-
Current Oncology (Toronto, Ont.) Jan 2022Patients with epithelial ovarian cancer (EOC), treated with niraparib maintenance, present with haematological and gastrointestinal toxicities. Limited data exist on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Patients with epithelial ovarian cancer (EOC), treated with niraparib maintenance, present with haematological and gastrointestinal toxicities. Limited data exist on niraparib safety assessment.
OBJECTIVE
To evaluate niraparib safety profile, as maintenance therapy, in women with platinum-sensitive EOC.
METHODS
PubMed and Cochrane searches were carried out up to April 2021 for randomised controlled trials (RCTs) evaluating niraparib versus placebo in EOC patients with a response to platinum-based chemotherapy. Regarding the meta-analysis, for dichotomous data, the pooled risk ratio (RR) was calculated.
RESULTS
A total of 1539 patients from three RCTs revealed that niraparib-treated patients are associated with a significantly higher risk of any grade of nausea (RR, 2.15; 95% CI, 1.86 to 2.48), fatigue (RR, 1.26; 95% CI, 1.05 to 1.52, < 0.00001), anemia (RR, 6.86; 95% CI, 2.54 to 18.52, = 0.0001), thrombocytopenia (RR, 7.02; 95% CI, 1.68 to 29.38, < 0.00001), vomiting (RR, 2.51; 95% CI, 1.50 to 4.19, = 0.0005), neutropenia (RR, 2.96; 95% CI, 1.13 to 7.73, < 0.00001), headache (RR, 2.08; 95% CI, 1.57 to 2.74, < 0.00001), constipation (RR, 2.10; 95% CI, 1.72 to 2.57, < 0.00001) and insomnia (RR, 2.48; 95% CI, 1.52 to 2.89, = 0.0003) when compared with placebo. For grade 3 or 4 adverse effects, significantly higher risk was only noted for fatigue (RR,6.25; 95% CI, 1.70 to 23.05, = 0.006), anemia (RR, 16.23; 95% CI, 4.86 to 54.17, < 0.00001), thrombocytopenia (RR, 35.12; 95% CI, 12.23 to 100.82, < 0.00001) and neutropenia episodes (RR, 6.35; 95% CI, 2.08 to 19.39, = 0.001) for those taking niraparib. Notably, incidents of adverse effects and discontinuation rates were substantially lower among patients treated with an individualised niraparib dose than those treated with the standard one. Efficacy was not reduced, and no treatment-related deaths occurred during the included trials.
CONCLUSION
Niraparib is considered an effective and well-tolerated choice, with an improved safety profile, for the maintenance treatment of EOC patients.
Topics: Carcinoma, Ovarian Epithelial; Female; Humans; Indazoles; Neoplasm Recurrence, Local; Ovarian Neoplasms; Piperidines
PubMed: 35049703
DOI: 10.3390/curroncol29010029 -
Medicine Dec 2022To estimate the acute analgesic efficacy of combined Pregabalin and Celecoxib after operation via a systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate the acute analgesic efficacy of combined Pregabalin and Celecoxib after operation via a systematic review and meta-analysis.
METHODS
Studies for inclusion were randomized controlled trials, reporting on relevant outcomes (0-6 hours, 24 hours, 7 days pain scores) with treatment with combined Pregabalin and Celecoxib.
RESULTS
The pooled results from meta-analysis demonstrated that compared with placebo, combined Pregabalin and Celecoxib reduced pain scores at 0 to 6 hours in 3 articles, 24 hours in 5 articles, 7 days in 2 articles (standard mean difference [SMD], -3.10 at 0-6 hours, -2.80 at 24 hours, -1.32 at 7 days, respectively). Combined Pregabalin and Celecoxib could significantly reduce the postoperative narcotic consumption in 3 studies (SMD, -1.99 at 36 hour).
DISCUSSION
This work suggested that combined Pregabalin and Celecoxib were efficacious in reduction of postoperative pain and narcotic requirements after surgery, whereas more trials are needed to further identify the efficacy of combined Pregabalin and Celecoxib in the management of acute postoperative pain.
