfilled inclusion criteria. Drugs received the following grade recommendations: Grade A for nifedipine, nicardipine, quinapril, IV iloprost, bosentan, tadalafil, and MQx-503; Grade B for beraprost, cicaprost, DMSO, cyclofenil, and atorvastatin; and Grade C for misoprostol, prazosin, OPC-2826, enalapril, sildenafil, antioxidant, and stanazolol. Calcium channel blockers, prostanoids, tadalafil, and bosentan received the highest recommendation level for their effectiveness. However, most systematic reviews reviewed just a handful of studies with small sample sizes and short follow-ups. Our review shows that the existing evidence on the efficacy of RP treatment in SSc patients is inconclusive which calls for further research, especially in the form of prospective studies of high quality with long-term follow-ups.
Topics: Humans; Raynaud Disease; Scleroderma, Systemic; Skin Ulcer; Treatment Outcome; Vasodilator Agents
PubMed: 25824427
DOI: 10.1007/s00296-015-3241-1 -
Brain Injury 2017Sleep disturbance is commonly reported following traumatic brain injury (TBI) and can adversely impact health and wellbeing and interfere with the rehabilitation... (Review)
Review
BACKGROUND
Sleep disturbance is commonly reported following traumatic brain injury (TBI) and can adversely impact health and wellbeing and interfere with the rehabilitation process. As such, effective treatment of sleep disturbance is critical for overall recovery. Sleep hygiene, which is non-invasive, low cost, and low risk, could serve as a suitable first line of treatment for individuals experiencing sleep disturbance post-TBI.
OBJECTIVE
To assess the efficacy of sleep hygiene on sleep outcomes post-TBI.
DESIGN
PsycINFO, Medline and EMBASE databases were systematically searched using mesh terms and keywords related to 'traumatic brain injury', 'sleep' and 'treatment'. Studies that met inclusion criteria were assessed on their methodological quality using validated assessment tools.
RESULTS
Ten studies met inclusion criteria, none of which contained a child or adolescent population. Their methodological quality varied. The following interventions were shown to improve sleep outcomes amongst adults with TBI: Cognitive Behaviour Therapy for Insomnia, blue light therapy, Problem Solving Treatment and combined sleep hygiene and Prazosin. There was mixed evidence for the efficacy of exercise on sleep outcomes.
CONCLUSION
Preliminary findings suggest that some sleep-hygiene-related interventions, either in isolation or in combination with other treatments, may reduce sleep difficulties post-TBI.
Topics: Brain Injuries, Traumatic; Cognitive Behavioral Therapy; Humans; Sleep; Sleep Hygiene; Sleep Wake Disorders
PubMed: 28326852
DOI: 10.1080/02699052.2017.1282042 -
Addiction (Abingdon, England) May 2021To assess the efficacy of drugs directly acting on alpha- and beta-adrenergic receptors in the treatment of patients suffering from tobacco or alcohol use disorder. (Meta-Analysis)
Meta-Analysis Review
AIM
To assess the efficacy of drugs directly acting on alpha- and beta-adrenergic receptors in the treatment of patients suffering from tobacco or alcohol use disorder.
METHODS
Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, studies were identified through PUBMED, EMBASE, the Cochrane Central Register of Controlled Trials and clinicaltrial.gov. We selected only randomized controlled trials with adult patients with tobacco or alcohol use disorders according to DSM-5 criteria. Interventions included any molecule having a direct pharmacological action on alpha- or beta-adrenergic receptors (agonist or antagonist). Comparators were placebo or other validated pharmacotherapies. The duration of the intervention was a minimum of 1 month, with 3 months of follow-up. Measurements included smoking cessation for tobacco; for alcohol, we selected abstinence, alcohol consumption (drinks per day or week) and heavy drinking days (HDD). Ten studies with tobacco and six with alcohol use disorder were included in the qualitative synthesis and fifteen studies in the quantitative analysis.
RESULTS
We found that clonidine, an alpha-2 agonist, significantly increased smoking abstinence [relative risk = 1.39 with a 95% confidence interval (CI) = 1.04, 1.84]. Beta-blockers had no significant effect on smoking abstinence. The alpha-1 antagonists prazosin and doxazosin decreased alcohol consumption [SMD = -0.32 (-0.56, -0.07)] but had no effect on abstinence or HDD.
