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BMJ Open Oct 2020Furazolidone containing regimen is effectivefor () infection, but its safetyremains controversial. To assess the safety of furazolidone containing regimenin infection. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Furazolidone containing regimen is effectivefor () infection, but its safetyremains controversial. To assess the safety of furazolidone containing regimenin infection.
DESIGN
A systematic review and meta-analysis.
DATA SOURCES
PubMed, Embase, Cochrane Library, Web of Science and Scopus databases were systematically searched for eligible randomised controlled trials.
ELIGIBILITY CRITERIA
Studies comparing furazolidone with non-furazolidone-containing regimen, variable durations or doses of furazolidone were included.
DATA EXTRACTION AND SYNTHESIS
Two reviewers independently selected studies and extracted data. Primary outcomes were the risk of total adverse events (AEs), serious AEs and severe AEs, expressed as relative risk (RR) with 95% CI. Secondary outcomes contained the incidence of individual adverse symptoms, AE-related treatment discontinuation and compliance.
RESULTS
Twenty-six articles were identified from 2039 searched records, of which 14 studies (n=2540) compared furazolidone with other antibiotics. The eradication rates of furazolidone-containing regimen were higher than those of other antibiotics in both intention-to-treat (RR 1.06, 95% CI 1.01 to 1.12) and per-protocol analysis (RR 1.05, 95% CI 1.00 to 1.10). Only two serious AEs were reported in furazolidone group (2/1221, 0.16%). No significant increased risk was observed for the incidence of total AEs (RR 1.04, 95% CI 0.89 to 1.21) and severe AEs (RR 1.81, 95% CI 0.91 to 3.60). Twelve studies (n=3139) compared different durations of furazolidone, and four studies (n=343) assessed variable doses. Elevated risk of total AEs and severe AEs were only found in a high daily dose of furazolidone rather than prolonged duration. The incidence of AE-related treatment discontinuation and compliance of patients were all similar, irrespective of dose and duration adjustments.
CONCLUSION
Furazolidone-containing regimen has a similar risk of AEs and compliance as non-furazolidone-containing regimen. A low daily dose of 200 mg is well-tolerated for 14 day regimen and should be first considered.
PROSPERO REGISTRATION NUMBER
CRD42019137247.
Topics: Anti-Bacterial Agents; Drug Therapy, Combination; Furazolidone; Helicobacter Infections; Helicobacter pylori; Humans
PubMed: 33077561
DOI: 10.1136/bmjopen-2020-037375 -
Inflammopharmacology Apr 2024Through the antioxidant and anti-inflammation pathways, melatonin is proposed as a safe and effective intervention in neurological diseases. This study aims to evaluate... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Through the antioxidant and anti-inflammation pathways, melatonin is proposed as a safe and effective intervention in neurological diseases. This study aims to evaluate the effects of melatonin supplementation on the neurobehavioral and clinical outcomes in animal models of multiple sclerosis (MS).
METHODS
This study was conducted following the PRISMA statement. Animal studies that reported the effects of melatonin in preclinical MS models, including the experimental autoimmune encephalomyelitis (EAE) and cuprizone model for demyelination are included in this study. A systematic search in PubMed, Web of Science, Embase, and Scopus up was conducted in April 2023. The collaborative Approach to Meta-Analysis and Review of Animal Experimental Studies (CAMARADES) critical appraisal tool was used for the quality assessment of the studies and the quantitative synthetizes were conducted using the comprehensive meta-analysis software.
RESULTS
Out of 542 studies, finally 21 studies, including 14 studies in the EAE model and 7 studies of the toxic demyelination method with cuprizone were included. The route of administration was intraperitoneal in 18 studies, oral in 2 studies, and subcutaneous in 1 study. The quantitative synthesis of the EAE clinical severity scale was associated with significant differences (standardized mean difference [SDM]: - 2.52; - 3.61 to - 1.42; p value < 0.01). In subgroup analyses, the difference was statistically significant in the mouse subgroup (SMD: - 2.60; - 3.74 to - 1.46; p value < 0.01).
DISCUSSION
This study encountered that melatonin may be associated with improved behavioral and cognitive outcomes of preclinical models of MS with acceptable safety profiles.
