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Clinical Rheumatology Aug 2020To compare the relative efficacy of current and investigational biologic and oral small molecule (OSM) treatments for active ankylosing spondylitis (AS).
OBJECTIVE
To compare the relative efficacy of current and investigational biologic and oral small molecule (OSM) treatments for active ankylosing spondylitis (AS).
METHODS
A systematic literature review was conducted to identify all phase 2/3 randomized trials of interest in patients with AS. Outcomes assessed were ≥ 20% improvement in the Assessment of Spondyloarthritis International Society Criteria (ASAS20) and change from baseline in Bath Ankylosing Spondylitis Functional Index (BASFI) and C-reactive protein (CRP) at weeks 12-16. Bayesian network meta-analyses were conducted for outcomes using a random effects model. Baseline-risk adjustment was also conducted to account for differences in placebo response across studies. Surface Under the Cumulative Ranking curve (SUCRA) values are reported, reflecting the relative probability that intervention was the best of all interventions.
RESULTS
The investigational agent tofacitinib 5 mg was the top-ranked treatment (SUCRA, 93%) for ASAS20 response, followed by intravenous (IV) golimumab 2 mg/kg (90%). Golimumab IV 2 mg/kg and infliximab 5 mg/kg were the top two ranked treatments for change from baseline in BASFI (golimumab IV, 81%; infliximab, 80%) and change from baseline in CRP (infliximab, 90%; golimumab IV, 82%).
CONCLUSIONS
Two approved therapies (golimumab IV, infliximab) and one investigational product ranked highest for efficacy in AS. Key Points • Although golimumab IV, infliximab, and tofacitinib ranked highest for efficacy in AS, differences in efficacy between approved and investigational therapies were not statistically significant.
Topics: Administration, Intravenous; Antibodies, Monoclonal; Bayes Theorem; Humans; Infliximab; Network Meta-Analysis; Randomized Controlled Trials as Topic; Spondylitis, Ankylosing; Therapies, Investigational; Tumor Necrosis Factor Inhibitors
PubMed: 32107666
DOI: 10.1007/s10067-020-04970-3 -
Head & Face Medicine Feb 2024The main aim of this systematic review and meta-analysis was to identify peer-reviewed scholarly journal articles reporting the significance of physiotherapy... (Meta-Analysis)
Meta-Analysis
The role of physiotherapy interventions in the management of temporomandibular joint ankylosis: a systematic review and meta-analysis : Running title: Physiotherapy in TMJ ankylosis.
BACKGROUND
The main aim of this systematic review and meta-analysis was to identify peer-reviewed scholarly journal articles reporting the significance of physiotherapy interventions in managing TMJ ankylosis. In addition, this study aimed to critically appraise the existing evidence on the prevalence and clinical presentation, physiotherapy intervention approaches, efficacy of physiotherapy interventions, adverse effects, and safety of physiotherapy interventions in TMJ ankylosis management.
METHODS
An all-inclusive literature search was conducted using the PubMed, Google Scholar, and Scopus electronic databases. The researchers screened the potential articles and assessed for eligibility based on the reported inclusion and exclusion criteria. The quality evaluation tool for observational cohort and cross-sectional studies developed by the National Institutes of Health (NIH) and the Cochrane Collaboration's Risk of Bias Tool were used to assess the quality of the included studies. Researchers also comprehensively analyzed the data, reported the results, and discussed them according to the predominant themes.
RESULTS
The primary electronic database search yielded 409 articles, of which 25 were included in this review. A secondary search was conducted from citations of the included studies, yielding 74 articles, of which six were included in the study. A significantly higher prevalence of bony ankylosis than fibrous ankylosis, with an overall effect size of p < 0.00001. In addition, there were significantly more unilateral than bilateral presentations with an overall effect size of p < 0.00001. Moreover, there were 78 reported complications out of 245 subjects according to five included studies demonstrating a significant effect size with p = 0.001 following the treatment protocols.