CONCLUSIONS
The noradrenaline system may represent a promising mechanism to target in tobacco and alcohol use disorders.
Topics: Adult; Alcoholism; Humans; Pharmaceutical Preparations; Receptors, Adrenergic; Smoking Cessation; Nicotiana
PubMed: 32959918
DOI: 10.1111/add.15265 -
BMC Geriatrics Sep 2022Adrenergic alpha-1 receptor antagonists (alpha-1 antagonists) are frequently used medications in the management of lower urinary tract symptoms (LUTS) suggestive of... (Meta-Analysis)
Meta-Analysis
Efficacy and safety of adrenergic alpha-1 receptor antagonists in older adults: a systematic review and meta-analysis supporting the development of recommendations to reduce potentially inappropriate prescribing.
BACKGROUND
Adrenergic alpha-1 receptor antagonists (alpha-1 antagonists) are frequently used medications in the management of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) and in the management of therapy-resistant arterial hypertension, two conditions frequently found in older adults. This systematic review aims at presenting a complete overview of evidence over the benefits and risks of alpha-1 antagonist treatment in people ≥ 65 years, and at deriving recommendations for a safe application of alpha-1 antagonists in older adults from the evidence found.
METHODS
A comprehensive literature search was performed (last update March 25 2022) including multiple databases (Medline/Pubmed, Embase, the Cochrane Library) and using the PICOS framework to define search terms. The selection of the studies was done by two independent reviewers in a two-step approach, followed by a systematic data extraction. Quality appraisal was performed for each study included using standardised appraisal tools. The studies retrieved and additional literature were used for the development of recommendations, which were rated for strength and quality according to the GRADE methodology.
RESULTS
Eighteen studies were included: 3 meta-analyses, 6 randomised controlled trials and 9 observational trials. Doxazosin in the management of arterial hypertension was associated with a higher risk of cardiovascular disease, particularly heart failure, than chlorthalidone. Regarding treatment of LUTS suggestive of BPH, alpha-1 antagonists appeared to be effective in the relief of urinary symptoms and improvement of quality of life. They seemed to be less effective in preventing disease progression. Analyses of the risk profile indicated an increase in vasodilation related adverse events and sexual adverse events for some agents. The risk of falls and fractures as well as the effects of long-term treatment remained unclear. All meta-analyses and 5 out of 6 interventional studies were downgraded in the quality appraisal. 7 out of 9 observational studies were of good quality.
CONCLUSIONS
It cannot be recommended to use doxazosin as first-line antihypertensive agent neither in older adults nor in younger patients. In the management of BPH alpha-1 antagonists promise to effectively relieve urinary symptoms with uncertainty regarding their efficacy in preventing long-term progression events.
Topics: Adrenergic alpha-1 Receptor Antagonists; Adrenergic alpha-Antagonists; Aged; Antihypertensive Agents; Chlorthalidone; Doxazosin; Humans; Hypertension; Inappropriate Prescribing; Lower Urinary Tract Symptoms; Male; Prostatic Hyperplasia; Quality of Life
PubMed: 36171560
DOI: 10.1186/s12877-022-03415-7 -
European Urology Jun 2016The urodynamic outcomes for α1-blockers (ABs) treatment in patients with lower urinary tract symptoms related to benign prostatic enlargement (LUTS/BPE) is a matter of... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The urodynamic outcomes for α1-blockers (ABs) treatment in patients with lower urinary tract symptoms related to benign prostatic enlargement (LUTS/BPE) is a matter of debate.
OBJECTIVE
To perform a systematic review and meta-analysis of studies evaluating the ABs urodynamic outcomes in patients with LUTS/BPE. The primary endpoint was variation in bladder outlet obstruction index (BOOI). Secondary endpoints were the maximum urinary flow rate (Qmax) and detrusor pressure at Qmax (PdetQmax). A meta-analysis of placebo-controlled randomized clinical trials (RCTs) was performed to compare ABs with placebo.
EVIDENCE ACQUISITION
A systematic review of PubMed/Medline, ISI Web of Knowledge, and Scopus databases was performed in May 2015. Seventeen studies were selected for inclusion.
