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PloS One 2023The function of coronary microcirculation is an important factor in predicting the prognosis of patients with acute coronary syndrome (ACS) who receive percutaneous... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The function of coronary microcirculation is an important factor in predicting the prognosis of patients with acute coronary syndrome (ACS) who receive percutaneous coronary intervention (PCI) therapy. Ticagrelor, a type of oral P2Y12 inhibitor, is widely prescribed to ACS patients and can improve prognosis compared to clopidogrel. However, the efficacy of ticagrelor on coronary microcirculation, compared to clopidogrel, remains unclear. The objective of this meta-analysis was to determine the efficacy of ticagrelor on coronary microcirculation.
METHODS
The PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases were comprehensively searched to identify studies until November 2022. Data was pooled using the fixed effects model or random effects model based on the level of heterogeneity. Sensitivity analyses were performed to measure the effects of potential confounders.
RESULTS
After screening, 16 trials with a total of 3676 participants were ultimately included in the analysis. The meta-analysis revealed that compared to clopidogrel, patients receiving ticagrelor exhibited a more significant reduction in the IMR (WMD: -6.23, 95% CI: -8.41 to -4.04), a reduction in the cTFC (WMD: -1.88; 95% CI: -3.32 to -0.45), and greater increases in CFR (WMD: 0.38; 95% CI: 0.18 to 0.57), MBG (RR 1.29, 95% CI 1.12 to 1.48), and TIMI (RR 1.03, 95% CI 1.00 to 1.06).
CONCLUSION
Our findings suggest that, compared to clopidogrel, ticagrelor has a significant effect in reducing coronary microcirculatory resistance, enhancing coronary blood flow reserve, and improving myocardial perfusion.
Topics: Humans; Acute Coronary Syndrome; Clopidogrel; Ticagrelor; Microcirculation; Percutaneous Coronary Intervention
PubMed: 37643179
DOI: 10.1371/journal.pone.0289243 -
Journal of Comparative Effectiveness... May 2018A systematic literature review and network meta-analysis were conducted to determine the relative efficacy and safety of interventions for treatment-naive chronic... (Meta-Analysis)
Meta-Analysis
AIM
A systematic literature review and network meta-analysis were conducted to determine the relative efficacy and safety of interventions for treatment-naive chronic lymphocytic leukemia patients, as comparative evidence is scarce.
MATERIALS & METHODS
Relative treatment effects of progression-free survival, overall survival and safety outcomes were estimated via network meta-analysis based on data identified via systematic literature review.
RESULTS
Ibrutinib was superior in all pairwise comparisons for progression-free survival (probability to be better [P] range: overall population: 69-100%; fludarabine-ineligible population: 69-100%) and overall survival (P range: overall: 89-100%; fludarabine-ineligible: 91-100%) and had the highest probability of being best for all outcomes.
CONCLUSION
Ibrutinib provides superior benefit in survival and safety compared with other front-line treatments of chronic lymphocytic leukemia.
Topics: Adenine; Antineoplastic Combined Chemotherapy Protocols; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Network Meta-Analysis; Piperidines; Progression-Free Survival; Pyrazoles; Pyrimidines; Vidarabine
PubMed: 29210593
DOI: 10.2217/cer-2017-0086 -
Biology of Blood and Marrow... Apr 2016Oral mucositis (OM) is a debilitating early adverse effect of allogeneic hematopoietic stem cell transplantation (HSCT). The intensity of the conditioning regimen... (Review)
Review
Oral mucositis (OM) is a debilitating early adverse effect of allogeneic hematopoietic stem cell transplantation (HSCT). The intensity of the conditioning regimen correlates with the incidence and severity of OM, but no studies have analyzed this relationship among various conditioning regimens. We performed a systematic review on the incidence and outcomes of OM in allogeneic HSCT patients and analyzed this association. A comprehensive search of several databases (Ovid Medline In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Cochrane CRCT, Cochrane DSR, Scopus) from 1990 to 2014 for studies of OM in allogeneic HSCT patients was conducted. Professional societies' meeting abstracts were also searched. Grade of OM was analyzed based on the World Health Organization (WHO) or National Cancer Institutes (NCI) Common Terminology Criteria for Adverse Events scales. Severe mucositis was defined as either grades 2 to 4 or grades 3 and 4, depending on the