CONCLUSION
This study highlighted the prevalence of bony ankylosis in temporomandibular joint ankylosis, emphasizing its impact on patients' well-being. On the other hand, the results show that physiotherapy is essential to optimize postoperative outcomes and minimize adverse events such as re-ankylosis. Practitioners and healthcare professionals must monitor postoperative recovery and ensure strict adherence to physiotherapy protocols for optimal outcomes.
Topics: Humans; Ankylosis; Cross-Sectional Studies; Physical Therapy Modalities; Temporomandibular Joint; Temporomandibular Joint Disorders
PubMed: 38424599
DOI: 10.1186/s13005-024-00416-2 -
Annals of Maxillofacial Surgery 2021The three commonly employed sequences of distraction osteogenesis (DO) in the management of temporomandibular joint (TMJ) ankylosis with dentofacial deformities include...
BACKGROUND
The three commonly employed sequences of distraction osteogenesis (DO) in the management of temporomandibular joint (TMJ) ankylosis with dentofacial deformities include post-arthroplastic distraction osteogenesis (PAD), simultaneous arthroplastic distraction osteogenesis (SAD), and pre-arthroplastic distraction osteogenesis (PrAD).
OBJECTIVE
The aim of this systematic review is to compare the effectiveness of various sequences of DO in the management of TMJ ankylosis with micrognathia/and obstructive sleep apnea syndrome (OSAS).
DATA SOURCES
A comprehensive online and manual search of English language literature with no date restrictions was done on March 2020.
ELIGIBILITY CRITERIA
Inclusion criteria were case series and prospective and retrospective studies involving adult/paediatric human subjects with unilateral/bilateral TMJ ankylosis and micrognathia/OSAS treated with DO.
STUDY APPRAISAL AND SYNTHESIS METHODS
Of 73 studies identified, only 10 were included in the qualitative synthesis. The outcomes assessed were as follows: maximum mouth opening (MMO), posterior airway space (PAS), polysomnography variables, reankylosis, mandibular length, and chin and mandible position.
RESULTS
All the included studies showed high risk of bias. MMO and mandibular length increased, chin and mandibular position improved by the end of treatment in all the three sequences, and polysomnography variables and PAS significantly improved in PrAD compared to PAD and improved in SAD compared to baseline. Reankylosis was significantly less in PrAD.
CONCLUSION
More well-designed studies comparing the three sequences of DO should be carried out to arrive at a consensus.
PubMed: 35265502
DOI: 10.4103/ams.ams_208_20 -
International Journal of Oral and... Jan 2023The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle... (Meta-Analysis)
Meta-Analysis Review
The aim of this study was to perform a systematic review of the literature on the temporomandibular joint (TMJ) prosthesis as a treatment option after mandibular condyle fracture. Three databases were searched (PubMed, Embase, Cochrane Library) and 2670 unique papers were identified. A total of 337 studies were included (121 case reports, 89 case series, and 127 cohort/clinical studies). In total 14,396 patients and 21,560 prostheses were described. Of the 127 cohort or clinical studies, 100 (79%) reported inclusion criteria, 54 (43%) reported exclusion criteria, and 96 (76%) reported the inclusion period. The base population from which patients were recruited was reported in 57 studies (45%). The reason for TMJ prosthesis implantation was reported for 4177 patients (29.0%). A history of condylar fracture was present in 83 patients (2.0%); a history of mandibular trauma was present in 580 patients (13.9%). The meta-analysis showed a pooled prevalence of condylar fracture of 1.6% (95% confidence interval 0.9-2.4%) and a pooled prevalence of trauma or condylar fracture of 11.3% (95% confidence interval 7.1-16.0%). Heterogeneity was highly significant (P < 0.001). The TMJ prosthesis appears to be reserved for patients with persistent pain, bony or fibrous ankylosis, or osteomyelitis after primary closed or open treatment of fractures of the mandibular condyle.