EVIDENCE SYNTHESIS
The overall pooled data showed a mean BOOI change of -14.19 (p<0.0001), a mean PdetQmax change of -11. 39cm H2O (p<0.0001), and a mean Qmax improvement of 2.27ml/s (p<0.0001). Subgroup analysis showed a mean BOOI change of -14.88 (p=0.01) for alfuzosin, -19.41 (p=0.01) for doxazosin, -16.47 (p<0.0001) for naftopidil, -30.45 (p<0.0001) for silodosin, -14.27 (p=0.002) for tamsulosin, and -6.69 (p=0.005) for terazosin. Subanalysis of RCTs containing a placebo arm showed a significant improvement in BOOI in patients undergoing ABs treatment. Meta-regression revealed a significant positive association between the percentage of patients with obstruction at baseline and the improvement in BOOI after treatment with ABs.
CONCLUSION
ABs improve BOOI in patients with LUTS/BPE mainly by reducing PdetQmax, and this effect is higher in patients presenting with urodynamic obstruction at baseline. The free Qmax variation underestimates the real effect of ABs on benign prostatic obstruction.
PATIENT SUMMARY
Results of this meta-analysis suggest that α1-blockers objectively improve urinary voiding function in patients with benign prostatic obstruction.
Topics: Adrenergic alpha-1 Receptor Antagonists; Clinical Trials as Topic; Doxazosin; Humans; Indoles; Male; Naphthalenes; Piperazines; Prazosin; Prostatism; Quinazolines; Severity of Illness Index; Sulfonamides; Tamsulosin; Urodynamics
PubMed: 26831507
DOI: 10.1016/j.eururo.2015.12.034 -
Hernia : the Journal of Hernias and... Dec 2023The rate of post-operative urinary retention (POUR) in inguinal hernia repairs (IHR) is estimated to be approximately 5.9% to 38% worldwide. Currently, there are minimal... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The rate of post-operative urinary retention (POUR) in inguinal hernia repairs (IHR) is estimated to be approximately 5.9% to 38% worldwide. Currently, there are minimal studies on the prophylaxis of POUR after IHR. Pre-operative administration of alpha-blockers such as (but not limited to) Tamsulosin, Prazosin and Alfuzosin has shown promising results in the prevention of POUR in patients undergoing IHR. This study aims to determine the effectiveness of prophylactic alpha-blockade in the prevention of POUR after IHR.
METHODS
This study reports the findings of a systematic review and meta-analysis. Randomised controlled trials (RCTs) using prophylactic alpha-blockade for the prevention of POUR after open and/or laparoscopic IHR in patients aged more than 18 years in all sex groups were included. Multiple databases were searched from inception to October 2021 using the PRISMA flow diagram. Data were extracted and analysed to include eligibility criteria, comparator, intervention, study and participant characteristics. Studies excluded were non-RCT studies and patients with known urinary tract disorders such as benign prostate hypertrophy, urinary incontinence and cancer of the bladder or prostate. Subgroup analyses were also conducted. All effect measures of each data were odds ratio with 95% confidence interval. All studies were pooled using the dichotomous random effects Mantel-Haenszel statistical mode and I was used to assess heterogeneity. Publication bias was detected using the Cochrane risk-of-bias tool for randomised trials (RoB-2) involving two independent reviewers.
RESULTS
A total of eight RCTs were identified which provided adequate numeric data for incorporation into the meta-analysis. Overall, administration of pre-operative alpha-blocker prior to IHR did not prevent POUR (95% CI 1.20 (0.96-1.49), I: 34%). Subgroup analysis comparing pre-operative use of prophylactic alpha-blocker in open versus laparoscopic IHR has shown statistically significant reduction of POUR prevention in the laparoscopic group (95% CI 0.66 (0.47-0.92)), I: 43%). The older age group benefited from pre-operative alpha-blocker use with reduced incidence of POUR post-IHR (95% CI 0.14 (0.08, 0.23), I: 0%)). Gender did not affect the difference of incidence of POUR post-IHR despite pre-operative alpha-blockers (95% CI 0.62 (0.27, 1.44)), I: 53%)).
CONCLUSION
Overall, this meta-analysis has shown that administration of prophylactic alpha-blockers did not prevent POUR. However, there was statistically significant reduction of POUR in patients undergoing laparoscopic IHR as compared to open, as well as in older patients (age more than 60 years) after administration of pre-operative alpha-blocker. Hence, the use of pre-operative alpha-blocker especially in older patients should be considered and more RCTs should be undertaken.
