Comparative Efficacy and Acceptability of Pharmacological Treatments for Ischaemic Optic Neuropathy: A Multiple-Treatment Meta-Analysis.

Comparative efficacy and acceptability of antidepressant treatment in patients with post-stroke depression: a multiple-treatments meta-analysis

Objective To investigate the clinical efficacy of Troxerutin combined with Dexamethasone for corneal edema after phacoemulsification. Methods Two hundred eyes of 198 cases of serious corneal edema after cataract phacoemulsification were randomly divided into the control group and the observation group. The patients in the observation group received peribulbar injection of Troxerutin and Dexamethasone additionally except the treatments in the control group. The fading time of corneal edema of 100 eyes in each group and the number of eyes with transparent cornea at 1, 3, 5 and 7 d after the surgery were observed and compared. Results The fading time of corneal edema in the observation group was shorter than that in the control group.On one day after the surgery, the number of eyes with transparent cornea was 100 in each group.The numbers of patients with corneal edema were 45 versus 15 (t=21.43), 66 versus 32 (t=23.13) and 82 versus 45 (t=29.53), respectively, on the 3, 5, 7th d after surgery in the control group and observation group and the differences were statistically significant (P<0.005). Conclusion Troxerutin and Dexamethasone for the recovery of corneal edema after cataract surgery is effective. Key words: Surgery, cataract; Edema corneal; Dexamethasone; Troxerutin; Peribulbar injection

Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis

Comparison of the effect of ranibizumab and dexamethasone implant in diabetic macular edema with concurrent epiretinal membrane

Background:New generation antidepressant therapies, including serotonin–norepinephrine reuptake inhibitor (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) were introduced in the late 1980s; however, few comprehensive studies compared the benefits and risks of various contemporary treatments for major depressive disorder (MDD) in pediatric patients.Objective:Multiple-treatments meta-analysis (MTM) was conducted to assess efficacy, acceptability, and safety of contemporary interventions in children and adolescents with MDD.Methods:Cochrane Library, AMED, CINAHL, EMBASE, LiLACS, MEDLINE, PSYCINFO, PSYNDEX, and Journal of Medicine and Pharmacy databases were searched for randomized controlled trials (RCTs) comparing medicinal interventions (citalopram, escitalopram, fluoxetine, mirtazapine, paroxetine, sertraline, venlafaxine), cognitive behavioral therapy (CBT), combined fluoxetine with CBT, and placebo treatment for acute MDD from January 1988 to March 2013. Treatment success, dropout rate, and suicidal ideation/attempt outcomes were measured. Bayesian methods were used to conduct a MTM including age and funding subgroups.Results:A total of 21 RCTs (4969 participants) were identified. Combined fluoxetine/CBT exhibited the highest efficacy, with fluoxetine alone superior to CBT, paroxetine, sertraline, citalopram, escitalopram, and placebo treatment. Sertraline, paroxetine, escitalopram, and venlafaxine showed superior acceptability to fluoxetine and combined fluoxetine/CBT. Combined fluoxetine/CBT combination was less safe, though CBT was safer than fluoxetine alone. Combined fluoxetine/CBT, fluoxetine, and mirtazapine exhibited the highest efficacy; sertraline, escitalopram, venlafaxine, and paroxetine were the best tolerated; and mirtazapine and venlafaxine were the safest.Conclusions:Sertraline and mirtazapine exhibited optimally balanced efficacy, acceptability, and safety for first-line acute treatment of child and adolescent MDD.

