Network Meta-analysis Research Articles

Comparative Efficacy of Different Pharmacological Treatments for Pityriasis Rosea: A Network Meta-Analysis

Background/Objectives: Pityriasis rosea (PR) is a self-limiting exanthematous disease associated with the endogenous reactivation of human herpesviruses (HHV)-6 and HHV-7. Classically, the lesions gradually resolve, leaving no sequelae. Therefore, the best treatment is reassuring the patient and suggesting a resting period. However, atypical PR cases characterized by extensive, persistent lesions and systemic symptoms may impact the patient’s quality of life, and, therefore, a treatment can be prescribed. There is limited evidence on the comparative effectiveness of pharmacological treatments for PR; therefore, we performed a network meta-analysis to compare these interventions. Methods: Overall, 12 randomized control trials (RCTs) were identified. The outcomes were itch resolution and rash improvement. Results were expressed as risk ratio (RR) and 95% confidence interval (CI). We also calculated the relative ranking of the interventions for achieving the aforementioned outcomes as their surface under the cumulative ranking (SUCRA). Results: On network meta-analysis, only oral steroids and the combination of oral steroids+antihistamine resulted significantly superior to the placebo in terms of itch resolution (RR 0.44, CI 0.27–0.72 and RR 0.47, CI 0.22–0.99). Oral steroids resulted in the best treatment (SUCRA 0.90) for itch resolution. In terms of rash improvement, only acyclovir and erythromycin resulted significantly superior to placebo (RR 2.55, CI 1.81–3.58; and RR 1.69, CI 1.23–2.33), and acyclovir outperformed all the other tested interventions. Consequently, acyclovir ranked as the best intervention (SUCRA score 0.92). Conclusions: Acyclovir represents the best option for patients with PR that have extensive, persistent lesions or systemic symptoms. Steroids and antihistamines seemed the best treatment for itch resolution.

Comparison of nonimplantable electrical stimulation in women with urinary incontinence: a systematic review and network meta-analysis of randomized controlled trials.

This study examined the effectiveness of various electrical stimulation methods in alleviating symptoms and enhancing the quality of life for women with urinary incontinence. We conducted a systematic search of PubMed, Cochrane Library, PEDro, EMBASE, and ClinicalTrials.gov from inception to August 2024. Randomized controlled trials (RCTs) that meet following criteria were included, urinary continence in women, using various electric stimulation treatments and evaluated outcomes related to symptoms, quality of life. Thirty RCTs were subjected to risk of bias assessment, certainty of evidence, and network meta-analysis. Statistical analysis was performed using a random-effects model, with continuous variables expressed as standardized mean difference (SMD) and 95% confidence interval (CI). Percutaneous tibial stimulation (SMD - 1.86, 95% CI - 2.77 to - 0.96) and intravaginal stimulation (SMD - 0.97, 95% CI - 1.55 to - 0.38) significantly reduced symptom severity. Additionally, percutaneous tibial, intravaginal, transcutaneous tibial, and trans-sacral stimulations improved quality of life. Percutaneous tibial stimulation was the most effective, followed by intravaginal stimulation. Despite moderate to low confidence in the evidence, large-scale RCTs are needed to evaluate long-term benefits of these treatment.

Efficacy and safety of different antibiotic treatment versus surgical treatment for acute appendicitis: A network meta-analysis.

This systematic review and network meta-analysis compared various antibiotic treatments with surgical treatment for acute appendicitis. We searched PubMed, Embase, Cochrane Library, and Wanfang databases for randomized controlled trials (RCTs) that met the prespecified inclusion criteria up to July 2023. The interventions included various antibiotics and surgery. The outcomes measured were initial treatment success, treatment success at 1-year follow-up, and treatment-related complications. Meta-analysis was conducted using R software with the gemtc package. Surfaces under the cumulative ranking curves (SUCRA) were used to rank the interventions. Thirteen RCTs involving nine treatments (cefotaxime [CTX] + tinidazole [TNZ], CTX + metronidazole [MTZ], ampicillin [AMP] + gentamicin [GEN] + MTZ, amoxicillin/clavulanate [AMC] + GEN, meropenem [MEM] + MTZ, AMC, ertapenem [ETP] + MTZ, ETP, and surgery) were included in this network meta-analysis. In head-to-head comparisons, no statistically significant difference was found between any two interventions for initial treatment success (p>0.05). The SUCRA indicated that surgery ranked first (SUCRA, 66.5%) for initial treatment success. Surgery was associated with an increased treatment success rate at 1-year follow-up compared to AMC (OR=0.01, 95% CrI=0.00-0.14, p<0.05), MEM+MTZ (OR=0.06, 95% CrI=0.00-0.42, p<0.05), and AMP+GEN+MTZ (OR=0.02, 95% CrI=0.00-0.23, p<0.05). No statistically significant differences were found between any two interventions regarding complications (p>0.05). Our network meta-analysis suggests that surgery ranks highest for initial treatment success and treatment success at 1-year follow-up. However, surgery may increase the complication rate.