FUNDING
The research was supported by the Student Research Committee, Tabriz University of Medical Sciences (grant number: 71005).
Topics: Humans; Mice; Animals; Multiple Sclerosis; Melatonin; Rodentia; Cuprizone; Encephalomyelitis, Autoimmune, Experimental; Dietary Supplements
PubMed: 38252220
DOI: 10.1007/s10787-023-01414-7 -
Journal of Clinical Psychopharmacology 2020We conducted a comprehensive meta-analysis of the comparison of tranylcypromine (TCP) and tricyclic antidepressants (TCAs) in the treatment of depression because such... (Meta-Analysis)
Meta-Analysis
PURPOSE
We conducted a comprehensive meta-analysis of the comparison of tranylcypromine (TCP) and tricyclic antidepressants (TCAs) in the treatment of depression because such work is lacking in medical scientific literature.
METHODS
Literature was searched for studies of TCP controlled by TCAs in multiple databases and in reviews of TCP and monoamine oxidase inhibitors. The natural logarithm of the odds ratio (logOR) and the pooled logOR according to a fixed effect model were calculated for the numbers of responders and nonresponders.
RESULTS
A total of 227 studies of TCP were found including 75 controlled studies of TCP-monotherapy. Twelve of 23 studies of TCP monotherapy and TCAs were excluded for several reasons (duplicates, safety studies, retrospective, cross-over), leaving 11 prospective and parallel controlled studies of TCP monotherapy versus TCAs (6 randomized double-blind). One study was excluded from the meta-analysis because of low quality of study design according to the Food and Drug Administration guidelines of studies of antidepressant drugs and high risk of bias according to the Cochrane's tool. Two studies with equal efficacy of TCP and TCAs in continuous endpoints did not provide dichotomous response data. A pooled logOR of 0.480 (95% confidence interval, 0.105-0.857, P = 0.01) resulted for the remaining eight studies in the primary meta-analysis, which favors TCP significantly over TCAs (test for heterogeneity: Х = 8.1, df = 7, P > 0.3, not heterogenous; I = 13.6%, heterogeneity not important). The result is robust with respect to inclusion of hypothetical response data of the 2 studies with continuous data only: pooled logOR, 0.350 (95% confidence interval, 0.028-0.672, P = 0.03). Visual inspection of forest plots and subgroup analysis suggest that superiority of TCP over TCAs is determined by 2 studies in psychomotor-retarded (anergic) depression.
CONCLUSIONS
Tranylcypromine and TCAs have an equal antidepressant effect in a mean sample of depressed patients with mixed psychomotor symptoms. Tranylcypromine might be superior to TCAs in depression with predominant psychomotor retardation.
Topics: Adult; Affect; Aged; Antidepressive Agents, Tricyclic; Depression; Female; Humans; Male; Middle Aged; Monoamine Oxidase Inhibitors; Psychomotor Performance; Tranylcypromine; Treatment Outcome; Young Adult
PubMed: 31834088
DOI: 10.1097/JCP.0000000000001153 -
Journal of Thoracic Disease May 2022Type 2 diabetes mellitus (T2D) and heart failure (HF) are closely related to the increased risk of atrial fibrillation (AF)/atrial flutter (AFL). However, massive...
The effectiveness of SGLT2 inhibitor in the incidence of atrial fibrillation/atrial flutter in patients with type 2 diabetes mellitus/heart failure: a systematic review and meta-analysis.
BACKGROUND
Type 2 diabetes mellitus (T2D) and heart failure (HF) are closely related to the increased risk of atrial fibrillation (AF)/atrial flutter (AFL). However, massive clinical studies have shown that sodium glucose cotransporter 2 inhibitor (SGLT2i) affects the occurrence of AF/AFL and its complications, but the promoting or inhibitory effect of SGLT2i on AF/AFL and its complications and the exact probability is not clear, meta-analysis can combine the existing research data to easily solve the clinical problems.