Topics: Male; Humans; Aged; Urinary Retention; Hernia, Inguinal; Herniorrhaphy; Postoperative Complications; Tamsulosin
PubMed: 36952050
DOI: 10.1007/s10029-023-02764-5 -
Medicine Aug 2021Alpha1-adrenoceptor antagonists (α1-blockers) are first-line drugs for the treatment of lower urinary tract symptoms associated with benign prostate hyperplasia (BPH).... (Comparative Study)
Comparative Study Meta-Analysis
Efficacy and tolerability of doxazosin gastro-intestinal therapeutic system versus tamsulosin in patients with lower urinary tract symptoms associated with benign prostatic hyperplasia: A systematic review and meta-analysis.
BACKGROUND
Alpha1-adrenoceptor antagonists (α1-blockers) are first-line drugs for the treatment of lower urinary tract symptoms associated with benign prostate hyperplasia (BPH). Doxazosin gastrointestinal therapeutic system (GITS) and tamsulosin belong to the 2 most frequently prescribed α1-blockers. This systematic review and meta-analysis was performed to compare the efficacy and tolerability of these 2 α1-blockers.
METHODS
A systematic review of published randomized controlled trials in English or Chinese language was performed using the PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and Vip databases. After data extraction and quality assessment, the meta-analysis was performed to compare clinical parameters (International Prostate Symptom Score [IPSS] total [IPSS-T], storage [IPSS-S], voiding [IPSS-V], maximum urine flow [Qmax], and postvoid residual) and adverse events (AEs) that changed after first drug intake.
RESULTS
After the screening, 8 eligible randomized controlled trials with 1316 patients were identified. Doxazosin-GITS showed a significantly higher efficacy compared with tamsulosin (IPSS-T P < .001, IPSS-S P < .001, and IPSS-V P < .001). There were no significant differences between the 2 drugs for changes in Qmax (P = .477) or postvoid residual (P = .739). The overall AEs were significantly lower in the doxazosin-GITS group (risk ratio: 0.77; 95% CI: 0.54-1.08; P = .036). However, dizziness (P = .387), headache (P = .745), asthenia (P = .693), postural hypotension (P = .114), and retrograde ejaculation (P = .187) were similar between the 2 groups.
CONCLUSIONS
This meta-analysis indicates that doxazosin-GITS has significantly higher efficacy and lower AEs than tamsulosin in patients with lower urinary tract symptoms/benign prostate hyperplasia.
Topics: Doxazosin; Humans; Lower Urinary Tract Symptoms; Male; Prostatic Hyperplasia; Tamsulosin; Treatment Outcome; Urological Agents
PubMed: 34414962
DOI: 10.1097/MD.0000000000026955 -
Transcultural Psychiatry Apr 2017There is a dearth of evidence on the effectiveness of pharmacological treatment for refugees with trauma-related disorders. The present paper provides an overview of... (Review)
Review
There is a dearth of evidence on the effectiveness of pharmacological treatment for refugees with trauma-related disorders. The present paper provides an overview of available literature on the subject and discusses the transferability of results from studies on other groups of patients with post traumatic stress disorder (PTSD). We conducted a systematic review of published treatment outcome studies on PTSD and depression among refugees. Fifteen studies were identified and reviewed. Most studies focused on the use of antidepressants. Included studies differed widely in method and quality. The majority were observational studies and case studies. Small sample sizes limited the statistical power. Few studies reported effect sizes, confidence intervals, and statistical significance of findings. No specific pharmacological treatment for PTSD among refugees can be recommended on the basis of the available literature. There is a need for well-designed clinical trials, especially with newer antidepressants and antipsychotics. Until such studies are available, clinical practice and design of trials can be guided by results from studies of other groups of PTSD patients, although differences in pharmacogenetics, compliance, and trauma reactions may affect the direct transferability of results from studies on nonrefugee populations.