Topics: Humans; Pregabalin; Celecoxib; Analgesics; Narcotics; Pain, Postoperative
PubMed: 36596023
DOI: 10.1097/MD.0000000000032080 -
Thrombosis Research Mar 2020Direct oral anticoagulants (DOACs) are now the first choice thromboprophylaxis in cancer patients who do not have a high risk of bleeding. In addition to the... (Review)
Review
BACKGROUND
Direct oral anticoagulants (DOACs) are now the first choice thromboprophylaxis in cancer patients who do not have a high risk of bleeding. In addition to the anticoagulant effects, potential anti-tumor effects of DOACs have also been studied in animal cancer models. In this study, we summarize the effects of DOACs on cancer growth and metastasis in animal models through a systematic review with a qualitative analysis.
METHODS
PubMed, EMBASE and Web of Science were systematically searched for original studies that describe animal models of cancer in which one of the experimental groups received DOAC monotherapy, and which reported quantitatively on primary tumor or metastases.
RESULTS
Nine studies - reporting a total of 19 animal experiments - met the inclusion criteria. These 19 experiments included spontaneous cancer (n = 2), carcinogenicity (n = 2), xenograft (n = 7) and syngeneic (n = 8) models, encompassing orthotopic (n = 7), subcutaneous (n = 5), intraperitoneal (n = 1) and intravenous (n = 2) injection of cancer cells and included treatments with the DOACs ximelagatran (n = 4), dabigatran etexilate (n = 6) and/or rivaroxaban (n = 11). DOAC treatment decreased tumor growth at implanted and metastatic site in 18.8% (3/16) and 20.0% (3/15) of the experiments, respectively. Conversely, DOACs increased tumor growth at implanted and metastatic site in 6.3% (1/16) and 20.0% (3/15) of the experiments, respectively.
CONCLUSION
DOAC monotherapy resulted in neoplastic changes in a rat carcinogenicity study, showed a lack of effect in mouse xenograft models, while the effect on cancer growth and metastasis in mouse syngeneic models depended on the timing of DOAC treatment and type of cancer model used.
Topics: Administration, Oral; Animals; Anticoagulants; Antithrombins; Dabigatran; Humans; Mice; Models, Animal; Neoplasms; Pyrazoles; Pyridones; Rats; Rivaroxaban; Venous Thromboembolism
PubMed: 31945588
DOI: 10.1016/j.thromres.2019.12.022 -
Current Neuropharmacology Oct 2021Both prescription and over-the-counter (OTC) drugs recently emerged among novel psychoactive substances (NPS) being reported as ingested for recreational purposes. Among...
BACKGROUND
Both prescription and over-the-counter (OTC) drugs recently emerged among novel psychoactive substances (NPS) being reported as ingested for recreational purposes. Among them, benzydamine (BZY), normally prescribed as an OTC anti-inflammatory drug, is reportedly being diverted and recreationally used.
OBJECTIVE
The aim of this study was to investigate how the misuse of BZY has been reported, illustrating its psychotropic molecular mechanism, and studying its psychopathological effects.
METHODS
We firstly conducted a systematic review of the literature concerning the abuse of BZY and its effects. For data gathering purposes, both PRISMA and PROSPERO guidelines were followed. All research methods were approved by PROSPERO (identification code CRD42020187266). Second, we analysed BZY-related data from the European Monitoring Agency (EMA) Adverse Drug Reactions (ADRs) database recorded during 2005-2020 regarding its abuse.
RESULTS
Eleven articles, published during 1997-2019, were included in our systematic review, including five case reports, four surveys, and two retrospective case series analyses. While nine articles dealt with the recreational use of BZY, two described an oral overdose of the drug. When specified, dosages of BZY consumed ranged from 500 to 1500mg. The EMA dataset contained three cases of BZY abuse.
CONCLUSION
Results from the systematic review showed BZY might be diverted for typical hallucinogenic properties occurring at high dosages. Healthcare professionals should be warned about a possible misuse/abuse of a commonly prescribed anti-inflammatory drug and be vigilant when prescribing it. Physicians working in emergency units should know that psychotic symptoms may be related to BZY abuse.
Topics: Anti-Inflammatory Agents; Benzydamine; Humans; Psychotic Disorders; Retrospective Studies
PubMed: 33441070
DOI: 10.2174/1570159X19666210113151136 -
JBRA Assisted Reproduction Jun 2024To verify, based on a systematic literature review, the effects of the main analgesics on male fertility. (Review)
Review
OBJECTIVE
To verify, based on a systematic literature review, the effects of the main analgesics on male fertility.