studies' definition of severity. Cohorts were analyzed based on regimen intensity; ie, reduced-intensity conditioning (RIC) (including nonmyeloablative) and myeloablative (MA). Random effect (RE) and standard logistic models weighted by the number of patients in each cohort were used for comparisons. A total of 624 studies were generated from the search. Of the 395 patients in 8 eligible MA regimen studies, 73.2% experienced any OM, whereas in 245 patients in the 6 eligible RIC regimen studies, 86.5% experienced any OM (chi-square P < .0001; RE, P = .05). Severe (grades 2 to 4) OM occurred among 79.7% of the WHO/NCI-graded MA patients and 71.5% of RIC patients (chi-square, P = .0421; RE, P < .01). In comparing graft-versus-host disease (GVHD) prophylaxis, only 55.4% of patients receiving nonmethotrexate regimens experienced OM; this was lower (chi-square, P < .0001; RE, P = .06) than that found among patients who received methotrexate (83.4%), either standard or reduced dose. Besides NCI and WHO grading scales, other scales included in the studies were Oral Mucositis Index, the Southwest Oncology Group Criteria, and Eastern Cooperative Oncology Group scale. To our knowledge, this is the first analysis on OM in allogeneic HSCT patients with respect to conditioning regimens, and we observed that RIC regimens led to a high incidence of OM similar to that of MA regimens. Clinical trials on treatment of OM are lacking, emphasizing the essential need for prospective studies in this arena. A significant variance in the criteria for grading OM underscores the importance of establishing a standard grading system for OM measurement in future allogeneic HSCT clinical trials.
Topics: Busulfan; Cyclophosphamide; Graft vs Host Disease; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Incidence; Methotrexate; Mouth Mucosa; Myeloablative Agonists; Severity of Illness Index; Stomatitis; Transplantation Conditioning; Transplantation, Homologous; Vidarabine
PubMed: 26409924
DOI: 10.1016/j.bbmt.2015.09.014 -
BMC Pharmacology & Toxicology Dec 2017Prasugrel and Ticagrelor are emerging antiplatelet drugs that might have the potential to replace currently used antiplatelet agents. Previous analyses comparing... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Prasugrel and Ticagrelor are emerging antiplatelet drugs that might have the potential to replace currently used antiplatelet agents. Previous analyses comparing prasugrel with ticagrelor mainly focused on an indirect comparison whereas direct comparison was reported only in a few recently published trials. We aimed to systematically carry out a head to head comparison of the adverse clinical outcomes which were associated with prasugrel versus ticagrelor in patients with acute coronary syndrome (ACS).
METHODS
Studies comparing prasugrel with ticagrelor (head to head comparison) were searched from online databases. Adverse cardiovascular outcomes were considered as the primary endpoints whereas bleeding outcomes were considered as the secondary endpoints in this analysis. The latest version of the RevMan software was used to carry out subgroup analyses whereby odds ratios (OR) with 95% confidence intervals (CI) and the calculated probability (P) were generated.
RESULTS
Four studies with a total number of 563 patients (2012 - 2016) were included (282 patients were treated with prasugrel and 281 patients were treated with ticagrelor). Results of this analysis did not show any significant difference in mortality between prasugrel and ticagrelor with OR: 1.52, 95% CI: 0.42 - 5.45; P = 0.52. In addition, myocardial infarction, major adverse cardiac events, stroke and stent thrombosis were also not significantly different with OR: 0.59, 95% CI: 0.08 - 4.58; P = 0.62, OR: 0.91, 95% CI: 0.37 - 2.21; P = 0.83, OR: 0.60, 95% CI: 0.08 - 4.58; P = 0.62 and OR: 0.59, 95% CI: 0.08 - 4.58; P = 0.62 respectively. Thrombolysis in myocardial infarction (TIMI) defined minor bleeding, and minimal bleeding were also not significantly different between these two newer antiplatelet agents with OR: 3.11, 95% CI: 0.48 - 19.94; P = 0.23, and OR: 2.39, 95% CI: 0.35 - 16.42; P = 0.38 respectively. Moreover, bleeding defined by the academic research consortium was also similarly manifested with OR: 0.92, 95% CI: 0.39 - 2.13; P = 0.84.
CONCLUSION
In patients with ACS, both prasugrel and ticagrelor showed similar adverse cardiovascular outcomes and bleeding events. No significant difference was observed between these two newer antiplatelet agents during this head to head comparison. However, upcoming trials with long term follow up periods might be expected to completely solve this important clinical issue.
