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Preventive Medicine Jun 2017Excellent medication adherence contributes to decreases in morbidity, mortality, and health care costs. Although researchers have tested many interventions to increase... (Meta-Analysis)
Meta-Analysis Review
Excellent medication adherence contributes to decreases in morbidity, mortality, and health care costs. Although researchers have tested many interventions to increase adherence, results are sometimes conflicting and often unclear. This systematic review applied meta-analytic procedures to integrate primary research that tested medication adherence interventions. Comprehensive searching completed in 2015 located 771 published and unpublished intervention studies with adherence behavior outcomes. Random-effects model analysis calculated standardized mean difference effect sizes. Meta-analytic moderator analyses examined the association between adherence effect sizes and sample, design, and intervention characteristics. Analyses were conducted in 2016. A standardized mean difference effect size of 0.290 comparing treatment and control groups was calculated. Moderator analyses revealed larger effect sizes for habit-based and behavioral-targeted (vs. cognitive-focused) interventions. The most effective interventions were delivered face-to-face, by pharmacists, and administered directly to patients. Effect sizes were smaller in studies with older and homeless participants. Risks of bias were common; effect sizes were significantly lower among studies with masked data collectors and intention-to-treat analyses. The largest effect sizes were reported by studies using medication electronic event monitoring and pill count medication adherence measures. Publication bias was present. This most comprehensive review to date documented that, although interventions can increase adherence, much room remains for improvement. Findings suggest health care providers should focus intervention content on behavioral strategies, especially habit-based interventions, more so than cognitive strategies designed to change knowledge and beliefs.
Topics: Bias; Humans; Medication Adherence; Research Design
PubMed: 28315760
DOI: 10.1016/j.ypmed.2017.03.008 -
Hypertension (Dallas, Tex. : 1979) Feb 2021Poor adherence to antihypertensive therapy is a major cause of poor blood pressure (BP) control in patients with hypertension. Regimen simplification may improve... (Meta-Analysis)
Meta-Analysis
Poor adherence to antihypertensive therapy is a major cause of poor blood pressure (BP) control in patients with hypertension. Regimen simplification may improve adherence and BP control. This systematic review assessed whether single-pill combination (SPC) therapy led to improved adherence, persistence, and better BP control compared with free-equivalent combination (FEC) therapy in patients with hypertension. PubMed, Medline, Embase, and the Cochrane Library were searched until July 2020, in addition to manual searching of relevant congress abstracts from 2014 to 2020 for studies including adults with hypertension aged ≥18 years receiving SPC or FEC antihypertensive therapy measuring any of the following: adherence, persistence, and reductions in systolic BP and/or diastolic BP. Adherence and persistence were summarized in a narrative analysis; direct pair-wise meta-analysis was conducted to compare BP reductions with SPC therapy versus FEC therapy using fixed-effect and random-effects models. Following screening, 44 studies were included. The majority (18 of 23) of studies measuring adherence showed adherence was significantly improved in patients receiving SPCs versus FECs. Overall, 16 studies measured persistence, of which 14 showed that patients receiving SPCs had significantly improved persistence or were significantly less likely to discontinue therapy than patients receiving FECs. Systolic BP (mean difference, -3.99 [95% CI, -7.92 to -0.07]; =0.05) and diastolic BP (-1.54 [95% CI, -2.67 to -0.41]; =0.0076) were both significantly reduced with SPC therapy compared with FEC therapy at week 12. SPC therapy leads to improved adherence and persistence compared with FEC therapy and may lead to better BP control in patients with hypertension.
Topics: Antihypertensive Agents; Drug Therapy, Combination; Humans; Hypertension; Medication Adherence; Treatment Outcome
PubMed: 33390044
DOI: 10.1161/HYPERTENSIONAHA.120.15781 -
Journal of Psychopharmacology (Oxford,... Mar 2023Major depressive disorder (MDD) is a highly burdensome health condition, for which there are numerous accepted pharmacological and psychological interventions.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Major depressive disorder (MDD) is a highly burdensome health condition, for which there are numerous accepted pharmacological and psychological interventions. Adjunctive treatment (augmentation/combination) is recommended for the ~50% of MDD patients who do not adequately respond to first-line treatment. We aimed to evaluate the current evidence for concomitant approaches for people with early-stage treatment-resistant depression (TRD; defined below).