METHODS
We performed a search in the registers of ClinicalTrials.gov from it,s inception to March 2021 to evaluate the occurrence of AF/AFL adverse events in SGLT2i in patients with T2D/HF. Almost all of the included studies were double-blind parallel allocation randomized controlled studies, and only one was open. The control groups all included placebo, some of which also included glimepiride, metformin, liraglutide, etc. Quality risk assessment of the included randomized controlled trials (RCTs) was conducted using Cochrane RoB 2.0., and the publication bias assessment was conducted using STATA 17.0. The odds ratio (OR) combined effect of 95% confidence interval (CI) was used for bivariate variables.
RESULTS
We included data from 22 confirmed trials that included 52,951 T2D/HF patients. The studies had no risk of bias. Analysis of the cumulative results showed that compared with placebo, SGLT2i can significantly reduce the incidence of AF/AFL by 18% (OR =0.82, 95% CI: 0.73 to 0.93, P=0.002), and reduce the incidence of arrhythmia by 14% (OR =0.86, 95% CI: 0.79 to 0.94, P=0.0006); among them, the incidence of AF/AFL in T2D patients was reduced by 20% (OR =0.80, 95% CI: 0.69 to 0.92, P=0.002); Dapagliflozin reduced the incidence of AF/AFL by 15% (OR =0.85, 95% CI: 0.74 to 0.98, P=0.03); the incidence of intracardiac thrombosis decreased by 69% (OR =0.31, 95% CI: 0.10 to 0.91, P=0.03), while the incidence of AF/AFL in women decreased by 17% (OR =0.83, 95% CI: 0.72 to 0.94, P=0.004).
DISCUSSION
This article provides a new direction for the use of SGLT2i, and hopefully it can provide certain theoretical basis for the broader clinical indications of SGLT2i in the future.
PubMed: 35693625
DOI: 10.21037/jtd-22-550 -
International Journal of Molecular... Jun 2022Most ovarian cancer cases are diagnosed at an advanced stage (III or IV), in which a primary debulking surgery combined with adjuvant systemic chemotherapy is the... (Review)
Review
Most ovarian cancer cases are diagnosed at an advanced stage (III or IV), in which a primary debulking surgery combined with adjuvant systemic chemotherapy is the standard management. Since targeted therapy is less toxic to human cells than systemic chemotherapy, it has drawn much attention and become more popular. Angiogenesis is a critical process during the proliferation of ovarian cancer cells. Currently, many studies have put emphases on anti-angiogenetic medication, such as bevacizumab, the first and most investigated angiogenesis inhibitor that can exert anti-neoplastic effects. Bevacizumab is a recombinant humanized monoclonal antibody that has been approved for first-line maintenance treatment of advanced ovarian cancer. This review is a summary of current literature about the molecular mechanisms of actions, safety, and effects of bevacizumab for use in advanced epithelial ovarian cancer. Some common side effects of bevacizumab will be also discussed. As an inhibitor of angiogenesis, bevacizumab binds to circulating vascular endothelial growth factor (VEGF) and thereby inhibits the binding of VEGF to its receptors on the surface of endothelial cells. Neutralization of VEGF prevents neovascularization and leads to apoptosis of tumor endothelial cells and a decrease in interstitial fluid pressure within the tumors, which allows greater capacity for chemotherapeutic drugs to reach specific targeted sites. Grossly, bevacizumab has demonstrated some significant therapeutic benefits in many randomized trials in combination with the standard chemotherapy for advanced epithelial ovarian cancer. Based on the available evidence, a higher dosage and a longer duration of bevacizumab appear to achieve better therapeutic effects and progression-free survival. On the other hand, patients with more severe diseases or at a higher risk of progression seem to benefit more from bevacizumab use. However, many unknown aspects of bevacizumab, including detailed mechanisms of actions, effectiveness, and safety for the treatment of ovarian cancer, warrant further investigation.
Topics: Angiogenesis Inhibitors; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Carcinoma, Ovarian Epithelial; Endothelial Cells; Female; Humans; Neovascularization, Pathologic; Ovarian Neoplasms; Vascular Endothelial Growth Factor A
PubMed: 35805914
DOI: 10.3390/ijms23136911 -
Expert Review of Anticancer Therapy May 2024The effect of age, sex, and eastern cooperative oncology group performance status (ECOG PS) on the efficacy and safety of immune checkpoint inhibitor (ICI) therapy among... (Meta-Analysis)
Meta-Analysis Review
The effect of age, sex, and eastern cooperative oncology group performance status on the efficacy and safety of immune checkpoint inhibitors in patients with hepatocellular carcinoma: a systematic review and meta-analysis.
