Efficacy of the biological treatments based on ACR70 response in rheumatoid arthritis: indirect comparison and meta-regression using Bayes-model

2011 ◽  
Vol 152 (23) ◽  
pp. 919-928 ◽  
Author(s):  
Valentin Brodszky
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Duration ◽  
Biological Therapy ◽  
Meta Analysis ◽  
Severe Disease ◽  
Controlled Trials ◽  
Relative Efficacy ◽  
Randomized Controlled ◽  
Biological Treatments ◽  
Meta Regression

The therapy of rheumatoid arthritis has been changed by biological treatments. Their efficacy was evaluated in several randomized controlled trials. These trials were different in patient characteristics and the administration regimen. Placebo was the control and direct comparison of biological treatments is missing. Objectives: In the present study the efficacy of biological treatments in patients with rheumatoid arthritis was compared based on the randomized controlled trials available in the literature. A meta-analysis was conducted and meta-regression was used to explore the relationship between disease characteristic variables and observed efficacy. Results: The related scientific literature is broad. Thirty two trials involving 18,500 patients were included into the current meta-analysis. The relative odds ratios of biological treatments compared to placebo varied between 3.6 and 20.0, and between 6.4 and 35.5 in case of monotherapy and combination with non-biological therapy, respectively. Disease duration and added non-biological therapy were in positive relationship with relative efficacy. More severe disease resulted smaller relative effect. Conclusions: The results show that the efficacy of biological treatments is similar. The relative efficacy worsens with more severe disease and improves with disease duration. Orv. Hetil., 2011, 152, 919–928.

Exercise therapy for sarcopenia in rheumatoid arthritis: A meta-analysis and meta-regression of randomized controlled trials

2021 ◽  
pp. 026921552110355
Author(s):  
Chun-De Liao ◽  
Hung-Chou Chen ◽  
Shih-Wei Huang ◽  
Tsan-Hon Liou
Keyword(s):  
Rheumatoid Arthritis ◽  
Randomized Controlled Trials ◽  
Muscle Mass ◽  
Exercise Therapy ◽  
Treatment Effects ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Regression Analyses ◽  
Randomized Controlled ◽  
Meta Regression

Objective: Rheumatoid arthritis and age are associated with high sarcopenia risk. Exercise is an effective treatment for preventing muscle mass loss in older adult populations. It remains unclear whether exercise affects muscle mass in people with rheumatoid arthritis. Thus, this meta-analysis investigated the effect of exercise on muscle mass gain in patients with rheumatoid arthritis. Data sources: PubMed, EMBASE, the Cochrane Library, the Physiotherapy Evidence Database (PEDro), the China Knowledge Resource Integrated Database, and Google Scholar were systematically searched until June 2021. Methods: The present study was conducted according to the guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Randomized controlled trials (RCTs) that reported the effects of exercise on muscle mass for rheumatoid arthritis were identified. The included RCTs were subject to meta-analysis and risk of bias assessment. Subgroup and random-effects meta-regression analyses were performed to identify any heterogeneity ( I2) of treatment effects across studies. Results: We included nine RCTs with a median PEDro score of 6/10 (range: 4/10–8/10). The weighted mean effect size for muscle mass was 0.77 (95% CI: 0.30–1.24; P = 0.001; I2 = 77%). Meta-regression analyses indicated that the disease duration significantly explained variance of treatment effects across studies (β = −0.006, R2 = 69.7%, P = 0.005). Conclusions: Exercise therapy effectively increased muscle mass in patients with rheumatoid arthritis. Treatment effects may be attenuated in those who have had rheumatoid arthritis for a relatively long time.

scholarly journals Remote Ischemic Preconditioning to Prevent Acute Kidney Injury After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Zigang Liu ◽  
Yongmei Zhao ◽  
Ming Lei ◽  
Guancong Zhao ◽  
Dongcheng Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Randomized Controlled Trials ◽  
Ischemic Preconditioning ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Subgroup Analyses ◽  
Meta Regression

Objective: Randomized controlled trials (RCTs) evaluating the influence of remote ischemic preconditioning (RIPC) on acute kidney injury (AKI) after cardiac surgery showed inconsistent results. We performed a meta-analysis to evaluate the efficacy of RIPC on AKI after cardiac surgery.Methods: Relevant studies were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effect model was used to pool the results. Meta-regression and subgroup analyses were used to determine the source of heterogeneity.Results: Twenty-two RCTs with 5,389 patients who received cardiac surgery −2,702 patients in the RIPC group and 2,687 patients in the control group—were included. Moderate heterogeneity was detected (p for Cochrane's Q test = 0.03, I2 = 40%). Pooled results showed that RIPC significantly reduced the incidence of AKI compared with control [odds ratio (OR): 0.76, 95% confidence intervals (CI): 0.61–0.94, p = 0.01]. Results limited to on-pump surgery (OR: 0.78, 95% CI: 0.64–0.95, p = 0.01) or studies with acute RIPC (OR: 0.78, 95% CI: 0.63–0.97, p = 0.03) showed consistent results. Meta-regression and subgroup analyses indicated that study characteristics, including study design, country, age, gender, diabetic status, surgery type, use of propofol or volatile anesthetics, cross-clamp time, RIPC protocol, definition of AKI, and sample size did not significantly affect the outcome of AKI. Results of stratified analysis showed that RIPC significantly reduced the risk of mild-to-moderate AKI that did not require renal replacement therapy (RRT, OR: 0.76, 95% CI: 0.60–0.96, p = 0.02) but did not significantly reduce the risk of severe AKI that required RRT in patients after cardiac surgery (OR: 0.73, 95% CI: 0.50–1.07, p = 0.11).Conclusions: Current evidence supports RIPC as an effective strategy to prevent AKI after cardiac surgery, which seems to be mainly driven by the reduced mild-to-moderate AKI events that did not require RRT. Efforts are needed to determine the influences of patient characteristics, procedure, perioperative drugs, and RIPC protocol on the outcome.

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