METHODS
We systematically searched Medline and Institute for Scientific Information Web of Science to identify randomised controlled trials of adjunctive treatment of ⩾10 adults with MDD who had not responded to ⩾1 adequate antidepressant. The cochrane risk of bias (RoB) tool was used to assess study quality. Pre-post treatment meta-analyses were performed, allowing for comparison across heterogeneous study designs independent of comparator interventions.
RESULTS
In total, 115 trials investigating 48 treatments were synthesised. The mean intervention duration was 9 weeks (range 5 days to 18 months) with most studies assessed to have low ( = 57) or moderate ( = 51) RoB. The highest effect sizes (ESs) were from cognitive behavioural therapy (ES = 1.58, 95% confidence interval (CI): 1.09-2.07), (es)ketamine (ES = 1.48, 95% CI: 1.23-1.73) and risperidone (ES = 1.42, 95% CI: 1.29-1.61). Only aripiprazole and lithium were examined in ⩾10 studies. Pill placebo (ES = 0.89, 95% CI: 0.81-0.98) had a not inconsiderable ES, and only six treatments' 95% CIs did not overlap with pill placebo's (aripiprazole, (es)ketamine, mirtazapine, olanzapine, quetiapine and risperidone). We report marked heterogeneity between studies for almost all analyses.
CONCLUSIONS
Our findings support cautious optimism for several augmentation strategies; although considering the high prevalence of TRD, evidence remains inadequate for each treatment option.
Topics: Adult; Humans; Aripiprazole; Risperidone; Depression; Depressive Disorder, Major; Ketamine
PubMed: 35861202
DOI: 10.1177/02698811221104058 -
International Journal of Environmental... Apr 2021Despite numerous studies evaluating the risk of breast cancer among oral contraception users, the effect of oral contraceptive on developing breast cancer remains... (Meta-Analysis)
Meta-Analysis Review
Despite numerous studies evaluating the risk of breast cancer among oral contraception users, the effect of oral contraceptive on developing breast cancer remains inconclusive. Therefore, we conducted a systematic review of literature with meta-analysis in order to quantitative estimate this association. The bibliographic database MEDLINE and EMBASE, and reference lists of identified articles were searched, with no language restrictions, from the start of publication to August 2010. We performed a reanalysis and overall estimate of 79 case-control studies conducted between 1960-2010, including a total of 72,030 incidents, histologically confirmed cases of breast cancer and 123,650 population/hospital controls. A decrease was observed in cancer risk in OC users before age 25 years (0.91, 0.83-1.00). However, the use of OCs before the first full-term pregnancy had a significant increased risk of breast cancer (OR, 1.14, 1.01-1.28, = 0.04), as did OC use longer than 5 years (1.09, 1.01-1.18, = 0.02). Pooled crude odds ratios of breast cancer in ever-users of oral contraceptives was 1.01 [95% confidence interval (CI), 0.95-1.07], compared with never-users. There was no significant increase in risk among premenopausal women (1.06, 0.92-1.22), postmenopausal women (0.99, 0.89-1.10), or nulliparous women (1.02, 0.82-1.26). Oral contraceptives do not appear to increase the risk of breast cancer among users. However, OC use before a first full-term pregnancy or using them longer than 5 years can modify the development of the breast cancer.
Topics: Adult; Breast Neoplasms; Case-Control Studies; Contraceptives, Oral; Female; Humans; Odds Ratio; Pregnancy; Risk Factors
PubMed: 33925599
DOI: 10.3390/ijerph18094638 -
Sports Medicine (Auckland, N.Z.) Oct 2020Oral contraceptive pills (OCPs) are double agents, which downregulate endogenous concentrations of oestradiol and progesterone whilst simultaneously providing daily... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Oral contraceptive pills (OCPs) are double agents, which downregulate endogenous concentrations of oestradiol and progesterone whilst simultaneously providing daily supplementation of exogenous oestrogen and progestin during the OCP-taking days. This altered hormonal milieu differs significantly from that of eumenorrheic women and might impact exercise performance, due to changes in ovarian hormone-mediated physiological processes.
OBJECTIVE
To explore the effects of OCPs on exercise performance in women and to provide evidence-based performance recommendations to users.
METHODS
This review complied with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A between-group analysis was performed, wherein performance of OCP users was compared with naturally menstruating women, and a within-group analysis was conducted, wherein performance during OCP consumption was compared with OCP withdrawal. For the between-group analysis, women were phase matched in two ways: (1) OCP withdrawal versus the early follicular phase of the menstrual cycle and (2) OCP consumption versus all phases of the menstrual cycle except for the early follicular phase. Study quality was assessed using a modified Downs and Black Checklist and a strategy based on the recommendations of the Grading of Recommendations Assessment Development and Evaluation working group. All meta-analyses were conducted within a Bayesian framework to facilitate probabilistic interpretations.
