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International Urology and Nephrology Mar 2015We carried out a systematic review and meta-analysis to assess the efficacy and safety of imidafenacin for treating overactive bladder in adult. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We carried out a systematic review and meta-analysis to assess the efficacy and safety of imidafenacin for treating overactive bladder in adult.
METHODS
A literature review was performed to identify all published randomized placebo-controlled trials of imidafenacin for the treatment of OAB. The search included the following databases: MEDLINE, EMBASE. The reference lists of retrieved studies were also investigated.
RESULTS
Five publications involving a total of 1,428 patients were used in the analysis, which compared imidafenacin with propiverine and solifenacin. We found that imidafenacin was effective in treating OAB in our meta-analysis, which was similar to propiverine in its efficacy. The mean number of UI per week (the standardized mean difference (SMD) = 1.23, 95% CI -0.19 to 2.65, p = 0.09), the mean number of urgency episodes per day (SMD = 0.26, 95% CI -0.11 to 0.63, p = 0.17), the mean number of micturitions per day (SMD = 0.01, 95% CI -0.30 to 0.31, p = 0.96), and the mean urine volume (ml) per micturition (SMD = -13.04, 95% CI -20.45 to -5.62, p = 0.0006) indicated that imidafenacin was similar to propiverine in its efficacy. Mean OABSS (SMD = 0.48, 95% CI -0.08 to 1.03, p = 0.09) indicated that imidafenacin was also similar to solifenacin in its efficacy. Besides, imidafenacin was better tolerated than propiverine in the safety, indicated by dry mouth (OR 0.73, 95% CI 0.54-0.98, p = 0.04) and any adverse events (OR 0.63, 95% CI 0.46-0.88, p = 0.006). Moreover, imidafenacin was also better tolerated than solifenacin in the safety, indicated by constipation (OR 0.21, 95% CI 0.08-0.53, p = 0.001) and any adverse events (OR 0.33, 95% CI 0.15-0.71, p = 0.004).
CONCLUSIONS
This meta-analysis indicates that imidafenacin was similar to propiverine or solifenacin in its efficacy for OAB and was better tolerated than propiverine or solifenacin in the safety for OAB. We conclude that imidafenacin is preferable to propiverine or solifenacin from a perspective of safety.
Topics: Adult; Benzilates; Constipation; Humans; Imidazoles; Randomized Controlled Trials as Topic; Solifenacin Succinate; Urinary Bladder, Overactive; Urological Agents; Xerostomia
PubMed: 25636812
DOI: 10.1007/s11255-015-0916-1 -
Reviews on Recent Clinical Trials Mar 2013Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children and adolescents. Stimulants are commonly prescribed for ADHD management.... (Review)
Review
Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children and adolescents. Stimulants are commonly prescribed for ADHD management. There is clinical trial evidence that some medications with noradrenergic properties such as atomoxetine are effective. It is of theoretical and practical importance if other agents with noradrenergic properties display a comparable pattern of efficacy. This paper is a systematic review of the efficacy and safety of venlafaxine for treating children and adolescents with ADHD. MEDLINE, Google scholar, Scopus, and Web of science (ISI) databases were electronically searched in July 2012, updated on November 2012. Time and language of publication were not exclusion criteria. Efficacy outcomes were assessed by a valid and reliable parent- and/or teacher-reported instrument to evaluate clinical symptoms. Adverse effects were also evaluated. There were three uncontrolled trials and only two double blind controlled clinical trials. Venlafaxine appeared effective for treating ADHD. The rates of some adverse effects of venlafaxine were less than those documented for methylphenidate. While one of the two small controlled trials did not find difference between venlafaxine ad methylphenidate, the other trial reported lower efficacy for venlafaxine. Headache, insomnia, and nausea were among the most common adverse effects. This systematic review provides preliminary support that venlafaxine may have short term utility in treating ADHD in children and adolescents. However, before recommending venlafaxine for treatment, more robust and larger clinical trials, in particular providing evidence of its long-term efficacy, safety and tolerability are required.