BACKGROUND
The effect of age, sex, and eastern cooperative oncology group performance status (ECOG PS) on the efficacy and safety of immune checkpoint inhibitor (ICI) therapy among hepatocellular carcinoma (HCC) patients remains elusive. Thus, a meta-analysis was conducted to evaluate whether such effects exist.
RESEARCH DESIGN AND METHODS
Eligible studies in PubMed, Embase, and Cochrane Library databases were retrieved.
RESULTS
One-hundred-and-eleven studies involving 14,768 HCC patients were included. The findings indicated that the ECOG PS didn't have a significant effect on the ORR and PFS in ICI-treated HCC patients (higher ECOG PS vs. lower ECOG PS: ORR: = 0.78, 95%CI = 0.55-1.10; PFS: = 1.15, 95%CI = 0.97-1.35), while those patients with a higher ECOG PS may have a worse OS ( = 1.52, 95% CI = 1.26-1.84). There is no significant evidence of the effect of age (older vs. younger) or sex (males vs. females) on the efficacy of ICI therapy in HCC.
CONCLUSION
ICI therapy in HCC should not be restricted strictly to certain patients in age or sex categories, while HCC patients with higher ECOG PS may require closer medication or follow-up strategy during ICI therapy.
PROSPERO REGISTRATION
CRD42024518407.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Immune Checkpoint Inhibitors; Age Factors; Sex Factors; Male; Female; Progression-Free Survival
PubMed: 38623811
DOI: 10.1080/14737140.2024.2341723 -
Clinical Lung Cancer Nov 2021The correlation between immune-related adverse events (irAEs) and prognosis remains controversial in advanced non-small cell lung cancer (NSCLC). The aim of this study... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The correlation between immune-related adverse events (irAEs) and prognosis remains controversial in advanced non-small cell lung cancer (NSCLC). The aim of this study was to systematically evaluate the effect of irAEs, especially checkpoint inhibitor pneumonitis (CIP), on the survival and treatment response in advanced NSCLC.
METHODS
The primary outcomes were overall survival (OS) and objective response rate (ORR). Databases were searched for relevant studies, and meta-analysis was conducted with RevMan.
RESULTS
A total of 51 studies involving 12,600 participants were included. The development of irAEs had an advantageous effect on OS and ORR in advanced NSCLC (OS: hazard ratio [HR], 0.56 [95% confidence interval [CI] 0.46 to 0.67]; ORR: odds ratio [OR], 3.13 [2.41 to 4.06]). The occurrence of endocrine and skin irAEs had advantageous effects on both OS and ORR (endocrine OS, HR, 0.47 [-0.37 to 0.59]; endocrine ORR: OR, 1.90 [1.27 to 2.84]; skin OS: HR, 0.48 [0.38 to 0.61]; skin ORR: OR, 4.30 [2.68 to 6.91]). Severe-grade irAEs resulted in shorter OS than low-grade irAEs (HR, 1.49 [1.06, 2.09]), and multiple irAEs resulted in better ORR compared with 1 irAE (OR, 2.04 [1.41 to 2.94]). The occurrence of CIP had no significant effect on OS (HR, 1.14 [0.70 to 1.86]), but it was associated with better ORR (OR, 2.12 [1.06 to 4.25]). Severe-grade CIP had no effect on OS or ORR, but CIP leading to treatment discontinuation resulted in shorter OS (HR, 2.35 [1.17 to 4.72]).
CONCLUSION
The development of irAEs had advantageous effects on survival and response in advanced NSCLC. CIP had no effect on survival, but it predicted better response.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Databases, Factual; Immunotherapy; Lung Neoplasms; Outcome Assessment, Health Care; Pneumonia; Prognosis; Survival
PubMed: 34183265
DOI: 10.1016/j.cllc.2021.05.004 -
Frontiers in Oncology 2022Although immune checkpoint inhibitors (ICIs) have revolutionized the current anticancer therapies, a considerable proportion of patients are found to hardly benefit from...