BackgroundRecent years have witnessed the rapid evolution of therapies in chronic-phase chronic myeloid leukemia (CP-CML). To assess the efficacy and tolerability of all reported front-line treatments for patients with newly diagnosed CML, a multiple-treatments meta-analysis was performed, which accounted for both direct and indirect comparisons among those treatments.MethodsPrimary outcomes were the percentage of patients achieving major molecular response (MMR) and complete cytogenetic response (CCyR) within 12 months. Secondary outcomes included the percentage of progression to accelerated phase (AP), serious adverse effects (AEs), overall discontinuation and discontinuation for drug-related AEs. Direct pairwise meta-analysis and indirect multi-comparison meta-analysis among those treatments in each outcome were both conducted. The surface under the cumulative ranking curve (SUCRA) was calculated for all treatments in each outcome. Cluster analysis demonstrated the division of treatments into distinct groupings according to efficacy and tolerability profiles.ResultsA total of 21 randomized controlled trials (RCTs, including 10,187 patients) comparing 15 different interventions for CP-CML patients were included in this study. SUCRA analysis suggested that all tyrosine kinase inhibitors (TKIs) are highly effective in newly diagnosed CP-CML when compared to traditional drugs. Newer TKIs and higher-dose imatinib generally resulted in faster cytogenetic and molecular responses when compared with standard-dose imatinib and traditional drugs. Furthermore, traditional drugs, higher-dose imatinib and newer TKIs demonstrated lower acceptability than standard-dose imatinib. One cluster of interventions, which included nilotinib (300/400 mg BID), dasatinib (100 mg QD) and radotinib (300 mg BID), demonstrated higher efficacy and tolerability than other treatments.ConclusionsNilotinib (300/400 mg BID), dasatinib (100 mg QD) and radotinib (300 mg BID) prove to be the most recommended front-line treatments of the greatest efficacy and tolerability for CP-CML patients. High-dose therapies are recommended only for patients in accelerated phase/blast phase or with suboptimal CML-CP response, and management of adverse events should be carried out to avoid compromising the clinical efficacy.

Objective To compare the efficary between posterior subtenon injection of triamcinolone acetonide(TA)and intravitreal injection of ranibizumab for the treatment of non-artertic anterior ischemic optic neuropathy (NAION). Methods Total of 60 eyes of 60 patients who were diagnosed as NAION from Jun. 2016 to Jun. 2018 were randomly divided into two groups.Group A, 30 eyes of 30 patients, received poeterior subtenon injection of triamcinolone acetonide (TA, 20mg). Group B, 30 eyes of 30 cases, received intravitreal injection of ranibizumab. The visual acuity, visual field and optic disc edema were recorded after treatment. Results The visual acuity, visual field and optic disc edema at 15 days after treatment were improved.In group A the vision field improved in 14 eyes (93.33%)among 15 eyes who received visual field examination, unchannged in 1 eye (6.67%). In group B the vision field were improved in 12 eyes(83.33%)among 15 eyes who received visual field examination, and unchannged in 3 eyes(16.67%). Conclusion Triamcinolone acetonide (TA) has the same efficacy as ranibizumab in the treatment of NAION.Triamcinolone acetonide are superior to Ranibizumab in economics and safety. Key words: Neuropathy, optic, ischemic, anterior, non-arteritic; Triamcinolone acetonide, subtenon injection; Ranibizumab, intravitreal injection

FROM: Taylor DM, Cornelius V, Smith L, et al . Comparative efficacy and acceptability of drug treatments for bipolar depression: a multiple-treatments meta-analysis. Acta Psychiatr Scand 2014;130:452–69. Bipolar disorder is...