Topics: Adolescent; Attention Deficit Disorder with Hyperactivity; Central Nervous System Stimulants; Child; Clinical Trials as Topic; Cyclohexanols; Dose-Response Relationship, Drug; Humans; Methylphenidate; Research Design; Selective Serotonin Reuptake Inhibitors; Venlafaxine Hydrochloride
PubMed: 23157376
DOI: 10.2174/1574887111308010002 -
Clinical and Experimental Rheumatology 2013The aim of this systematic review of the literature and meta-analysis of randomised controlled trials (RCTs) was to compare the efficacy of orally administered... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aim of this systematic review of the literature and meta-analysis of randomised controlled trials (RCTs) was to compare the efficacy of orally administered ketoprofen with that of ibuprofen and/or diclofenac.
METHODS
The literature was systematically reviewed in accordance with the Cochrane Collaboration guidelines. The search was restricted to randomised clinical trials published in the Medline and Embase databases up to June 2011, and comparing the efficacy of oral ketoprofen (50-200 mg/day) with ibuprofen (600-1800 mg/day) or diclofenac (75-150 mg/day).
RESULTS
A total of 13 RCTs involving 898 patients met the inclusion criteria: eight comparing ketoprofen with ibuprofen, and five comparing ketoprofen with diclofenac. The results of the meta-analysis showed a statistically significant difference in efficacy in favour of ketoprofen. The difference between ketoprofen and the pooled ibuprofen/diclofenac data was also statistically significant (0.459, 95% CI 0.33-0.58; p=0.00) at all point-estimates of the mean weighted size effect. Ketoprofen was significantly superior to both diclofenac (mean = 0.422; 95% CI 0.19-0.65; p=0.0007) and ibuprofen (mean = 0.475; 95% CI 0.32-0.62; p=0.0000) at all point-estimates. Heterogeneity for the analysed efficacy outcome was not statistically significant in any of the meta-analyses.
CONCLUSIONS
The efficacy of orally administered ketoprofen in relieving moderate-severe pain and improving functional status and general condition was significantly better than that of ibuprofen and/or diclofenac.
Topics: Administration, Oral; Anti-Inflammatory Agents, Non-Steroidal; Diclofenac; Female; Humans; Ibuprofen; Ketoprofen; Male; Pain; Pain Measurement; Patient Selection; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 23711416
DOI: No ID Found -
Pharmacological Research Sep 2010The term neuroenhancement refers to improvement in the cognitive, emotional and motivational functions of healthy individuals through, inter alia, the use of drugs. Of... (Review)
Review
The term neuroenhancement refers to improvement in the cognitive, emotional and motivational functions of healthy individuals through, inter alia, the use of drugs. Of known interventions, psychopharmacology provides readily available options, such as methylphenidate and modafinil. Both drugs are presumed to be in widespread use as cognitive enhancers for non-medical reasons. Based on a systematic review and meta-analysis we show that expectations regarding the effectiveness of these drugs exceed their actual effects, as has been demonstrated in single- or double-blind randomised controlled trials. Only studies with sufficient extractable data were included in the statistical analyses. For methylphenidate an improvement of memory was found, but no consistent evidence for other enhancing effects was uncovered. Modafinil on the other hand, was found to improve attention for well-rested individuals, while maintaining wakefulness, memory and executive functions to a significantly higher degree in sleep deprived individuals than did a placebo. However, repeated doses of modafinil were unable to prevent deterioration of cognitive performance over a longer period of sleep deprivation though maintaining wakefulness and possibly even inducing overconfidence in a person's own cognitive performance.
Topics: Animals; Benzhydryl Compounds; Central Nervous System Stimulants; Cognition; Emotions; Humans; Methylphenidate; Modafinil; Motivation
PubMed: 20416377
DOI: 10.1016/j.phrs.2010.04.002 -
Journal of Optometry 2018The aim of the present meta-analysis is to compare the efficacy of cyclopentolate and tropicamide in controlling accommodation during refraction. (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
The aim of the present meta-analysis is to compare the efficacy of cyclopentolate and tropicamide in controlling accommodation during refraction.
METHODS
A comprehensive literature search was performed in PubMed, Scopus, Science direct and Ovid databases by the key words: "tropicamide"; "cyclopentolate"; "cycloplegia" and "cycloplegic" from inception to April 2016. Methodological quality of the literature was evaluated according to the Oxford Center for Evidence Based Medicine and modified Newcastle-Ottawa scale. Statistical analyses were performed using Comprehensive Meta-Analysis (version 2; Biostat Inc., USA).