DATA SOURCES
The studies were analyzed from the PubMed, SciELO and LILACS databases.
STUDY SELECTION
The articles selected for the present review included: cohort studies; cross-sectional studies, clinical trials; complete studies; studies with animal models that addressed the proposed theme and that were published within the stipulated period from March 1, 2013, to March 31, 2023, in English, Portuguese and Spanish. These would later have to go through inclusion stages such as framing the type of study and exclusion criteria.
DATA COLLECTION
Author's name, year of publication, study population, number of patients, analgesic, administration time, dose, and effect.
CONCLUSIONS
There are in vitro and in vivo studies that link paracetamol and ibuprofen to endocrine and seminal changes that are harmful to male fertility. However, more clinical research is needed to determine the doses and timing of administration that affect fertility. The effects of aspirin on male fertility are still unclear due to the lack of studies and consistent methodologies. There is not enough research on dipyrone and its relationship with male fertility, requiring more studies in this area.
Topics: Humans; Male; Analgesics; Fertility; Infertility, Male; Ibuprofen; Acetaminophen; Animals; Dipyrone; Aspirin
PubMed: 38546117
DOI: 10.5935/1518-0557.20240020 -
Aging Sep 2021Many recent studies have investigated the role of drug interventions for coronavirus disease 2019 (COVID-19) infection. However, an important question has been raised... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Many recent studies have investigated the role of drug interventions for coronavirus disease 2019 (COVID-19) infection. However, an important question has been raised about how to select the effective and secure medications for COVID-19 patients. The aim of this analysis was to assess the efficacy and safety of the various medications available for severe and non-severe COVID-19 patients based on randomized placebo-controlled trials (RPCTs).
METHODS
We did an updated network meta-analysis. We searched the databases from inception until July 31, 2021, with no language restrictions. We included RPCTs comparing 49 medications and placebo in the treatment of severe and non-severe patients (aged 18 years or older) with COVID-19 infection. We extracted data on the trial and patient characteristics, and the following primary outcomes: all-cause mortality, the ratios of virological cure, and treatment-emergent adverse events. Odds ratio (OR) and their 95% confidence interval (CI) were used as effect estimates.
RESULTS
From 3,869 publications, we included 61 articles related to 73 RPCTs (57 in non-severe COVID-19 patients and 16 in severe COVID-19 patients), comprising 20,680 patients. The mean sample size was 160 (interquartile range 96-393) in this study. The median duration of follow-up drugs intervention was 28 days (interquartile range 21-30). For increase in virological cure, we only found that proxalutamide (OR 9.16, 95% CI 3.15-18.30), ivermectin (OR 6.33, 95% CI 1.22-32.86), and low dosage bamlanivimab (OR 5.29, 95% CI 1.12-24.99) seemed to be associated with non-severe COVID-19 patients when compared with placebo, in which proxalutamide seemed to be better than low dosage bamlanivimab (OR 5.69, 95% CI 2.43-17.65). For decrease in all-cause mortality, we found that proxalutamide (OR 0.13, 95% CI 0.09-0.19), imatinib (OR 0.49, 95% CI 0.25-0.96), and baricitinib (OR 0.58, 95% CI 0.42-0.82) seemed to be associated with non-severe COVID-19 patients; however, we only found that immunoglobulin gamma (OR 0.27, 95% CI 0.08-0.89) was related to severe COVID-19 patients when compared with placebo. For change in treatment-emergent adverse events, we only found that sotrovimab (OR 0.21, 95% CI 0.13-0.34) was associated with non-severe COVID-19 patients; however, we did not find any medications that presented a statistical difference when compared with placebo among severe COVID-19 patients.
CONCLUSION
We conclude that marked variations exist in the efficacy and safety of medications between severe and non-severe patients with COVID-19. It seems that monoclonal antibodies (e.g., low dosage bamlanivimab, baricitinib, imatinib, and sotrovimab) are a better choice for treating severe or non-severe COVID-19 patients. Clinical decisions to use preferentially medications should carefully consider the risk-benefit profile based on efficacy and safety of all active interventions in patients with COVID-19 at different levels of infection.
Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Azetidines; COVID-19; Humans; Imatinib Mesylate; Immunologic Factors; Network Meta-Analysis; Oxazoles; Purines; Pyrazoles; SARS-CoV-2; Severity of Illness Index; Sulfonamides; Thiohydantoins; Treatment Outcome; COVID-19 Drug Treatment
PubMed: 34531332
DOI: 10.18632/aging.203522 -
Annals of Palliative Medicine Sep 2022To study and review the effectiveness of oral care interventions for palliative patients for amelioration of clinical conditions affecting oral cavity.
BACKGROUND
To study and review the effectiveness of oral care interventions for palliative patients for amelioration of clinical conditions affecting oral cavity.
METHODS
Following PRISMA standard, a systematic evaluation of articles published between 2000 and 2021 was undertaken utilising five databases on interventions studies. This comprehensive review consists of randomised controlled trials (RCTs) and specific types of non-randomised studies (NRS) examining oral care interventions for palliative patients. Three independent authors screened search records, identified related studies, extracted data and evaluated risk of bias. The key findings of each study were summarised according to the research questions and data that generated during the data extraction procedure.
RESULTS
Out of the 67 identified studies, seven were included in this review (five RCTs and two NRSs) involving head-and-neck cancer, oral cancer, oral mucositis, xerostomia and individuals with malignant disease. Interventions studied were: Ziziphus honey, artificial saliva, CAM2028-Benzydamine, morphine mouthwash, ketamine mouthwash, bethanechol tablets and caphosol with regular oral-care. The durations of interventions in the included studies were largely short-term (six weeks or less). Overall, six studies revealed good results in support of the intervention, with magnitudes of effect ranging from 13.2-10,110.0%. However, just four researches found significant changes, with magnitudes of effect ranging from 50.0-10,110.0%. Although two of the trials have not revealed significant changes in the results, investigations have indicated a reduction in oral conditions in the group with interventions. Only one trial has not indicated an improvement in oral conditions in the groups which received the interventions.
DISCUSSION
By assessing the efficacy of available oral hygiene interventions for palliative patients, this systematic review can help palliative team finds the viable strategies to apply in controlling oral problems among hospice patients. Even though only four of the seven research found a statistically significant difference, most studies found great effectiveness in favour of intervention.
Topics: Benzydamine; Bethanechol; Head and Neck Neoplasms; Humans; Ketamine; Morphine Derivatives; Mouthwashes; Palliative Care; Saliva, Artificial
PubMed: 36096743
DOI: 10.21037/apm-22-215 -
Journal For Immunotherapy of Cancer May 2021COVID-19, the syndrome caused by the infection with SARS-CoV-2 coronavirus, is characterized, in its severe form, by interstitial diffuse pneumonitis and acute...
COVID-19, the syndrome caused by the infection with SARS-CoV-2 coronavirus, is characterized, in its severe form, by interstitial diffuse pneumonitis and acute respiratory distress syndrome (ARDS). ARDS and systemic manifestations of COVID-19 are mainly due to an exaggerated immune response triggered by the viral infection. Cytokine release syndrome (CRS), an inflammatory syndrome characterized by elevated levels of circulating cytokines, and endothelial dysfunction are systemic manifestations of COVID-19. CRS is also an adverse event of immunotherapy (IMTX), the treatment of diseases using drugs, cells, and antibodies to stimulate or suppress the immune system. Graft-versus-host disease complications after an allogeneic stem cell transplant, toxicity after the infusion of chimeric antigen receptor-T cell therapy and monoclonal antibodies can all lead to CRS. It is hypothesized that anti-inflammatory drugs used for treatment of CRS in IMTX may be useful in reducing the mortality in COVID-19, whereas IMTX itself may help in ameliorating effects of SARS-CoV-2 infection. In this paper, we focused on the potential shared mechanisms and differences between COVID-19 and IMTX-related toxicities. We performed a systematic review of the clinical trials testing anti-inflammatory therapies and of the data published from prospective trials. Preliminary evidence suggests there might be a benefit in targeting the cytokines involved in the pathogenesis of COVID-19, especially by inhibiting the interleukin-6 pathway. Many other approaches based on novel drugs and cell therapies are currently under investigation and may lead to a reduction in hospitalization and mortality due to COVID-19.