Topics: Acute Coronary Syndrome; Adenosine; Humans; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Purinergic P2Y Receptor Antagonists; Randomized Controlled Trials as Topic; Ticagrelor
PubMed: 29233189
DOI: 10.1186/s40360-017-0189-7 -
Neurologia I Neurochirurgia Polska 2022This study was performed to compare probabilities of SDI on the Expanded Disability Status Scale (EDSS) in patients with relapsing-remitting multiple sclerosis (RRMS),... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
This study was performed to compare probabilities of SDI on the Expanded Disability Status Scale (EDSS) in patients with relapsing-remitting multiple sclerosis (RRMS), treated with cladribine tablets (CT) or fingolimod (FTY), natalizumab (NAT), alemtuzumab (ALE) and ocrelizumab (OCR).
CLINICAL RATIONALE FOR THE STUDY
Progression of neurological disability as measured by the EDSS has been a common endpoint in multiple sclerosis (MS) trials. Novel therapies can not only slow this process, but in some patients even reverse it. This effect can be measured by the sustained disability improvement (SDI) - an endpoint that seems to continuously gain importance in clinical practice. Despite that, SDI has rarely been explored as an outcome in MS clinical studies, mostly as post-hoc analyses from randomised trials or as retrospective analyses based on patient registry records.
MATERIAL AND METHODS
A systematic review was conducted in Medline, Embase and Cochrane to identify clinical trials (RCT or non-RCT) evaluating 6-month SDI. An indirect comparison via network meta-analysis (NMA) was performed. Bayesian inference with Markov chains Monte Carlo methods were applied.
RESULTS
Eight trials presenting SDI results and applicable for NMA were included: six non-RCTs, with control groups selected by propensity score matching, and two RCTs. NMA results revealed that probability of achieving 6-month SDI with CT was significantly higher compared to all other high efficacy disease-modifying drugs with available data - HR (95% Crl - Bayesian Credibility Interval) vs. FTY: 4.98 (2.11-11.79); vs. NAT: 3.12 (1.31-7.27); vs. ALE: 9.29 (3.40-25.21). The main results were confirmed in the sensitivity analyses.
CONCLUSIONS
Of all considered therapies, treatment with cladribine tablets was associated with a higher probability of sustained disability improvement in RRMS patients. As this conclusion is based on available clinical data of limited quality, future studies, as well as real-world data, would be valuable to provide further evidence regarding the comparative effectiveness of RRMS therapies.
Topics: Humans; Cladribine; Multiple Sclerosis; Immunosuppressive Agents; Network Meta-Analysis; Retrospective Studies; Bayes Theorem; Multiple Sclerosis, Relapsing-Remitting; Tablets
PubMed: 36421066
DOI: 10.5603/PJNNS.a2022.0068 -
British Journal of Clinical Pharmacology Aug 2020We performed a systematic review and meta-analysis to compare the efficacy and safety of ticagrelor and prasugrel with those of clopidogrel in CYP2C19... (Meta-Analysis)
Meta-Analysis
Efficacy and safety of clopidogrel versus prasugrel and ticagrelor for coronary artery disease treatment in patients with CYP2C19 LoF alleles: a systemic review and meta-analysis.
AIM
We performed a systematic review and meta-analysis to compare the efficacy and safety of ticagrelor and prasugrel with those of clopidogrel in CYP2C19 reduced-metabolizers.
METHODS
PubMed, Cochrane and Web of Science were systematically searched for randomized controlled trials or cohort studies up to January 2020. The primary endpoint was major adverse cardiovascular events (MACE), including cardiovascular (CV) death, all-cause death, myocardial infarction (MI), stent thrombosis and stroke. The secondary endpoint was bleeding. Pooled effects were measured by relative risk (RR) with 95% confidence intervals (CIs). Publication bias was evaluated with Egger's regression test and adjusted by trim and fill method.
RESULTS
Twelve studies comprising 5829 CV patients with CYP2C19 loss-of-function alleles were included. Patients who received ticagrelor or prasugrel showed a lower risk of MACE than those who received clopidogrel (RR 0.524; 95% CI: 0.375, 0.731). The former also had lower risks of CV death (RR 0.409; 95% CI: 0.177, 0.946), all-cause death (RR 0.441; 95% CI: 0.263, 0.739), MI (RR 0.554; 95% CI: 0.414, 0.741) and stent thrombosis (RR 0.587; 95% CI: 0.348, 0.988) than the latter patient group. The risk of stroke was not significantly different between patients receiving the alternatives and those receiving clopidogrel (RR 0.605; 95% CI: 0.257, 1.425). Major and minor bleeding risk was not significantly different between patients treated with alternatives and clopidogrel (RR 1.019; 95% CI: 0.827, 1.260 and RR 1.235; 95% CI: 0.581, 2.628, respectively).