RESULTS
The present meta-analysis included six studies (three randomized controlled trials and three case-control studies). Pooled standardized difference in the mean changes in the refractive error was 0.175 D [lower and upper limits: -0.089; 0.438] more plus in the cyclopentolate group compared to the tropicamide group; however, this difference was not statistically significant (p=0.194; Cochrane Q value=171.72 (p<0.05); I=95.34%). Egger's regression intercept was -5.33 (p=0.170). Considering type of refractive errors; refractive assessment procedure and age group; although cycloplegic effect of cyclopentolate was stronger than tropicamide; however, this effect was only statistically significant in children; hyperopic patients and with retinoscopy.
CONCLUSION
We suggest that tropicamide may be considered as a viable substitute for cyclopentolate due to its rapid onset of action. Although these results should be used cautiously in infants and in patients with high hyperopia or strabismus when using tropicamide as the sole cycloplegic agent especially in situations that the findings are variable or there is no consistency between the examination results and clinical manifestations of the visual problems.
Topics: Accommodation, Ocular; Case-Control Studies; Cyclopentolate; Diagnostic Techniques, Ophthalmological; Humans; Mydriatics; Randomized Controlled Trials as Topic; Refractive Errors; Tropicamide
PubMed: 29132914
DOI: 10.1016/j.optom.2017.09.001 -
Diclofenac Versus Dexamethasone Following Strabismus Surgery: A Systematic Review and Meta-Analysis.Journal of Ocular Pharmacology and... 2021To compare outcomes of diclofenac versus dexamethasone in patients after strabismus surgery. A systematic review and meta-analysis were performed as per the Preferred... (Comparative Study)
Comparative Study Meta-Analysis
To compare outcomes of diclofenac versus dexamethasone in patients after strabismus surgery. A systematic review and meta-analysis were performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was conducted on MEDLINE, EMBASE, EMCARE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL). All randomized controlled trials (RCTs) comparing the outcomes of diclofenac versus dexamethasone poststrabismus surgery were included. An extraction spreadsheet for data collection and Review Manager 5.3 were used for data analysis based on the fixed and random effects models. Discomfort, inflammation, chemosis, conjunctival gap, and intraocular pressure (IOP) were primary outcome measures. Secondary outcomes included conjunctival congestion and injection, discharge, and drop intolerance. Fixed and random effects models were used for the analysis. Five RCTs enrolling 248 subjects were enrolled. At week 2 postoperatively, there was a significant difference favoring diclofenac over dexamethasone in terms of discomfort (mean difference [MD] = -0.37, = 0.02), conjunctival inflammation (MD = -0.16, = 0.02), conjunctival chemosis (MD = -0.16, = 0.04), and postoperative conjunctival gap (MD = -0.17, = 0.002). In terms of IOP, there were no significant differences. However, no statistically significant differences were noted at weeks 1 and 4 postoperatively. For secondary outcomes, dexamethasone had significantly improved conjunctival congestion; however, diclofenac had significantly less injection at the site of muscle attachments at week 2. No significant difference was noted in terms of discharge and drop intolerance. Diclofenac is comparable to dexamethasone when used following strabismus surgery. However, a significant difference favoring diclofenac in terms of discomfort, inflammation, conjunctival chemosis, and conjunctival gap was only noted at 2 weeks postoperatively. The authors suggest conducting further studies to support the effectiveness of diclofenac as an alternative to corticosteroids following strabismus surgery.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Dexamethasone; Diclofenac; Glucocorticoids; Humans; Pain, Postoperative; Prognosis; Randomized Controlled Trials as Topic; Strabismus
PubMed: 33944620
DOI: 10.1089/jop.2020.0133 -
British Journal of Clinical Pharmacology Aug 2023Animal studies suggest that methylphenidate treatment for around 3 months may lead to less mineralized and weaker appendicular bones. A systematic review was conducted...
AIMS
Animal studies suggest that methylphenidate treatment for around 3 months may lead to less mineralized and weaker appendicular bones. A systematic review was conducted to summarize the evidence from observational studies, and a self-controlled case series study was used to compare the risk before and after treatment initiation.