Objective To evaluate the treatment efficacy and safety of troxerutin and cerebroprotein hydrolysate injection(TCHI) in patients with traumatic brain injury. Methods A total of 360 patients with traumatic brain injury were admitted to neurosurgery departments at 10 medical centers (mainly led by Beijing Hospital of Health Ministry) and enrolled into this prospective, multi-center, placebo-controlled, clinical trial from June 2013 to July 2014. Through stratified random sampling, patients were randomized into the TCHI (n=240) group and placebo group (n=120). TCHI(40 mg/ml, 2ml/d, iv) or placebo had been intravenously administered for 14 days starting from patient admission. The parameters were compared between the two groups that included Glasgow coma scale (GCS), Glasgow outcome scale (GOS), level of consciousness, language and motor functions, Karnofsky performance status scale (KPS) and incidence rate of adverse events. Results The study was successfully conducted in 321 out of the 360 cases, which included 213 patients in the TCHI group and 108 patients in the placebo group. The treatment lasted 14 days in both groups. The GCS in TCHI group (14.1±2.0) was significantly higher than that in placebo group (13.4±2.3) (P=0.007), and the ratio of consciousness in TCHI group was remarkably higher than that in placebo group (81.8% vs. 70.0%) (P=0.036). At the 30-day follow-up, the rate of good outcomes assessed by GOS (82.3% vs. 58.1%), rate of normal verbal functional (86.1% vs 61.9%), rate of normal function in upper/lower limb (88.9%/90.4% vs. 78.1%/81.9%) and KPS score(91.3 vs. 89.1) (P<0.05). No serious adverse effects were noted in either group. Conclusion TCHI could be helpful for shortening the coma period and improving the patient's life quality as well as long-term outcome. Key words: Craniocerebral trauma; Multicenter study; Randomized controlled trial; Troxerutin and cerebroprotein hydrolysate injection

Indirect Comparison Using Individual Patient Level Data Comparing Efficacy and Safety of a Daratumumab Monotherapy Vs. EU Approved Comparator Therapies in Patients with Multiple Myeloma

Journal of Comparative Effectiveness ResearchVol. 1, No. 3 CommentaryComparative effectiveness research: a view from the other side of the pondMichael D RawlinsMichael D RawlinsNational Institute for Health & Clinical Excellence, London, UK and London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. Search for more papers by this authorEmail the corresponding author at michael.rawlins@nice.org.ukPublished Online:18 May 2012https://doi.org/10.2217/cer.12.17AboutSectionsView ArticleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinkedInRedditEmail View articleReferences1 Doll R, Peto R. Randomised controlled trials and retrospective controls. Br. Med. J.280(6206),44 (1980).Crossref, Medline, CAS, Google Scholar2 Glasziou P, Chalmers I, Rawlins M, McCulloch P. When are randomised controlled trials unnecessary? Picking signal from noise. BMJ334(7589),349–351 (2007).Crossref, Medline, Google Scholar3 Garside R, Round A, Dalziel K, Stein K, Royle P. The effectiveness and cost–effectiveness of imatinib in chronic myeloid leukaemia. Health Technol. Assess.6(33),1–162 (2002).Crossref, Medline, CAS, Google Scholar4 Jong GW, van der Linden PD, Bakker EM et al. Unlicensed and off-label drug use in a paediatric ward of a general hospital in the Netherlands. Eur. J. Clin. Pharmacol.58(4),293–297 (2002).Crossref, Medline, Google Scholar5 Lindell-Osuagwu L, Korhonen MJ, Saano S, Helin-Tanninen M, Naaranlahti T, Kokki H. Off-label and unlicensed drug prescribing in three paediatric wards in Finland and review of the international literature. J. Clin. Pharm. Ther.34(3),277–287 (2009).Crossref, Medline, CAS, Google Scholar6 Caldwell DM, Ades AE, Higgins JP. Simultaneous comparisons of multiple treatments: combining direct and indirect evidence. BMJ331(7521),897–900 (2005).Crossref, Medline, Google Scholar7 Rawlins MD. Therapeutics, Evidence and Decision-Making. Hodder Arnold, London, UK (2011).Google Scholar8 Jansen JP, Fleurence R, Devine B et al. Interpreting indirect treatment comparisons and network meta-analysis for health-care decision making: report of the ISPOR task force on indirect treatment comparisons good research practices: part 1. Value Health14(4),417–428 (2011).Crossref, Medline, Google Scholar9 Cipriani A, Furukawa TA, Salanti G et al. Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis. Lancet373(9665),746–755 (2009).Crossref, Medline, CAS, Google Scholar10 Schwarz D, Lellouch J. Explanatory and pragmatic attitudes in therapeutic trials. J. Chronic Dis.20(8),637–648 (1967).Crossref, Medline, Google Scholar11 Quanstrum KH, Hayward RA. Lessons from the mammography wars. N. Engl. J. Med.363(11),1076–1078 (2010).Crossref, Medline, CAS, Google Scholar12 Hackshaw A. Benefits and harms of mammography screening. BMJ344,D8279 (2012).Crossref, Medline, Google Scholar13 Gotzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst. Rev.19(1),CD001877 (2011).Google Scholar101 Gingrich N, Rawlins MD. Economist Debates. This house believes that the widespread use of comparative effectiveness reviews and cost/benefit analyses will stifle medical innovation and lead to an unacceptable rationing of healthcare (2009). The Economist Newspaper Limited© (2011). www.economist.com/debate/overview/155 (Accessed February 2012)Google ScholarFiguresReferencesRelatedDetailsCited ByA translation table for patient-centered comparative effectiveness research: guidance to improve the value of research for clinical and health policy decision-makingSean R Tunis, Donna A Messner, Penny Mohr, Richard E Gliklich & Robert W Dubois18 May 2012 | Journal of Comparative Effectiveness Research, Vol. 1, No. 3 Vol. 1, No. 3 Follow us on social media for the latest updates Metrics Downloaded 142 times History Published online 18 May 2012 Published in print May 2012 Information© Future Medicine LtdFinancial & competing interests disclosureM Rawlins has been chairman of the National Institute for Health and Clinical Excellence since 1999. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.No writing assistance was utilized in the production of this manuscript.PDF download