Comparative effects of tea and coffee drinking on body weight in adults: a systematic review and network meta-analysis of randomised trials.

We aimed at quantifying the effects of different tea and coffee on weight loss in adults. We searched PubMed, Scopus, CENTRAL and grey literature sources to July 2024. The study excluded cross-over trials without washout period, those in critically ill patients, pregnant or breast-feeding women, multicomponent interventions and active control groups with tea or coffee. A random-effects network meta-analysis with a Bayesian framework was performed to calculate the mean difference (MD) and 95 % credible intervals (CrIs). The certainty of evidence was rated using the Grading of Recommendations Assessment, Development, and Evaluation approach, and risk of bias was assessed using Cochrane tool. Twenty-two randomised controlled trials with 1710 participants (average intervention duration = 10 weeks) were included. Green tea was effective for weight loss compared with placebo (MD: −1·23 kg, 95 % CrI: −2·45, −0·02; low certainty evidence) or water (MD: −1·61 kg, 95 % CrI: −2·90, −0·35; very low certainty evidence), while other beverages (coffee, decaffeinated coffee, green coffee, black tea and sour tea) were not. Green tea was effective for weight loss compared with water in sensitivity analysis of healthy individuals (MD: −3·31 kg, 95 % CrI: −5·83, −1·04). Based on very low to low certainty evidence, green tea drinking may result in a small weight loss in adults. This study mainly focused on weight loss effects of green tea and coffee, with limited data on other teas. Only five trials had longer intervention durations, suggesting future research on long-term effects. Most trials had high bias risk and low certainty, requiring more high-quality trials.

Efficacy and safety of systemic treatment for progressive and refractory desmoid tumor: a systematic review and Bayesian network meta-analysis.

Desmoid tumors (DT) are rare, locally invasive tumors originating from connective tissue. Surgical intervention is no longer the standard treatment for DT, as systemic therapy gradually replaces it due to its superior efficacy. Despite the availability of various treatment modalities, there is a need for a first-line systemic treatment regimen that offers both effective disease control and acceptable safety profiles. To assess the efficacy and safety of different systemic treatment agents for DT, we conducted a systematic review and network meta-analysis. Eligible studies were identified through searches of PubMed, Embase, and the Cochrane Library databases, and data were extracted according to predefined inclusion criteria. Three articles and clinical data from 295 patients with progressive and refractory DT were included in this Bayesian network meta-analysis. When considered by objective response rate (ORR), the efficacy of γ-secretase inhibitor versus placebo (OR 0.12, 95%CI 0.01-1.68) is superior to that of TKI (OR 0.49, 95%CI 0.03-7.62) and chemotherapy (OR 0.90, 95%CI 0.02-40.00). Vascular endothelial growth factor (VEGF)-TKI (OR, 0.09; 95% CI, 0.01-1.79) seemed to have the highest improvement in terms of 1-yr PFS rate, while chemotherapy seemed to have the highest improvement across all therapies in terms of 2-yr PFS rate across all therapies (OR, 0.06; 95 percent CI, 0.01-2.98). In terms of safety, the incidence of AEs is highest for γ-secretase inhibitor versus placebo (OR 0.16, 95%CI 0.02-1.55), while TKI is associated with the least AEs (OR 0.62, 95%CI 0.06-6.97). γ-secretase inhibitor provides superior local control of tumors, while chemotherapy and TKI may offer better long-term survival benefits. Among the three regimens, TKI demonstrated better treatment-related safety. These findings have important implications for guiding clinical practice in systemic treatment of DT.

Right ventricular outlet tract reconstruction for tetralogy of fallot: systematic review and network meta-analysis.