RESULTS
42 studies and 590 participants were included. Most studies (83%) were graded as moderate, low or very low quality, with 17% achieving high quality. For the between-group meta-analysis comparing OCP users with naturally menstruating women, posterior estimates of the pooled effect were used to calculate the probability of at least a small effect (d ≥ 0.2). Across the two between-group comparison methods, the probability of a small effect on performance favouring habitual OCP users was effectually zero (p < 0.001). In contrast, the probability of a small effect on performance favouring naturally menstruating women was moderate under comparison method (1) (d ≥ 0.2; p = 0.40) and small under comparison method (2) (d ≥ 0.2; p = 0.19). Relatively large between-study variance was identified for both between-group comparisons ([Formula: see text] = 0.16 [95% credible interval (CrI) 0.01-0.44] and [Formula: see text] = 0.22 [95% CrI 0.06-0.45]). For the within-group analysis comparing OCP consumption with withdrawal, posterior estimates of the pooled effect size identified almost zero probability of a small effect on performance in either direction (d ≥ 0.2; p ≤ 0.001).
CONCLUSIONS
OCP use might result in slightly inferior exercise performance on average when compared to naturally menstruating women, although any group-level effect is most likely to be trivial. Practically, as effects tended to be trivial and variable across studies, the current evidence does not warrant general guidance on OCP use compared with non-use. Therefore, when exercise performance is a priority, an individualised approach might be more appropriate. The analysis also indicated that exercise performance was consistent across the OCP cycle.
Topics: Athletic Performance; Contraceptives, Oral; Exercise; Female; Humans
PubMed: 32666247
DOI: 10.1007/s40279-020-01317-5 -
Cancers Nov 2021To perform a meta-analysis of case-control studies that addressed the association between oral contraceptive pills (OC) use and breast cancer (BrCa), PubMED (MEDLINE),... (Review)
Review
To perform a meta-analysis of case-control studies that addressed the association between oral contraceptive pills (OC) use and breast cancer (BrCa), PubMED (MEDLINE), Embase, and the Cochrane Library were searched to identify case-control studies of OC and BrCa published between 2009 and 2020. We used the DerSimonian-Laird method to compute pooled odds ratios (ORs) and confidence intervals (CIs), and the Mantel-Haenszel test to assess the association between OC use and cancer. Forty-two studies were identified that met the inclusion criteria and we included a total of 110,580 women (30,778 into the BrCa group and 79,802 into the control group, of which 15,722 and 38,334 were using OC, respectively). The conducted meta-analysis showed that the use of OC was associated with a significantly increased risk of BrCa in general, OR = 1.15, 95% CI: 1.01 to 1.31, = 0.0358. Regarding other risk factors for BrCa, we found that increased risk was associated significantly with early menarche, nulliparous, non-breastfeeding, older age at first parity, postmenopause, obesity, smoking, and family history of BrCa. Despite our conclusion that birth control pills increase the cancer risk being supported by extensive previous studies and meta-analyzes, further confirmation is required.
PubMed: 34830807
DOI: 10.3390/cancers13225654 -
JAMA Pediatrics Nov 2017Childhood anxiety is common. Multiple treatment options are available, but existing guidelines provide inconsistent advice on which treatment to use. (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Childhood anxiety is common. Multiple treatment options are available, but existing guidelines provide inconsistent advice on which treatment to use.
OBJECTIVES
To evaluate the comparative effectiveness and adverse events of cognitive behavioral therapy (CBT) and pharmacotherapy for childhood anxiety disorders.
DATA SOURCES
We searched MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and SciVerse Scopus from database inception through February 1, 2017.
STUDY SELECTION
Randomized and nonrandomized comparative studies that enrolled children and adolescents with confirmed diagnoses of panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, or separation anxiety and who received CBT, pharmacotherapy, or the combination.
DATA EXTRACTION AND SYNTHESIS
Independent reviewers selected studies and extracted data. Random-effects meta-analysis was used to pool data.
MAIN OUTCOMES AND MEASURES
Primary anxiety symptoms (measured by child, parent, or clinician), remission, response, and adverse events.