An Up-To-Date Investigation Into the Correlation Between Proton Pump Inhibitor Use and the Clinical Efficacy of Immune Checkpoint Inhibitors in Advanced Solid Cancers: A Systematic Review and Meta-Analysis.
BACKGROUND
Although immune checkpoint inhibitors (ICIs) have revolutionized the current anticancer therapies, a considerable proportion of patients are found to hardly benefit from these drugs. Accumulating studies have demonstrated that concomitant proton pump inhibitor (PPI) use may affect the clinical efficacy of ICIs; however, their results are inconsistent. In this study, based on updated evidence, we aimed to perform a meta-analysis to clarify the prognostic significance of PPI use in advanced solid cancer patients receiving ICI therapy.
METHODS
Eligible literature was searched using PubMed, Cochrane Library, Web of Science, EMBASE, and other network resources before July 2021. Clinical outcome was evaluated using overall survival (OS) and progression-free survival (PFS). The correlation of PPI use with OS or PFS was determined based on hazard ratios (HRs) and 95% confidence intervals (CIs).
RESULTS
A total of 17 studies enrolling 9,978 ICI-treated cancer patients were included in our meta-analysis. The global analysis demonstrated that PPI use was significantly correlated with worse OS [HR = 1.29 (1.10-1.50)] instead of PFS [HR = 1.19 (0.98-1.44)] in solid cancer patients receiving ICI therapy. In a subgroup analysis, the negative correlation of PPI use with ICI efficacy was significant in patients with non-small cell lung cancer [PFS, HR = 1.27 (1.10-1.47)] and urothelial carcinoma [OS, HR = 1.55 (1.31-1.84), PFS, HR = 1.52 (1.13-2.06)] and mixed cohorts containing multiple cancer types [OS, HR = 1.40 (1.16-1.69)], while an opposite result was observed in the PFS of patients with melanoma [HR = 0.48 (0.25-0.90)]. Moreover, the unfavorable prognostic impact of PPI use was also significant in patients over 65 years old [OS, HR = 1.28 (1.05-1.55), PFS, HR = 1.32 (1.12-1.56)] or those receiving anti-PD-1 [OS, HR = 1.37 (1.04-1.79)] or anti-PD-L1 therapies (OS, HR = 1.49 (1.30-1.69), PFS, HR = 1.34 (1.20-1.50). Finally, PPI use was significantly correlated with a worse prognosis in patients receiving PPIs 30 days before and/or after ICI initiation (OS, HR = 1.38 (1.18-1.62), PFS, HR = 1.23 (1.06-1.43)).
CONCLUSION
Although our global analysis revealed PPI use was not correlated with the PFS of ICI-treated patients, considering the results of our subgroup analysis, PPIs should be still cautiously used shortly before or during ICI therapy. Furthermore, more clinical validations and related mechanism investigations are of great necessity to clarify the clinical correlation of PPI use with ICI efficacy.
SYSTEMATIC REVIEW REGISTRATION
[https://www.crd.york.ac.uk/prospero/], PROSPERO [No. CRD42021243707].
PubMed: 35280736
DOI: 10.3389/fonc.2022.753234 -
Medicine Dec 2019We designed the study to investigate the incidence risk of Programmed Cell Death-1 (PD-1) or Ligand 1 (PD-L1) inhibitor-related endocrine dysfunction in patients with... (Meta-Analysis)
Meta-Analysis
PURPOSE
We designed the study to investigate the incidence risk of Programmed Cell Death-1 (PD-1) or Ligand 1 (PD-L1) inhibitor-related endocrine dysfunction in patients with lung cancer.
METHOD
All the data were collected by 1 primary reviewer and then independently reviewed by 2 secondary reviewers according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISM) guidelines. Incidence risk of all-grade and grade 3-5 PD-1/PD-L1 inhibitors related endocrine dysfunction in patients with lung cancer were taken into account.