Dexamethasone(DEX)(6mg/sm/d) and Prednisolone(PRED)(60mg/sm/d) in Induction Therapy of Childhood ALL Are Equally Effective: Results of the 2nd Interim Analysis of EORTC Trial 58951

Su1134 Comparative Efficacy of Biologic Therapy in the Management of Biologic-Naive Patients With Ulcerative Colitis: An Indirect Treatment Comparison Meta-Analysis

Background:The vascular endothelial growth factor inhibitor bevacizumab (BEV) given in combination with interferon-α-2a (IFN), and the tyrosine kinase inhibitors (TKIs) sunitinib (SUN) and pazopanib (PAZ), have all shown significant increase in progression-free survival (PFS) in first-line metastatic renal-cell carcinoma (mRCC) therapy. These targeted therapies are currently competing to be primary choice; hence, in the absence of direct head-to-head comparison, there is a need for valid indirect comparison assessment.Methods:Standard indirect comparison methods were applied to independent review PFS data of the pivotal Phase III trials, to determine indirect treatment comparison hazard-ratios (HR) with 95% confidence intervals (95% CI). As BEV+IFN and SUN have been compared to IFN, indirect comparison was enabled by the common IFN comparator arms. As PAZ was compared to placebo (PLA), a connector trial (IFN vs PLA) was required for the indirect comparison to BEV+IFN. Sensitivity analyses taking into account real-life influence of patient compliance on clinical outcomes were performed.Results:The indirect efficacy comparison resulted in a statistically nonsignificant PFS difference of BEV+IFN vs SUN (HR: 1.06; 95% CI: 0.78–1.45; P = 0.73) and of BEV+IFN vs PAZ (range based on different connector trials; HR: 0.74–1.03; P = 0.34–0.92). Simulating real-life patient compliance and its effectiveness impact showed an increased tendency towards BEV+IFN without reaching statistical significance.Conclusions:There is no statistically significant PFS difference between BEV+IFN and TKIs in first-line mRCC. These findings imply that additional treatment decision criteria such as tolerability and therapy sequencing need to be considered to guide treatment decisions.

Comparative efficacy and acceptability of antimanic drugs in acute mania: a multiple-treatments meta-analysis