RESULTS
A total of 7719 patients were included from 115 studies. Of these, 4290 (55.6%) were female, and the mean (range) age was 9.2 (5.4-16.1) years. Compared with pill placebo, selective serotonin reuptake inhibitors (SSRIs) significantly reduced primary anxiety symptoms and increased remission (relative risk, 2.04; 95% CI, 1.37-3.04) and response (relative risk, 1.96; 95% CI, 1.60-2.40). Serotonin-norepinephrine reuptake inhibitors (SNRIs) significantly reduced clinician-reported primary anxiety symptoms. Benzodiazepines and tricyclics were not found to significantly reduce anxiety symptoms. When CBT was compared with wait-listing/no treatment, CBT significantly improved primary anxiety symptoms, remission, and response. Cognitive behavioral therapy reduced primary anxiety symptoms more than fluoxetine and improved remission more than sertraline. The combination of sertraline and CBT significantly reduced clinician-reported primary anxiety symptoms and response more than either treatment alone. Head-to-head comparisons were sparse, and network meta-analysis estimates were imprecise. Adverse events were common with medications but not with CBT and were not severe. Studies were too small or too short to assess suicidality with SSRIs or SNRIs. One trial showed a statistically nonsignificant increase in suicidal ideation with venlafaxine. Cognitive behavioral therapy was associated with fewer dropouts than pill placebo or medications.
CONCLUSIONS AND RELEVANCE
Evidence supports the effectiveness of CBT and SSRIs for reducing childhood anxiety symptoms. Serotonin-norepinephrine reuptake inhibitors also appear to be effective based on less consistent evidence. Head-to-head comparisons between various medications and comparisons with CBT represent a need for research in the field.
Topics: Anti-Anxiety Agents; Anxiety Disorders; Child; Cognitive Behavioral Therapy; Combined Modality Therapy; Comparative Effectiveness Research; Humans; Selective Serotonin Reuptake Inhibitors; Treatment Outcome
PubMed: 28859190
DOI: 10.1001/jamapediatrics.2017.3036 -
Contraception and Reproductive Medicine 2018Along with increasing availability and utilization of contraception, It is also important to confirm that the effects of contraception use on resumption of fertility... (Review)
Review
INTRODUCTION
Along with increasing availability and utilization of contraception, It is also important to confirm that the effects of contraception use on resumption of fertility after discontinuation However currently evidences on resumption of fertility after contraception use are inconclusive and practically fertility after termination of contraception remains a big concern for women who are using contraception. This fear poses a negative impact on utilization and continuation of contraception. Therefore, Estimating the rate of pregnancy resumption after contraceptive use from the available reports and identifying the associating factors are important for designing a strategy to overcome the problem.
METHODS
The review was conducted through a systematic literature search of articles published between 1985 and 2017. Five bibliographic databases and libraries: PubMed/Medline, Global Health Database, Embase, the Cochrane Library, and African Index Medicus were used. After cleaning and sorting, analysis was performed using STATA version 11. The pooled rate of conception was estimated with a random-effects model. Heterogeneity was assessed by the I and publication bias through funnel plot.
RESULTS
Twenty two studies that enrolled a total of 14,884 women who discontinued contraception were retained for final analysis. The pooled rate of pregnancy was 83.1% (95% CI = 78.2-88%) within the first 12 months of contraceptive discontinuation. It was not significantly different for hormonal methods and IUD users. Similarly the type of progesterone in specific contraception option and duration of oral-contraceptive use do not significantly influence the return of fertility following cessation of contraception. However the effect of parity in the resumption of pregnancy following cessation of contraception was inconclusive.
CONCLUSION AND RECOMMENDATION
Contraceptive use regardless of its duration and type does not have a negative effect on the ability of women to conceive following termination of use and it doesn't significantly delay fertility. Therefore, appropriate counseling is important to assure the women to use the methods as to their interest.
PubMed: 30062044
DOI: 10.1186/s40834-018-0064-y -
JAMA Psychiatry Mar 2020Cognitive behavioral therapy is recommended for anxiety-related disorders, but evidence for its long-term outcome is limited. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Cognitive behavioral therapy is recommended for anxiety-related disorders, but evidence for its long-term outcome is limited.
OBJECTIVE
This systematic review and meta-analysis aimed to assess the long-term outcomes after cognitive behavioral therapy (compared with care as usual, relaxation, psychoeducation, pill placebo, supportive therapy, or waiting list) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).
DATA SOURCES
English-language publications were identified from PubMed, PsycINFO, Embase, Cochrane, OpenGrey (1980 to January 2019), and recent reviews. The search strategy included a combination of terms associated with anxiety disorders (eg, panic or phobi*) and study design (eg, clinical trial or randomized controlled trial).