Topics: Humans; Mandibular Condyle; Temporomandibular Joint Disorders; Tooth Ankylosis; Mandibular Fractures; Temporomandibular Joint; Ankylosis
PubMed: 35752530
DOI: 10.1016/j.ijom.2022.05.014 -
RMD Open Jan 2024To evaluate the prevalence of symptoms and factors associated with irritable bowel syndrome (IBS) in axial spondyloarthritis (ax-SpA). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the prevalence of symptoms and factors associated with irritable bowel syndrome (IBS) in axial spondyloarthritis (ax-SpA).
METHODS
In a cross-sectional multicentric study, consecutive patients with ax-SpA treated with biologics in five rheumatology departments were asked for IBS Rome IV criteria. Demographic data, lifestyle behaviours and disease characteristics were recorded. Second, a systematic literature review and meta-analysis were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
Of the 500 patients with ax-SpA included, 124 reported IBS symptoms (25%). Female gender, unemployment, higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and worse Bath Ankylosing Spondylitis Functional Index scores, multiple lines of biologics, fibromyalgia, anxiety, depression and lower physical activity were associated with IBS symptoms. In multivariate model, the risk of IBS was associated with anxiety and physical inactivity. From the literature review, the prevalence of IBS in patients with SpA was 15.4% (8.8% to 23.3%). Meta-analysis of the five studies comparing the presence of IBS in patients with SpA (323/7292) and healthy controls (484/35587) showed a significant increase of IBS in patients with SpA (OR=1.59 (1.05 to 2.40)).
CONCLUSION
The prevalence of IBS symptoms was high in the ax-SpA population and should therefore be considered in the presence of gastrointestinal disorders. The presence of IBS symptoms was associated with anxiety and low physical activity in multivariate analysis. Patients with IBS symptoms tended to have more difficult to manage disease characterised by higher activity, worse functional score and multiple lines of treatment in univariate analysis.
Topics: Humans; Female; Irritable Bowel Syndrome; Cross-Sectional Studies; Spondylitis, Ankylosing; Spondylarthritis; Biological Products
PubMed: 38216286
DOI: 10.1136/rmdopen-2023-003836 -
RMD Open Nov 2023Axial spondyloarthritis (axSpA) can limit work participation. Our objective was to characterise productivity in patients with axSpA, including changes after 12-16 weeks... (Meta-Analysis)
Meta-Analysis
Work productivity in patients with axial spondyloarthritis initiating biological or targeted synthetic disease-modifying antirheumatic drugs: a systematic literature review and meta-analysis.
BACKGROUND
Axial spondyloarthritis (axSpA) can limit work participation. Our objective was to characterise productivity in patients with axSpA, including changes after 12-16 weeks of treatment with biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).
METHODS
A systematic literature review identified studies published from 1 January 2010 to 21 October 2021 reporting work productivity using the Work Productivity and Activity Impairment (WPAI) questionnaire in patients with axSpA initiating b/tsDMARDs. Baseline and Week 12-16 overall work productivity, absenteeism, presenteeism and activity impairment scores were used in a random-effects meta-analysis to calculate absolute mean change from baseline for each WPAI-domain.
RESULTS
Eleven studies in patients with axSpA who received either placebo (n=727) or treatment with adalimumab, bimekizumab, etanercept, ixekizumab, secukinumab or tofacitinib (n=994) were included. In working patients initiating a b/tsDMARD, mean baseline overall work productivity impairment, absenteeism and presenteeism scores were 52.1% (N=7 studies), 11.0% and 48.8% (N=6 studies), respectively. At Week 12-16, the pooled mean change from baseline in overall work impairment for b/tsDMARDs or placebo was -21.6% and -12.3%. When results were extrapolated to 1 year, the potential annual reductions in cost of paid and unpaid productivity loss per patient ranged from €11 962.88 to €14 293.54.
CONCLUSIONS
Over 50% of employed patients with active axSpA experienced work impairment, primarily due to presenteeism. Overall work productivity improved at Weeks 12-16 to a greater extent for patients who received b/tsDMARDs than placebo. Work productivity loss was associated with a substantial cost burden, which was reduced with improvements in impairment.