METHODS
Literature search was conducted using PubMed, Embase and the Cochrane Library to identify observational studies on methylphenidate and fractures. We also conducted a self-controlled case series study with individuals aged 5-24 years who received methylphenidate treatment and experienced fractures from 2001 to 2020 in Hong Kong. Incidence rate ratios and 95% confidence intervals were calculated by comparing the incidence rate in the methylphenidate-exposed period compared with nonexposed period.
RESULTS
Six cohort studies and 2 case-control studies were included in the systematic review. For all-cause fractures, studies found a 39-74% lower risk in treated-attention deficit hyperactivity disorder (ADHD) group compared with untreated ADHD but no difference between stimulants and nonstimulants. Differences between sexes and treatment duration were also found-significant results were shown in males and those with longer treatment duration. Among 43 841 individuals with ADHD medication before the year 2020, 2023 were included in the self-controlled case series analysis. The risks of fractures were lower by 32-41% in different treatment periods when compared with 6 months before treatment initiation.
CONCLUSION
Methylphenidate treatment may lower the risk of all-cause fractures from both study designs; however, further evidence is needed about the treatment duration and sex effect. Conclusions on stress fractures are not yet established, and further research is required.
Topics: Male; Humans; Methylphenidate; Central Nervous System Stimulants; Attention Deficit Disorder with Hyperactivity; Cohort Studies; Research Design
PubMed: 36918367
DOI: 10.1111/bcp.15714 -
European Journal of Gastroenterology &... Dec 2016Postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) is the most common complication following ERCP. We carried out a systematic review and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIM
Postendoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis (PEP) is the most common complication following ERCP. We carried out a systematic review and meta-analysis of the global literature on PEP prevention to provide clinical guidance and a framework for future research in this important field.
METHODS
PubMed, Embase, Science Citation Index, Ovid, and the Cochrane Controlled Trials Register were searched by two independent reviewers to identify full-length, prospective, randomized controlled trials (RCTs) published up until March 2016 investigating the use of pancreatic duct stents and pharmacological agents to prevent PEP.
RESULTS
Twelve RCTs comparing the risk of PEP after pancreatic duct stent placement (1369 patients) and 30 RCTs comparing pharmacological agents over placebo (10251 patients) fulfilled the inclusion criteria and were selected for final review and analysis. Meta-analysis showed that prophylactic pancreatic stents significantly decreased the odds of post-ERCP pancreatitis [odds ratio (OR), 0.28; 95% confidence interval (CI), 0.18-0.42]. Significant OR reduction of PEP was also observed in relation to rectal administration of diclofenac (OR, 0.24; 95% CI, 0.12-0.48) and rectal administration of indometacin (OR, 0.59; 95% CI, 0.44-0.79) compared with placebo. Subgroup analysis showed a significant reduction with bolus-administered somatostatin (OR, 0.23; 95% CI, 0.11-0.49). Subgroup analysis showed a significant reduction with bolus-administered somatostatin (OR, 0.23; 95% CI, 0.11-0.49).
CONCLUSION
Pancreatic stent placement, rectal diclofenac, and bolus administration of somatostatin appear to be most effective in preventing post-ERCP pancreatitis.