STUDY SELECTION
Randomized clinical trials on posttreatment and at least 1-month follow-up effects of cognitive behavioral therapy compared with control conditions among adults with generalized anxiety disorder, panic disorder with or without agoraphobia, social anxiety disorder, specific phobia, PTSD, or OCD.
DATA EXTRACTION AND SYNTHESIS
Researchers independently screened records, extracted statistics, and assessed study quality. Data were pooled using a random-effects model.
MAIN OUTCOMES AND MEASURES
Hedges g was calculated for anxiety symptoms immediately after treatment and at 1 to 6 months, 6 to 12 months, and 12 months or more after treatment completion.
RESULTS
Of 69 randomized clinical trials (4118 outpatients) that were mainly of low quality, cognitive behavioral therapy compared with control conditions was associated with improved outcomes after treatment completion and at 1 to 6 months and at 6 to 12 months of follow-up for a generalized anxiety disorder (Hedges g, 0.07-0.40), panic disorder with or without agoraphobia (Hedges g, 0.22-0.35), social anxiety disorder (Hedges g, 0.34-0.60), specific phobia (Hedges g, 0.49-0.72), PTSD (Hedges g, 0.59-0.72), and OCD (Hedges g, 0.70-0.85). At a follow-up of 12 months or more, these associations were still significant for generalized anxiety disorder (Hedges g, 0.22; number of studies [k] = 10), social anxiety disorder (Hedges g, 0.42; k = 3), and PTSD (Hedges g, 0.84; k = 5), but not for panic disorder with or without agoraphobia (k = 5) and could not be calculated for specific phobia (k = 1) and OCD (k = 0). Relapse rates after 3 to 12 months were 0% to 14% but were reported in only 6 randomized clinical trials (predominantly for panic disorder with or without agoraphobia).
CONCLUSIONS AND RELEVANCE
The findings of this meta-analysis suggest that cognitive behavioral therapy for anxiety-related disorders is associated with improved outcomes compared with control conditions until 12 months after treatment completion. At a follow-up of 12 months or more, effects were small to medium for generalized anxiety disorder and social anxiety disorder, large for PTSD, and not significant or not available for other disorders. High-quality randomized clinical trials with 12 months or more of follow-up and reported relapse rates are needed.
Topics: Anxiety Disorders; Cognitive Behavioral Therapy; Humans; Obsessive-Compulsive Disorder; Stress Disorders, Post-Traumatic; Treatment Outcome
PubMed: 31758858
DOI: 10.1001/jamapsychiatry.2019.3986 -
International Journal of Gynaecology... Jun 2018Combined oral contraceptives (COCs) containing various progestogens could be associated with differential risks for venous thromboembolism (VTE). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Combined oral contraceptives (COCs) containing various progestogens could be associated with differential risks for venous thromboembolism (VTE).
OBJECTIVE
To evaluate the comparative risks of VTE associated with the use of low-dose (less than 50 μg ethinyl estradiol) COCs containing different progestogens.
SEARCH STRATEGY
PubMed and the Cochrane Library were searched from database inception through September 15, 2016, by combining search terms for oral contraception and venous thrombosis.
SELECTION CRITERIA
Studies reporting VTE risk estimates among healthy users of progestogen-containing low-dose COCs were included.
DATA COLLECTION AND ANALYSIS
A random-effects model was used to generate pooled adjusted risk ratios and 95% confidence intervals; subgroup and sensitivity analyses assessed the impact of monophasic-COC use and study-level characteristics.
MAIN RESULTS
There were 22 articles included in the analysis. The use of COCs containing cyproterone acetate, desogestrel, drospirenone, or gestodene was associated with a significantly increased risk of VTE compared with the use of levonorgestrel-containing COCs (pooled risk ratios 1.5-2.0). The analysis restricted to monophasic COC formulations with 30 μg of ethinyl estradiol yielded similar findings. After adjustment for study characteristics, the risk estimates were slightly attenuated.
CONCLUSIONS
Compared with the use of levonorgestrel-containing COCs, the use of COCs containing other progestogens could be associated with a small increase in risk for VTE.
Topics: Contraceptives, Oral, Combined; Ethinyl Estradiol; Female; Humans; Odds Ratio; Progestins; Risk; Venous Thromboembolism; Venous Thrombosis
PubMed: 29388678
DOI: 10.1002/ijgo.12455