Topics: Anti-Inflammatory Agents; Antibodies, Monoclonal, Humanized; COVID-19; Cytokine Release Syndrome; Humans; Immunization, Passive; Immunotherapy; Interleukin 1 Receptor Antagonist Protein; Interleukin-1beta; Interleukin-6; Nitriles; Pyrazoles; Pyrimidines; SARS-CoV-2; Tumor Necrosis Factor-alpha; COVID-19 Serotherapy; COVID-19 Drug Treatment
PubMed: 33986127
DOI: 10.1136/jitc-2021-002392 -
Journal of the American Heart... Jul 2019Background Several studies have investigated the effect of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer, but the... (Meta-Analysis)
Meta-Analysis
Background Several studies have investigated the effect of non-vitamin K antagonist oral anticoagulants (NOACs) in atrial fibrillation (AF) patients with cancer, but the results remain controversial. Therefore, we conducted a meta-analysis to compare the efficacy and safety of NOACs versus warfarin in this population. Methods and Results We systematically searched the PubMed and Embase databases until February 16, 2019 for studies comparing the effect of NOACs with warfarin in AF patients with cancer. Risk ratios (RRs) with 95% CIs were extracted and pooled by a random-effects model. Five studies involving 8908 NOACs and 12 440 warfarin users were included. There were no significant associations between cancer status and risks of stroke or systemic embolism, major bleeding, or death in AF patients. Compared with warfarin, NOACs were associated with decreased risks of stroke or systemic embolism (RR, 0.52; 95% CI, 0.28-0.99), venous thromboembolism (RR, 0.37, 95% CI, 0.22-0.63), and intracranial or gastrointestinal bleeding (RR, 0.65; 95% CI, 0.42-0.98) and with borderline significant reductions in ischemic stroke (RR, 0.63; 95% CI, 0.40-1.00) and major bleeding (RR, 0.73; 95% CI, 0.53-1.00). In addition, risks of efficacy and safety outcomes of NOACs versus warfarin were similar between AF patients with and without cancer. Conclusions In patients with AF and cancer, compared with warfarin, NOACs had lower or similar rates of thromboembolic and bleeding events and posed a reduced risk of venous thromboembolism.
Topics: Anticoagulants; Atrial Fibrillation; Dabigatran; Embolism; Factor Xa Inhibitors; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Intracranial Hemorrhages; Neoplasms; Pyrazoles; Pyridines; Pyridones; Rivaroxaban; Stroke; Thiazoles; Venous Thromboembolism; Warfarin
PubMed: 31310583
DOI: 10.1161/JAHA.119.012540 -
BMC Immunology Mar 2020Allogeneic hematopoietic stem cell transplantation (allo-HSCT) and immunosuppressive therapy (IST) are two major competing treatment strategies for acquired aplastic... (Review)
Review
BACKGROUND
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) and immunosuppressive therapy (IST) are two major competing treatment strategies for acquired aplastic anemia (AA). Whether allo-HSCT is superior to IST as a front-line treatment for patients with AA has been a subject of debate. To compare the efficacy and safety of allo-HSCT with that of IST as a front-line treatment for patients with AA, we performed a meta-analysis of available studies that examined the impact of the two major competing treatment strategies for AA.
RESULTS
Fifteen studies including a total of 5336 patients were included in the meta-analysis. The pooled hazard ratio (HR) for overall survival (OS) was 0.4 (95% CI 0.074-0.733, P = 0.016, I = 58.8%) and the pooled HR for failure-free survival (FFS) was 1.962 (95% CI 1.43-2.493, P = 0.000, I = 0%). The pooled relative risk (RR) for overall response rate (ORR) was 1.691 (95% CI 1.433-1.996, P = 0.000, I = 11.6%).
CONCLUSION
Although survival was significantly longer among AA patients undergoing first-line allo-HSCT compared to those undergoing first-line IST, the selection of initial treatment for patients with newly diagnosed AA still requires comprehensive evaluation of donor availability, patient age, expected quality of life, risk of disease relapse or clonal evolution after IST, and potential use of adjunctive eltrombopag.
Topics: Anemia, Aplastic; Animals; Benzoates; Combined Modality Therapy; Hematopoietic Stem Cell Transplantation; Humans; Hydrazines; Immunosuppression Therapy; Pyrazoles; Transplantation, Homologous
PubMed: 32138642
DOI: 10.1186/s12865-020-0340-x