Concerns persist regarding pulmonary regurgitation after transannular patch repair (TAP) for Tetralogy of Fallot. Despite various architectural preservation techniques being introduced, the optimal strategy remains controversial. We aimed to compare different right ventricular outlet tract reconstruction techniques. PubMed, EMBASE and Cochrane Central were searched through March 2024 to identify comparative studies on right ventricular outlet tract reconstruction techniques (PROSPERO ID: CRD42024519404). The primary outcome was mid-term pulmonary regurgitation, with secondary outcomes including postoperative mortality, postoperative pulmonary regurgitation, length of intensive care unit stays, postoperative right ventricular outlet tract pressure gradient, and mid-term mortality. We performed a network meta-analysis to compare outcomes among TAP, valve-repairing (VR), TAP with neo-valve creation (TAPN), and valve-sparing (VS). Two randomized controlled studies and 32 observational studies were identified with 8,890 patients. TAP carried a higher risk of mid-term pulmonary regurgitation compared to TAPN (HR, 0.53; 95％CI [0.33; 0.85]) and VS (HR, 0.27; 95% CI [0.19; 0.39]), with no significant difference compared to VR. VS was also associated with reduced postoperative mortality compared to TAP (RR, 0.31; 95% CI [0.18; 0.56]), in addition to reduced ventilation time. TAP also carried an increased risk of postoperative pulmonary regurgitation compared to the other groups. The groups were comparable in terms of length of intensive care unit stay, right ventricular outlet tract pressure gradient, and mid-term mortality. VR was associated with a reduced risk of postoperative pulmonary regurgitation, while TAPN was associated with reduced risks of both postoperative and mid-term pulmonary regurgitation.

Comparative efficacy and safety of Chinese patent medicines as an adjunctive therapy for diabetic peripheral neuropathy: systematic review and network meta-analysis of randomized controlled trials

Context Diabetic peripheral neuropathy (DPN) is the most common complication of diabetes mellitus. Chinese patent medicines (CPMs) are widely used in clinical practice to treat DPN. Objective This study aims to summarize the latest evidence on the harms and benefits of CPMs as adjunctive therapy for DPN. Materials and methods We conducted searches for randomized controlled trials (RCTs) evaluating CPMs in conjunction with mecobalamin (Mec) or alpha-lipoic acid (αLA) across eight databases up to July 2024. The surface under the cumulative ranking area (SUCRA) was utilized to assess the clinical efficacy rate (CER), the peroneal motor nerve conduction velocity (pMNCV), the peroneal sensory nerve conduction velocity (pSNCV), the median motor nerve conduction velocity (mMNCV), and the median sensory nerve conduction velocity (mSNCV). Results The search yielded 128 eligible studies with 31 CPMs with Mec and 39 eligible studies with 17 CPMs with αLA. SUCRA rankings indicated that, when combined with Mec, Mailuoning liquid (lMLN) was the most effective regimen for CER, Honghua injection (iHH) for pMNCV, Maixuekang capsule (cMXK) for pSNCV, Dengzhanxixin injection (iDZXX) for mMNCV, and Tongxinluo capsule (cTXL) for mSNCV. Combined with αLA, Danhong injection (iDH) showed the highest efficacy for CER, pSNCV, and mSNCV, while Xueshuantong injection (iXShT) was the most effective for pMNCV and mMNCV. Conclusion This network meta-analysis confirms the efficacy and safety of 37 CPMs combined with Mec or αLA for treating DPN. However, given the potential risk of bias and the very low certainty of the evidence, these recommendations should be adopted with caution.

Effects of new hypoglycemic drugs on patients with heart failure: a systematic review and network meta-analysis.