Topics: Humans; Antirheumatic Agents; Spondylitis, Ankylosing; Efficiency; Etanercept; Axial Spondyloarthritis
PubMed: 38035757
DOI: 10.1136/rmdopen-2023-003468 -
Advances in Rheumatology (London,... Mar 2021Hyperhomocysteinemia is associated with autoimmune diseases such as ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA).... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Hyperhomocysteinemia is associated with autoimmune diseases such as ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA). Current findings regarding plasma/serum homocysteine (HCY) levels in AS patients are inconsistent. This study aims to systematically evaluate the association between circulating HCY levels and AS.
METHODS
Online electronic databases (PubMed, Web of Science, Embase, ScienceDirect, China National Knowledge Infrastructure (CNKI), and Wanfang data) were used to retrieve all relevant articles published up to May 7, 2020. The pooled standardized mean difference (SMD) with 95% confidence interval (CI) was calculated using the random-effect model, Stata16 software.
RESULTS
Nine articles containing 778 AS patients and 522 controls were included in this meta-analysis. No significant differences in HCY levels were found between AS and control groups (pooled SMD = 0.46, 95% CI = - 0.30 to 1.23, P = 0.23). However, subgroup analysis suggested that HCY levels were significantly higher (P < 0.05) in the AS group treated with methotrexate (MTX) compared with the control group. In contrast, HCY levels were significantly (P < 0.05) lower in the AS group receiving anti-TNF-α treatment compared with the control group. No significant differences were detected between HCY levels and disease activity scores (Bath AS disease activity index, BASDAI), and methylenetetrahydrofolate reductase (MTHFR) C677T genotype.
CONCLUSION
This meta-analysis indicates that HCY levels are similar between AS and controls, and do not correlate with disease activity. However, different medical treatments cause fluctuations of circulating HCY levels in AS patients. Further and larger-scale studies are needed to confirm these findings.
TRIAL REGISTRATION
This study was registered at international prospective register of systematic reviews (PROSPERO), registration number: CRD42020184426 .
Topics: Homocysteine; Humans; Spondylitis, Ankylosing
PubMed: 33691801
DOI: 10.1186/s42358-021-00175-7 -
Materials (Basel, Switzerland) Apr 2022In many cases, the replanted teeth may undergo resorption or ankyloses. Recent studies show that autologous platelet concentrates (APCs) may improve the outcomes of... (Review)
Review
INTRODUCTION
In many cases, the replanted teeth may undergo resorption or ankyloses. Recent studies show that autologous platelet concentrates (APCs) may improve the outcomes of tooth replantation. The aim of this systematic review was to summarize and critically appraise the currently available literature on the use of APCs before tooth replantation.
METHODOLOGY
An electronic search was conducted on the following research databases: PubMed/MEDLINE, ISI Web of Science, EMBASE and Scopus. The following medical subject heading (MeSH) keywords used were: ((tooth replantation) OR (replanted tooth) OR (teeth replantation) OR (replanted teeth)) AND ((autologous platelet concentrate) OR (platelet-rich plasma) OR (platelet-rich fibrin) OR (autologous platelet)). The studies' data was extracted, and the research' quality was rated using the CARE and ARRIVE protocols.
RESULTS
Ten case reports and three animal studies, one cell study and one study, which included both animal and in vitro experiments, were included in this review. In majority of the studies, APCs improved the outcomes of tooth replantation. However, there were various sources of bias in the most of the research, which may have influenced the results.
CONCLUSIONS
Although majority of the studies indicate that APCs may improve outcomes of tooth replantation, majority of the studies contained numerous sources of bias. Additionally, the sample size of the included subjects is inadequate to predict the clinical efficacy of APCs in management of replanted teeth. Large-scale, multi-center and long-term studies are required to ascertain the efficacy of APCs in improve the outcomes of tooth replantation.