Topics: Adrenergic alpha-1 Receptor Antagonists; Adrenergic alpha-2 Receptor Agonists; Antidepressive Agents; Antipsychotic Agents; Clonidine; Humans; Practice Guidelines as Topic; Prazosin; Refugees; Stress Disorders, Post-Traumatic
PubMed: 27956478
DOI: 10.1177/1363461516682180 -
European Journal of Psychotraumatology 2024Clonidine is a centrally acting anti-adrenergic agent that may have applications in post-traumatic stress disorder (PTSD), particularly for sleep. In this systematic... (Review)
Review
Clonidine is a centrally acting anti-adrenergic agent that may have applications in post-traumatic stress disorder (PTSD), particularly for sleep. In this systematic review, we aimed to summarize the effect of clonidine on sleep quality and duration, nightmares, and PTSD symptom severity in adults with PTSD. PubMed (Medline), Embase, PsycINFO, CINAHL, and clinicaltrials.gov were searched up to April 2023. Studies on clonidine use in adult PTSD patients reporting data on the effect on sleep, nightmares, and PTSD symptoms were included. A narrative summary and a meta-analysis of the study findings are presented. Ten reports, accounting for = 569 patients with PTSD (145 on clonidine and 436 controls), were included in the final selection. There were four case reports, four observational studies, one non-blind clinical trial, and one crossover randomized controlled trial (RCT). Median clonidine dose was 0.15 mg/day (range: 0.1-0.5 mg/day). Median follow-up time was 31 days (range: 3 days to 19 months). The quality of the evidence was rated from very low to low. There was marked between-study heterogeneity and low power in the individual studies, but many reported improved sleep quality, nightmare reduction, and improvement of PTSD symptoms for patients treated with clonidine. Meta-analysis was only possible for two studies reporting the effect of clonidine on nightmares, and showed no difference from the comparator (i.e. prazosin or terazosin) (odds ratio: 1.16; 95% confidence interval: 0.66 to 2.05), potentially pointing towards non-inferiority between these medications. Future research, such as well-powered RCTs, is needed to identify the efficacy in the lower dose range and the most suitable treatment group, and to obtain good evidence on the effects of clonidine in the treatment of sleep disorders related to PTSD.
Topics: Clonidine; Humans; Stress Disorders, Post-Traumatic; Dreams; Sleep Quality; Adrenergic alpha-2 Receptor Agonists
PubMed: 38941125
DOI: 10.1080/20008066.2024.2366049 -
Urology Journal Aug 2020Alpha-blockers have been proven as an effective method for increasing the stone expulsion rate of distal ureteral stones. Limited studies have focused on doxazosin; its... (Meta-Analysis)
Meta-Analysis
PURPOSE
Alpha-blockers have been proven as an effective method for increasing the stone expulsion rate of distal ureteral stones. Limited studies have focused on doxazosin; its efficacy remained unclear. We performed this meta-analysis to investigate the efficacy and safety of doxazosin for patients diagnosed with distal ureteral stones less than 10mm.
MATERIALS AND METHODS
We systematically searched Ovid MEDLINE®, Cochrane Library, EMBASE, and PubMed for articles comparing doxazosin and conventional care or tamsulosin for distal ureteral stones through October 2019. The outcome measures were stone expulsive rate (SER), stone expulsive time (SET), pain episodes, analgesics consumption, and adverse events.
RESULTS
We included 12 studies involving 836 participants with distal ureteral stones less than 10mm in our review. The present meta-analysis showed doxazosin could significantly increase SER [RR=1.64,95%CI (1.32, 2.04), P < 0.00001], shorten SET [WMD=-3.97,95% CI (-5.68, -2.27), P < 0.00001] compared with conventional care. In the subgroup analyses, doxazosin showed no benefit in the children subgroup (<16 years old) [RR=1.63,95% CI (0.73,3.64), P =0.23]. No statistically significant difference was observed regarding the effectiveness of doxazosin and tamsulosin in SER, SET, and safety. 9 in 286 participants reported doxazosin-related adverse events; most were mild to moderate.
CONCLUSION
This meta-analysis may suggest that doxazosin is a safe and effective MET for distal ureteral stones less than 10mm. It is not demonstrated to have any significant difference with tamsulosin in SER, SET, and safety. However, it showed no benefits for patients<16 years old.
Topics: Adrenergic alpha-1 Receptor Antagonists; Doxazosin; Humans; Treatment Outcome; Ureteral Calculi
PubMed: 32869260
DOI: 10.22037/uj.v16i7.5958