CONCLUSION
CYP2C19 reduced-metabolizers can expect better clinical outcome on using prasugrel or ticagrelor rather than clopidogrel.
Topics: Acute Coronary Syndrome; Alleles; Clopidogrel; Coronary Artery Disease; Cytochrome P-450 CYP2C19; Humans; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Purinergic P2Y Receptor Antagonists; Ticagrelor; Treatment Outcome
PubMed: 32320492
DOI: 10.1111/bcp.14317 -
Journal of the American Heart... Apr 2019Background As reports on the influence of cigarette smoking, an important cardiovascular risk factor, on platelet ADP -P2Y12 receptor inhibitors lack consistency, we... (Meta-Analysis)
Meta-Analysis
Background As reports on the influence of cigarette smoking, an important cardiovascular risk factor, on platelet ADP -P2Y12 receptor inhibitors lack consistency, we aimed to assess the effectiveness and safety of platelet ADP -P2Y12 receptor inhibitors influenced by smoking status. Methods and Results PubMed, Web of Science, EMBASE , Clinical Trials, and the Cochrane Library were searched from inception until June 2018. Among the 5076 citations retrieved, 22 studies, including 163 011 patients with or without percutaneous coronary intervention, were included for meta-analysis. Compared with nonsmokers within the first year of follow-up, the reductions of stroke and major adverse cardiovascular event rate were 18% ( P=0.008) and 26% ( P=0.02), respectively. A 20% reduction in stroke ( P=0.02) and a 34% reduction in major adverse cardiovascular event ( P=0.0001) rates were observed in smoking patients without percutaneous coronary intervention. No significant difference was observed in clinical outcome rates among prasugrel, ticagrelor, and clopidogrel in different smoking status. No significant difference was found in myocardial infarction and bleeding event incidence between current smokers and nonsmokers. Conclusions We concluded that current smokers had a lower incidence of major adverse cardiovascular events and stroke events than did nonsmokers, particularly in the early period (1 year) and among patients without percutaneous coronary intervention. However, because of the lack of original adjusted data, smoker's paradox still needs to consider the impact of age and other covariates. Thus, a differential risk-benefit evaluation should be considered, according to different smoking status, patient conditions, and therapy time points.
Topics: Acute Coronary Syndrome; Aged; Cardiovascular Diseases; Cigarette Smoking; Clopidogrel; Female; Hemorrhage; Humans; Male; Middle Aged; Myocardial Infarction; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Prasugrel Hydrochloride; Purinergic P2Y Receptor Antagonists; Stroke; Ticagrelor; Treatment Outcome
PubMed: 30898054
DOI: 10.1161/JAHA.118.010889 -
PloS One 2021Patients with minor ischemic stroke or transient ischemic attack represent a high-risk population for recurrent stroke. No direct comparison exists comparing dual... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Patients with minor ischemic stroke or transient ischemic attack represent a high-risk population for recurrent stroke. No direct comparison exists comparing dual antiplatelet therapy regimens-namely, Ticagrelor and Aspirin versus Clopidogrel and Aspirin. This systematic review and network meta-analysis (NMA) will examine the efficacy of these two different antiplatelet regimens in preventing recurrent stroke and mortality up to 30 days.
METHODS AND ANALYSIS
MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) will be searched with the assistance of a medical information specialist. Two independent reviewers will screen studies for inclusion; eligible studies will include randomized controlled trials that enrolled adults presenting with acute minor ischemic stroke or transient ischemic attack and compared one or more of the interventions against each other and/or a control. The primary outcomes will be recurrent ischemic stroke up to 30 days from symptom onset. Secondary outcomes will include safety outcomes (I.e. major bleeding and mortality), functional disability, and outcomes up to 90 days from symptom onset. A Bayesian approach to NMA will be implemented using the BUGSnet function in R Software. Between group comparisons for time-to-event (TTE) and dichotomous outcomes will be presented in terms of hazard ratios and odds ratios with 95% credible intervals, respectively. Secondary effect measures of treatment ranking will also be estimated.