Currently, there is no relevant study comparing sodium-dependent glucose transporter 2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and dipeptidyl peptidase inhibitor (DPP4i) head to head to evaluate their comprehensive impact on heart failure patients. We conducted a comprehensive literature search across multiple databases. Utilizing the risk of bias tool from the Cochrane Collaboration, the methodological quality of included studies was critically assessed and potential publication bias was examined via funnel plots. All results are presented as mean difference; 95% confidence interval (MD; 95% CI). The network meta-analysis indicated that in regards to left ventricular function, there is a big difference in the left ventricular ejection fraction (LVEF) of Empagliflozin 25mg (13.64; 0.26, 27.01) compared to Canagliflozin 100mg; and significant differences in the left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) of Dapagliflozin 10mg (-0.76; -1.27, -0.25 and -0.95; -1.86, -0.05), Vildagliptin 50mg (-1.05; -1.47, -0.63 and -1.12; -2.19, -0.05), and Sitagliptin 100mg (-1.34; -2.31, -0.38 and -1.89; -3.50, -0.27) compared to Empagliflozin 10mg. In terms of the quality of life, there are significant differences in the N-terminal pro-B-type natriuretic peptide (NT-proBNP) and the Quality of life score of Sitagliptin 100mg (408.08; 213.59, 602.57 and 3.74; 1.57, 5.92) compared to Dapagliflozin 5mg. In terms of the cardiovascular outcome events, there is a significant difference in the heart failure rehospitalization rate of Dapagliflozin 10mg (0.45; 0.25, 0.82) and Empagliflozin 10mg (0.48; 0.28, 0.81) compared to Liraglutide 1.8mg. Further significant differences are found in the all-cause mortality of Dapagliflozin 10mg (0.81; 0.66, 0.98) compared to Vildagliptin 50mg; the cardiovascular death of Albiglutide 30mg (0.49; 0.28, 0.86) compared to Exenatide 2mg; and the arrhythmic events of Liraglutide 1.8mg (0.49; 0.26, 0.90) compared to Empagliflozin 10mg. The network meta-analysis of SGLT2i, GLP-1RA, and DPP4i as a class of drugs showed that GLP-1RA is superior to SGLT2i in improving LVEF and reducing myocardial infarction/acute coronary syndrome, whereas DPP4i is superior to SGLT2i in improving LVEDV and LVESV. GLP-1RA is superior to SGLT2i in improving LVEF and reducing myocardial infarction/acute coronary syndrome, whereas DPP4i is superior to SGLT2i in improving LVEDV and LVESV. Key message What is already known on this topic-It has been confirmed that three new hypoglycemic drugs have a protective effect on the cardiovascular system. Studies have shown that sodium-dependent glucose transporter 2 inhibitors (SGLT2i) can improve cardiovascular outcomes and enhance the quality of life of heart failure patients. Currently, SGLT2i is widely used in the clinical treatment of heart failure, and related studies have shown that glucagon-like peptide-1 receptor agonists (GLP-1RA) and dipeptidyl peptidase inhibitor (DPP4i) also play important roles in the treatment of heart failure. What this study adds-However, there is no relevant research on whether these drugs' clinical efficacy is dose-dependent. How this study might affect research, practice, or policy-This study included different doses of hypoglycemic drugs and used a network meta-analysis method to comprehensively evaluate the effects of three hypoglycemic drugs on heart function, quality of life, and prognosis in heart failure patients, providing a basis for clinical practice.

Long-Term Efficacy and Safety of Bimekizumab and Other Biologics in Moderate to Severe Plaque Psoriasis: Updated Systematic Literature Review and Network Meta-analysis.

Biologic treatments have made complete skin clearance in moderate to severe plaque psoriasis a real possibility. Although clinical trials demonstrated the superiority of bimekizumab over secukinumab, adalimumab, and ustekinumab, direct comparisons with other biologics are not available. This systematic literature review (SLR) and network meta-analysis (NMA) aimed to evaluate the 1-year efficacy and safety of bimekizumab versus other biologic systemic therapies for moderate to severe plaque psoriasis. We conducted an SLR to retrieve published randomised controlled trials (RCTs) in patients with moderate to severe plaque psoriasis. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews and PsycINFO on 13 January 2022. Two NMA types were used to analyse the long-term achievement of 100% improvement from baseline in Psoriasis Area and Severity Index (PASI100): (1) NMA of cumulative clinical benefits, based on the area under the curve, from week0 to 52; (2) multinomial NMA at weeks44‒60. Binomial NMA was used to evaluate long-term serious adverse events (SAEs). The SLR identified 38 RCTs, of which 19 were included in the NMA. Bimekizumab 320mg administered every 4weeks to week16 then every 8weeks (Q4W/Q8W) showed a greater cumulative average number of days of PASI100 response compared with all other biologics. These differences were statistically significant versus all biologics, except risankizumab 150mg. The multinomial NMA demonstrated that interleukin (IL)-17 and IL-23 inhibitors were the most efficacious treatments. No significant differences were found in long-term occurrence of SAEs. Bimekizumab 320mg Q4W/Q8W was superior to most other treatments in maintaining complete skin clearance during the first year of treatment. It demonstrated a greater cumulative average number of days with completely clear skin while displaying a comparable safety profile compared with all other biologics.

