A meta-analysis of efficacy and safety of genotype-guided versus standard of care treatment strategies in selecting antiplatelet therapy in patients with acute coronary syndrome

2020 ◽  
Author(s):  
Salik Nazir ◽  
Keerat R. Ahuja ◽  
Hafeez U. H. Virk ◽  
Ahmed Elzanaty ◽  
Tayyab A. Waheed ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Standard Of Care ◽  
Efficacy And Safety ◽  
Coronary Syndrome ◽  
Care Treatment ◽  
Standard Of Care Treatment

Efficacy and Safety of Oral P2Y12 Inhibitors in Older Patients with Acute Coronary Syndrome: A Frequentist Network Meta-Analysis

Drugs & Aging ◽  
2021 ◽  
Author(s):  
Izza Shahid ◽  
Muhammad Abdullah Nizam ◽  
Vanita Motiani ◽  
Ritesh G. Menezes ◽  
Unaiza Naeem ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Older Patients ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome

Response to placebo in non-renal, non-neuropsychiatric systemic lupus erythematosus: a systematic review and pooled analysis

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 73-80
Author(s):  
Konstantinos Tselios ◽  
Laura Wakani ◽  
Dafna D Gladman ◽  
Jiandong Su ◽  
Murray B Urowitz
Keyword(s):  
Systematic Review ◽  
Lupus Erythematosus ◽  
Standard Of Care ◽  
Data Retrieval ◽  
Efficacy And Safety ◽  
End Points ◽  
Care Treatment ◽  
Pubmed Database ◽  
Neuropsychiatric Sle ◽  
Standard Of Care Treatment

Abstract Objectives Most randomized controlled trials (RCTs) in SLE have failed to reach their respective end points, with the rates of response to placebo (plus standard-of-care treatment) being unexpectedly high. The aim of this systematic review was to quantify the response to placebo in non-renal, non-neuropsychiatric lupus. Methods The PubMed database was searched (from 2000 to December 2019) for phase II/III RCTs assessing the efficacy and safety of biologics in non-renal, non-neuropsychiatric SLE. Data on the efficacy and safety of the placebo-treated patients were collected in a pre-established data retrieval form. Descriptive statistics were used. Results A total of 24 RCTs (n = 11128 in total) were included. Placebo-treated patients (n = 3899) were mostly females (93.5%), Caucasians (60.2%), of mean age 39.7 years, and having a mean disease duration of 7.4 years. Their mean initial SLEDAI 2000 was 10.4, whereas 60.5% had positive anti-dsDNA antibodies, 41.9% low C3 and 35.6% low C4 at randomization. Standard-of-care treatment included glucocorticosteroids in 85.9%, antimalarials in 72.8% and immunosuppressives in 48.5%. The response to placebo was 36.2% for the primary end point (as defined in each study), 39.8% for the SLE Responder Index-4 (SRI-4), 29.2% for SRI-5, 28.4% for SRI-6 and 30.9% for BILAG-based Combined Lupus Assessment response. Regarding safety, there were serious adverse events in 16.3% of patients, serious infections in 5.5% and malignancies in 0.3%, and death occurred in 0.56% of patients. Conclusion More than one-third of the placebo-treated patients achieved their respective primary end points in RCTs with biologics in non-renal, non-neuropsychiatric SLE. The response rate was higher for certain end points, such as the SRI-4, while it decreased with more stringent end points.

scholarly journals Acute Coronary Syndrome, Antiplatelet Therapy, and Bleeding: A Clinical Perspective

2020 ◽  
Vol 9 (7) ◽  
pp. 2064
Author(s):  
Gregorio Tersalvi ◽  
Luigi Biasco ◽  
Giacomo Maria Cioffi ◽  
Giovanni Pedrazzini
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Platelet Function ◽  
Clinical Decision Making ◽  
Treatment Strategies ◽  
Clinical History ◽  
Bleeding Risk ◽  
Bleeding Complications ◽  
Coronary Syndrome

Inhibition of platelet function by means of dual antiplatelet therapy (DAPT) is the cornerstone of treatment of acute coronary syndrome (ACS). While preventing ischemic recurrences, inhibition of platelet function is clearly associated with an increased bleeding risk, a feared complication that may lead to significant morbidity and mortality. Since bleeding risk management is intrinsically associated with therapeutic adjustments undertaken during the whole clinical history of patients with acute coronary syndrome, single decisions taken from the very first day to years of follow-up might be decisive. This review aims at providing a clinically oriented, patient-tailored approach in reducing the risk and manage bleeding complications in ACS patients treated with DAPT. The steps in clinical decision making from the day of ACS to follow-up are analyzed. New treatment strategies to enhance the safety of DAPT are also described.

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