ETHICS AND DISSEMINATION
No formal research ethics approval are necessary. We will disseminate our findings through scientific conference presentations, peer-reviewed publications, and social media/the press. The findings from this review will aid clinicians in decision-making on the choice of antithrombotic therapy in a high-risk stroke population and could be important in the development of future treatment trials and guidelines. Registration ID with Open Science Framework: 10.17605/OSF.IO/XDJYZ.
Topics: Aspirin; Bayes Theorem; Brain Ischemia; Clopidogrel; Drug Therapy, Combination; Dual Anti-Platelet Therapy; Hemorrhage; Humans; Ischemic Attack, Transient; Ischemic Stroke; Network Meta-Analysis; Platelet Aggregation Inhibitors; Ticagrelor
PubMed: 33909676
DOI: 10.1371/journal.pone.0250553 -
Medicine May 2021We aimed to systematically evaluate the efficacy and safety ticagrelor monotherapy following percutaneous coronary intervention. (Meta-Analysis)
Meta-Analysis
BACKGROUND
We aimed to systematically evaluate the efficacy and safety ticagrelor monotherapy following percutaneous coronary intervention.
METHODS
Online databases were searched for relevant studies (published between the years 2015 and 2020) comparing 1-month Dual antiplatelet therapy (DAPT) followed by 23-month ticagrelor monotherapy with 12-month DAPT followed by 12-month aspirin monotherapy following percutaneous coronary intervention. Primary outcomes assessed efficacy whereas secondary outcomes assessed safety. Odds ratios (OR) with 95% confidence intervals (CIs) based on a random effect model were calculated and the analysis was carried out by the RevMan 5.3 software.
RESULTS
Only 6 studies were selected for this meta-analytical research. The meta-analysis results: MI(OR:0.96, 95% CI:0.86-1.06, P = .40), stroke (OR:1.04, 95% CI: 0.87-1.25, P = .68), stent thrombosis (OR: 0.91,95% CI:0.76-1.10,P = .32),New-Q Wave (OR:0.85,95% CI: 0.72-1.00, P = .05), all cause death (OR:0.91, 95% CI: 0.87-0.96, P < .0001), death from cardiovascular (OR: 0.76, 95% CI: 0.58-0.99, P = .04), revascularization (OR: 0.93, 95% CI: 0.87-0.99, P = .03). Ticagrelor monotherapy was associated with a significantly lower rate of myocardial Infarction (MI), stroke, stent thrombosis, all cause death, death from cardiovascular and revascularization (OR:0.91,95% CI:0.87-0.96, P < .0001) when compared to DAPT. Besides, DAPT was associated with a significantly higher rate of BARC3 or 5 bleeding (OR:0.85, 95% CI: 0.68-1.06; P = .16) when compared to ticagrelor. When bleeding was further subdivided, minor or major bleeding was also significantly higher with DAPT (OR: 0.72, 95% CI: 0.41-1.27; P = .26). GUSTO moderate or severe bleeding was also significantly higher with DAPT (OR: 0.77, 95% CI: 0.39-1.52; P = .45).
CONCLUSION
Ticagrelor monotherapy after short-term dual-antiplatelet therapy (DAPT) can optimize ischemic and bleeding risks. And, it can reduce the occurrence of events outcome (MI, revascularization, stroke, stent thrombosis).
Topics: Drug Administration Schedule; Dual Anti-Platelet Therapy; Humans; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors; Ticagrelor
PubMed: 34011127
DOI: 10.1097/MD.0000000000026070 -
Blood Nov 2017In chronic lymphocytic leukemia (CLL) patients with mutated , 3 recent studies have demonstrated prolonged progression-free survival (PFS) after treatment with... (Review)
Review
In chronic lymphocytic leukemia (CLL) patients with mutated , 3 recent studies have demonstrated prolonged progression-free survival (PFS) after treatment with fludarabine-cyclophosphamide-rituximab (FCR) chemoimmunotherapy. We performed a systematic review to assess the benefit of FCR for patients with CLL and identified 5 randomized trials that met our inclusion criteria. FCR improved complete remission, PFS and overall survival vs the comparator; median PFS was not reached in the subgroup of CLL patients with mutated .
Topics: Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Disease-Free Survival; Female; Humans; Immunoglobulin Heavy Chains; Immunoglobulin Variable Region; Immunotherapy; Leukemia, Lymphocytic, Chronic, B-Cell; Middle Aged; Mutation; Remission Induction; Rituximab; Time Factors; Vidarabine
PubMed: 29025740
DOI: 10.1182/blood-2017-07-731588