Treatment for essential tremor: a systematic review and Bayesian Model-based Network Meta-analysis of RCTs

Essential tremor (ET) significantly impacts patients' daily lives and quality of life, presenting a considerable challenge in clinical practice. In recent years, novel therapeutic regimens have been investigated in randomized controlled trials (RCTs). This study aims to investigate and evaluate the relative efficacy and safety of various therapeutic interventions for ET. We did a systematic review and Bayesian Model-based Network Meta-analysis (NMA) of RCTs. Following PRISMA-NMA guidelines, a comprehensive database search was conducted up to April 1, 2024 to identify RCTs focused on ET treatments. The Bayesian Markov Chain Monte Carlo (MCMC) method was utilized for the analysis, evaluating the relative efficacy and safety of treatments using standardized mean difference (SMD) and log odds ratios (log ORs), respectively. Additionally, the Surface Under the Cumulative Ranking Curve (SUCRA) was applied to assess the relative efficacy of the treatment modalities. PROSPERO registration: CRD42023415752. This study included 33 RCTs involving 1251 patients, covering 19 oral medication treatments and six non-oral medication treatments. NMA showed that deep brain stimulation (DBS) (SMD=-4.93; 95% CI: [-7.73,-2.13]), CX-8998 (SMD=-2.69; 95% CI: [-5.26,-0.14]), atenolol (SMD=-2.36; 95% CI: [-4.70,-0.10]), and propranolol (SMD=-1.59; 95% CI: [-2.25,-0.67]) showed relative efficacy compared to placebo, with DBS demonstrating relative efficacy compared to 15 other treatment methods. However, GRADE assessment indicated that the evidence level for these conclusions was "low" or "very low." According to SUCRA rankings, DBS (0.97) ranked first in relative efficacy, followed by CX-8998 (0.80), thalamotomy (0.79), atenolol (0.76), metoprolol (0.66), propranolol (0.64), magnetic resonance guided focus ultrasound (MR-FUS) (0.624), ICI-118551 (0.620), nimodipine (0.61) and phenobarbitone (0.59). In terms of safety, as a network graph could not be constructed, DBS and thalamotomy were excluded from the NMA, while other effective treatments showed no significant differences in safety compared to placebo. Our study results indicate that CX-8998, propranolol, and atenolol demonstrate relative efficacy and safety in treating ET. DBS is effective for medication-resistant ET and ranks first in relative efficacy, though our NMA lacks safety data for DBS. Given the low overall grade of evidence, these results should be applied cautiously in clinical practice. Further large-scale, head-to-head RCTs are needed. This work was supported by grants from the National Nature Science Foundation of China (Grant No. 82271459).

Comparison of Implant Placement Accuracy Between Manual, Robot-Assisted, Computer-Navigated, Augmented Reality Navigated, Patient-Specific Instrumentation, and Accelerometer Navigated Total Hip Arthroplasty: A Systematic Review and Network Meta-Analysis.

Malpositioning of the acetabular cup during total hip arthroplasty (THA) can lead to complications. Robotic surgery and navigation techniques aim to address this issue, but there is limited evidence regarding which method can achieve better clinical outcomes. Therefore, this network meta-analysis (NMA) aimed to compare the efficacy of various navigation methods. This NMA of prospective randomized controlled trials compared robot-assisted systems (RAS), computer-assisted navigation systems (CAS), augmented reality-based portable navigation (AR), patient-specific instrumentation (PSI), portable accelerometer-based navigation (PN), and conventional methods (C) for THA procedures. We searched MEDLINE, EMBASE, Cochrane, Central Register of Controlled Trials, International Clinical Trials Platform Search Portal, and ClinicalTrials.gov. databases. The primary outcomes included revision surgery and postoperative clinical scores, and the secondary outcomes encompassed cup placement accuracy, acetabular cup placement outliers from the Lewinnek safe zone, surgical time, and complications. We used a Bayesian random-effects NMA, and confidence of evidence was assessed using confidence in NMA. We identified 45 studies including 2,122 patients. We did not find large differences in revision surgery, clinical outcome scores, cup inclination, or anteversion angle accuracy among the modalities. AR, CAS, and PSI exhibited a lower risk of outliers from safe zones than C. In addition, RAS and CAS had a longer surgical time than C. Robotic and navigation tools did not reduce the revision risk or enhance clinical outcomes. AR, CAS, PSI, and PN may decrease the risk of cup placement outliers in safe zones. However, the cup placement accuracy was equivalent, and the surgical time may be longer in RAS and CAS than in C. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Different minimally invasive surgical methods to hysterectomy for benign gynecological disease: A systematic review and network meta-analysis.