RESULTS
Overall, 12 clinical trials comprising 6108 patients were identified in this systematic review and meta-analysis. The incidence risk of hypothyroidism, hyperthyroidism and adrenal insufficiency was higher in NSCLC patients receiving combination treatments. The incidence rate of all-grade of hypothyroidism was lower in PD-1/PD-L1 inhibitor subgroup compared to chemotherapy (OR = 22.62, 95%CI:9.79-52.25), while the similar result was seen in another treatment regimen (PD-1 + platinum-based chemotherapy vs platinum-based chemotherapy) (OR = 2.93, 95%CI: [2.08, 4.11). The different result can be seen in the group related to the other treatment regimen (1PD-1/PD-L1 inhibitor vs 2 PD-1/PD-L1 inhibitors) (OR = 0.40, 95%CI:0.21-0.76). All the results of the above analysis were considered to be statistical significant. Similar result could also be seen in meta-analysis related to hyperthyroidism and adrenal insufficiency.
CONCLUSION
The incidence risk of endocrine dysfunctions, including hypothyroidism, hyperthyroidism and adrenal insufficiency, were higher for PD-1/PD-L1 inhibitors group.
Topics: Antineoplastic Agents, Immunological; B7-H1 Antigen; Biomarkers, Tumor; Carcinoma, Non-Small-Cell Lung; Endocrine System Diseases; Global Health; Humans; Incidence; Lung Neoplasms; Nivolumab; Programmed Cell Death 1 Receptor
PubMed: 31852114
DOI: 10.1097/MD.0000000000018310 -
International Immunopharmacology Mar 2024Immune checkpoint inhibitors (ICIs) have effectively improved the clinical outcome of advanced non-small cell lung cancer (NSCLC). Opioids are commonly used for pain... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Immune checkpoint inhibitors (ICIs) have effectively improved the clinical outcome of advanced non-small cell lung cancer (NSCLC). Opioids are commonly used for pain relief in cancer patients. This study aims to clarify the prognostic impact of opioid use in advanced NSCLC patients receiving ICI therapy.
METHODS
A systematic literature review was carried out using online databases before July 2023. The meta-analysis was used to clarify the correlation of opioid use with the overall survival (OS) or progression-free survival (PFS) of ICI-treated NSCLC patients, both of which were determined using hazard ratios (HRs) coupled with 95 % confidence intervals (CIs). Then, an independent cohort enrolling 181 NSCLC patients was utilized for validation. Finally, a comprehensive bioinformatics analysis based on TCGA cohort was performed to investigate the prognostic significance of opioid target genes (OTGs) and their correlation with immune infiltration in NSCLC patients.
RESULTS
A total of 8 studies enrolling 1174 patients were included in the meta-analysis. Opioid use was negatively associated with worse PFS (HR = 2.16, 95 %CI: 1.26-3.71) and OS (HR = 2.02, 95 %CI: 1.54-2.63) in ICI-treated NSCLC patients. The retrospective validation confirmed the above result and identified opioid use as an independent unfavorable predictor for PFS and OS in both the entire cohort and ICI subgroup. The bioinformatic analysis identified 14 prognostic OTGs (CYP17A1, PDYN, PYCARD, FGA, NTSR1, FABP1, HPCA, PENK, PDGFB, LIN7A, FKBP5, TYMS, CACNA1H and LDHA), most of which were correlated with immune infiltration in NSCLC. A risk model was constructed based on 14 OTGs and found to effectively stratify the clinical outcome in both the training and validation set, independent of age, gender and TNM staging system. The model was also significantly correlated with infiltration of activated dendritic cells, neutrophils and tumor infiltrating lymphocytes. Finally, a nomogram was constructed based on the model, age, gender and TNM stage, which could predict well the 1-, 3- and 5-year survival of NSCLC patients.
CONCLUSION
Opioid use is correlated with the poor clinical outcome in ICI-treated NSCLC patients. Precise pain management is highly advocated and opioids are recommended to be cautiously used in these patients. OTGs have the potential to be prognostic biomarkers for NSCLC patients and their role in tumor immunity needs to be further investigated.
Topics: Humans; Analgesics, Opioid; Carcinoma, Non-Small-Cell Lung; Immune Checkpoint Inhibitors; Lung Neoplasms; Membrane Proteins; Opioid-Related Disorders; Retrospective Studies; Vesicular Transport Proteins
PubMed: 38325047
DOI: 10.1016/j.intimp.2024.111611