Topics: Administration, Intravenous; Administration, Rectal; Anti-Inflammatory Agents, Non-Steroidal; Cholangiopancreatography, Endoscopic Retrograde; Diclofenac; Hormones; Humans; Indomethacin; Odds Ratio; Pancreatic Ducts; Pancreatitis; Postoperative Complications; Somatostatin; Stents
PubMed: 27580214
DOI: 10.1097/MEG.0000000000000734 -
European Neuropsychopharmacology : the... Oct 2014To review the evidence from randomized controlled trials (RCTs) on the safety and efficacy of guanfacine in pediatric attention deficit hyperactivity disorder (ADHD), a... (Meta-Analysis)
Meta-Analysis Review
To review the evidence from randomized controlled trials (RCTs) on the safety and efficacy of guanfacine in pediatric attention deficit hyperactivity disorder (ADHD), a bibliographic search up to May 2014 was performed using the Cochrane Library׳s Central Register of Controlled Trials, the Embase, PsycINFO, and Medline databases, and clinical trials registers. The search terms used were: ["guanfacine"] and ["child" or "adolescent" or "pediatrics"] and ["randomized controlled trial"] and ["Attention Deficit Disorder with Hyperactivity" or "Attention Deficit Disorder" or "Attention Hyperactivity Disorder" or "Hyperactivity" or "ADHD"]. A meta-analysis was performed using response, defined as a score ≤ 2 on the Clinical Global Impression Improvement score, as the outcome measure. In all, 7 out of 48 studies were included, for a total of 1752 participants. All studies compared guanfacine versus placebo, with a duration ranging from 6 to 16 weeks. In all, the Clinical Global Impression Improvement score was reported as a secondary measure. Overall, 694/1177 (59.0%) participants in the guanfacine group benefited from the treatment compared to 192/575 (33.3%) in the placebo group (pooled OR 3.2; 95%CI 2.4-4.1). The participants with at least one adverse event were 948 (82.4%) in the guanfacine and 376 (67.9%) in the placebo group (OR 2.6; 95%CI 1.6-4.4). Somnolence (OR 4.9), sedation (OR 2.8), and fatigue (OR 2.2), were the adverse events with the greatest risk of occurrence in the guanfacine versus the placebo group. On the basis of seven randomized, placebo controlled trials guanfacine resulted safe and effective in treating children and adolescents with ADHD.
Topics: Adolescent; Attention Deficit Disorder with Hyperactivity; Child; Guanfacine; Humans; Psychotropic Drugs; Randomized Controlled Trials as Topic
PubMed: 25156577
DOI: 10.1016/j.euroneuro.2014.08.001 -
Addiction (Abingdon, England) Dec 2019Addiction to methamphetamine/amphetamine (MA/A) is a major public health problem. Currently there are no pharmacotherapies for MA/A use disorder that have been approved... (Meta-Analysis)
Meta-Analysis
AIMS
Addiction to methamphetamine/amphetamine (MA/A) is a major public health problem. Currently there are no pharmacotherapies for MA/A use disorder that have been approved for use by the US Food and Drug Administration or the European Medicines Agency. We reviewed the effectiveness of pharmacotherapy for MA/A use disorder to assess the quality, publication bias and overall strength of the evidence.
METHODS
Systematic review and meta-analysis. We searched multiple data sources (MEDLINE, PsycINFO and Cochrane Library) to April 2019 for systematic reviews (SRs) and randomized controlled trials (RCTs). Included studies recruited adults who had MA/A use disorder; sample sizes ranged from 19 to 229 participants. Outcomes of interest were abstinence, defined as 3 or more consecutive weeks with negative urine drug screens (UDS); overall use, analyzed as the proportion of MA/A negative UDS specimens; and treatment retention. One SR of pharmacotherapies for MA/A use disorder and 17 additional RCTs met our inclusion criteria encompassing 17 different drugs (antidepressants, antipsychotics, psychostimulants, anticonvulsants and opioid antagonists). We combined the findings of trials with comparable interventions and outcome measures in random-effects meta-analyses. We assessed quality, publication bias and the strength of evidence for each outcome using standardized criteria.
RESULTS
There was low-strength evidence from two RCTs that methylphenidate may reduce MA/A use: 6.5 versus 2.8% MA/A-negative UDS in one study (n = 34, P = 0.008) and 23 versus 16% in another study (n = 54, P = 0.047). Antidepressants as a class had no statistically significant effect on abstinence or retention on the basis of moderate strength evidence. Studies of anticonvulsants, antipsychotics (aripiprazole), opioid antagonists (naltrexone), varenicline and atomoxetine provided either low-strength or insufficient evidence of no effect on the outcomes of interest. Many of the studies had high or unclear risk of bias.
CONCLUSIONS
On the basis of low- to moderate-strength evidence, most medications evaluated for methamphetamine/amphetamine use disorder have not shown a statistically significant benefit. However, there is low-strength evidence that methylphenidate may reduce use.
Topics: Amphetamine-Related Disorders; Anticonvulsants; Antidepressive Agents; Antipyretics; Drug Therapy; Humans; Methylphenidate; Naltrexone; Outcome Assessment, Health Care; Varenicline
PubMed: 31328345
DOI: 10.1111/add.14755