This network meta-analysis aimed to compare the perioperative efficacy of various minimally invasive hysterectomy procedures for treating benign gynecological diseases and to assess whether vaginal natural orifice transluminal endoscopic hysterectomy (VNOTEH), a recently emerging procedure, is inferior to traditional laparoscopy. We searched PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Data, and China VIP Database from inception to August 2022 and updated in June 2023. We included randomized controlled trials (RCTs) comparing different minimally invasive hysterectomy techniques in patients with benign gynecological conditions. The intervention measures included nine minimally invasive hysterectomies. The two researchers used the Cochrane risk-of-bias assessment tool for study appraisal. All statistical analyses and drawings were performed using STATA 17.0 and R 4.4.1. A network meta-analysis (NMA) was conducted to compare the effectiveness of minimally invasive hysterectomy and rank its relative impact probabilistically. A total of 78 RCTs involving 7640 patients and nine minimally invasive hysterectomy methods with 16 intervention combinations were included in this study. Among these, 2, 63, and 13 studies were deemed to have a low, medium, and high risk of bias, respectively. Based on the Surface Under the Cumulative Ranking (SUCRA) probability ranking results of NMA, laparoendoscopic single-site surgery-laparoscopic-assisted vaginal hysterectomy (LESS-LAVH) demonstrated superior outcomes in terms of complications, infections, and 24-h postoperative pain scores. LAVH exhibited better performance in injuries and hospital stays, total laparoscopic hysterectomy showed the least blood loss, and vaginal hysterectomy had the shortest operation time. LESS-LAVH and LAVH are recommended options, if feasible. Meanwhile, VNOTEH can achieve comparable results to traditional laparoscopy but requires careful attention to the risk of injury and infection. Future research should aim to broaden the search scope by including high-quality, large-scale, multicenter RCTs.

What's the optimal temperature control strategy in patients receiving ECPR after cardiac arrest? A network meta-analysis

BackgroundThe optimal temperature control strategy in extracorporeal cardiopulmonary resuscitation (ECPR) patients is unknown, and several trials have reported conflicting results regarding its effectiveness. We aimed to conduct a systemic review and network meta-analysis (NMA) to assess the efficacy of temperature control in ECPR patients. MethodsDatabase searching of studies reporting data on temperature control strategy during ECPR in MEDLINE, EMBASE, Scopus, and Cochrane Library was performed. Primary outcomes were overall survival and neurological outcome. Pairwise meta-analysis and Bayesian NMA were performed on studies comparing outcomes among groups of moderate hypothermia (32–34 °C), mild hypothermia (34.1–36 °C) and normothermia (36.1–37.5 °C). ResultsNineteen retrospective studies were included (5622 patients). Statistically significant differences in good neurological outcome were observed in the direct comparison of moderate hypothermia and mild hypothermia (OR, 1.73; 95 % CI: 1.07–2.81) as well as moderate hypothermia and normothermia (OR, 2.14; 95 % CI: 1.24–3.67)., but no significant differences were found in the NMA result. There was no difference in either survival outcome or the incidence of bleeding complications among any groups according to direct or indirect analysis. ConclusionsDirect evidence suggests that moderate hypothermia might be associated with improved neurological outcomes in ECPR patients. However, no significant differences in survival outcomes were observed in either the direct or NMA results. Given the lower level of the evidence, interpretation should be made with caution.

Efficacy of different traditional Chinese medicine decoctions in the treatment of ischemic stroke: a network meta-analysis

Efficacy of different traditional Chinese medicine decoctions in the treatment of ischemic stroke: a network meta-analysis

Perioperative safety and oncological efficacy of simultaneous versus colorectal and liver first two-staged resections in patients with synchronous colorectal liver metastases: a systematic review and network meta-analysis

Perioperative safety and oncological efficacy of simultaneous versus colorectal and liver first two-staged resections in patients with synchronous colorectal liver metastases: a systematic review and network meta-analysis

Comparative effectiveness of lifestyle interventions on children's body composition management: A systematic review and network meta-analysis

Comparative effectiveness of lifestyle interventions on children's body composition management: A systematic review and network meta-analysis

Clinical effect and contributing factors of acupuncture for knee osteoarthritis: a systematic review and pairwise and exploratory network meta-analysis.