PubMed: 35454469
DOI: 10.3390/ma15082776 -
Disease Markers 2022Methylenetetrahydrofolate reductase (MTHFR) is a critical rate-limiting enzyme in the homocysteine/methionine metabolism pathway that is implicated in the pathogenesis... (Meta-Analysis)
Meta-Analysis
Methylenetetrahydrofolate reductase (MTHFR) is a critical rate-limiting enzyme in the homocysteine/methionine metabolism pathway that is implicated in the pathogenesis and progression of autoimmune diseases. Previous association studies have been performed to investigate the effect of polymorphisms in on the risk of autoimmune diseases with inconsistent results. Therefore, this meta-analysis was designed to assess the association between the 677 C/T and 1298 A/C polymorphisms and the susceptibility to autoimmune diseases. We identified reports by a literature search in the following electronic databases: PubMed, Ovid, Web of science, and China National Knowledge Infrastructure. Statistical analyses of the summary odds ratios (ORs) and 95% confidence intervals (CIs) were done using STATA software. In a recessive genetic model, the 677 C/T polymorphism was associated with an increased risk of Behcet's disease (OR = 1.97, 95% CI, 1.31-2.97), multiple sclerosis (OR = 1.57, 95% CI, 1.03-2.38), and ankylosing spondylitis (OR = 2.90, 95% CI, 1.92-4.38). The 1298 A/C polymorphism was associated an increased risk of multiple sclerosis in a heterozygote comparison (OR = 2.36, 95% CI, 1.29-4.30) and in a dominant model (OR = 2.31, 95% CI, 1.24-4.29). This meta-analysis demonstrated that the 677 C/T was a risk factor for Behcet's disease, multiple sclerosis, and ankylosing spondylitis, and the 1298 A/C was a risk factor for multiple sclerosis.
Topics: Autoimmune Diseases; Behcet Syndrome; Genetic Predisposition to Disease; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Multiple Sclerosis; Polymorphism, Genetic; Spondylitis, Ankylosing
PubMed: 35686035
DOI: 10.1155/2022/4568145 -
Clinical and Experimental Rheumatology 2020The objective of this systematic literature review was to evaluate the effect of obesity and/or body mass index (BMI) on radiographic findings of spondyloarthritis (SpA)...
OBJECTIVES
The objective of this systematic literature review was to evaluate the effect of obesity and/or body mass index (BMI) on radiographic findings of spondyloarthritis (SpA) for both axial and peripheral inflammation and damage.
METHODS
Medline, Embase and Cochrane databases were screened on February 13, 2017. The titles and the abstracts were independently screened by two investigators. Articles that have evaluated the link between BMI and plain radiography, ultrasound (US) and magnetic resonance imaging (MRI) in SpA were investigated.
RESULTS
The literature search resulted in 613 articles, 5 of which met the inclusion criteria for the final analysis. Studies mostly investigated the effect of BMI on axial disease and mostly in ankylosing spondylitis. The major finding was that a higher BMI was closely related with new bone formation including syndesmophytes, enthesophytes and also a higher modified Stoke Ankylosing Spondylitis Spinal Score. Fewer studies looked at the effect of BMI on the peripheral enthesis which found a moderately positive correlation between the Madrid Sonographic Enthesitis Index for enthesitis on US and BMI. Gender was a significant factor to influence this link with one study correlated US enthesophyte scores with BMI in males but not in females. No studies on MRI met the inclusion criteria to be included.
CONCLUSIONS
BMI is linked to both axial and peripheral new bone formation and entheseal inflammation by imaging, as supported by the limited number of studies in the literature. Its effect on the sacroiliac joint and spinal inflammation is not clear as MRI studies are lacking.
Topics: Body Mass Index; Female; Humans; Inflammation; Magnetic Resonance Imaging; Male; Obesity; Severity of Illness Index; Spondylarthritis; Spondylitis, Ankylosing
PubMed: 31074718
DOI: No ID Found