This study aims to evaluate (1) the effect and safety of acupuncture in patients with knee osteoarthritis (KOA) and explore (2) whether the effect of acupuncture differed according to acupuncture type, acupuncture dose and follow-up time. Systematic review and pairwise and exploratory network meta-analysis. PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals and Wanfang from inception to 13 November 2023. Randomised controlled trials comparing acupuncture with sham acupuncture, non-steroidal anti-inflammatory drugs (NSAIDs), usual care or waiting list groups, intra-articular (IA) injection and blank groups in patients with KOA. Eligible interventions included manual acupuncture (MA) and electroacupuncture (EA). The primary outcome was pain intensity at the end of treatment. 80 trials (9933 participants) were included. Very low certainty evidence suggested that acupuncture may reduce pain intensity compared with sham acupuncture (standardised mean difference, SMD -0.74, 95% CI -1.08 to -0.39, corresponded to a difference in Visual Analogue Scale of -18.50 mm, -27.00 to -9.75), NSAIDs (SMD -0.86 to -1.26 to -0.46, corresponded to -21.50 mm, -31.50 to -11.50), usual care or waiting list groups (SMD -1.01, -1.47 to -0.54, corresponded to -25.25 mm, -36.75 to -13.50) and blank groups (SMD -1.65, -1.99 to -1.32, corresponded to -41.25 mm, -49.75 to -33.00), but not IA injection. Similar results were also found in other outcomes. For most of the subgroup analyses, acupuncture type, acupuncture dose and follow-up time did not show a significant relative effect. Only when compared with NSAIDs, a higher dose of acupuncture may provide greater pain relief (interaction p<0.001). The network meta-analysis revealed that electroacupuncture (SMD -0.75, 95% CI -1.34 to -0.17) had a greater effect on pain relief in patients with KOA compared with manual acupuncture. The findings suggest that acupuncture may provide clinically important effects in reducing pain and improving physical function in patients with KOA, but the certainty of evidence was very low. Electroacupuncture and higher dose of acupuncture probably are two potential contributing factors. CRD42021232177.

Efficacy and Safety of Somapacitan Relative to Somatrogon and Lonapegsomatropin in Pediatric Growth Hormone Deficiency: Systematic Literature Review and Network Meta-analysis.

Since direct comparisons of long-acting growth hormones (LAGHs) are lacking, analyses were performed to indirectly compare the efficacy and safety of somapacitan versus somatrogon and lonapegsomatropin in children with growth hormone deficiency (GHD). A systematic literature review (SLR) identified studies of once-weekly LAGHs for the treatment of pediatric GHD. Indirect comparisons (ICs) using a Bayesian hierarchical network meta-analysis and a random effects model were performed using daily growth hormone (GH) 0.034mg/kg/day (base case) or 0.024-0.034mg/kg/day (alternative analyses) as the common comparator to compare height outcomes to 52weeks [annualized height velocity, height velocity standard deviation score (SDS), and height SDS]. Identified evidence did not allow IC of safety or longer-term efficacy outcomes so these were qualitatively described. The SLR identified two somapacitan trials, three somatrogon trials (one included in alternative analyses only), and one lonapegsomatropin trial comparing the LAGH with daily GH in treatment-naïve pre-pubertal children for IC. ICs revealed no differences at 52weeks between somapacitan versus somatrogon and lonapegsomatropin, as well as daily GH, with respect to all growth outcomes considered in children with GHD. All three LAGHs had sustained efficacy and were generally well tolerated, with comparable efficacy and safety to daily GH, with the exception of observed injection site pain for somatrogon. No efficacy and safety differences were identified in comparisons of once weekly somapacitan versus somatrogon and lonapegsomatropin, as well as daily GH. All treatments were generally well tolerated, with the exception of observed injection site pain for somatrogon.

Mixed comparison of intervention with eccentric, isometric, and heavy slow resistance for Victorian Institute of Sport Assessment Patella Questionnaire in adults with patellar tendinopathy: A systematic review and network meta-analysis

Mixed comparison of intervention with eccentric, isometric, and heavy slow resistance for Victorian Institute of Sport Assessment Patella Questionnaire in adults with patellar tendinopathy: A systematic review and network meta-analysis

Radiofrequency treatments for lumbar facet joint syndrome: a systematic review and network meta-analysis.

Lumbar facet joint syndrome (FJS) is a common cause of chronic low back pain (LBP). Radiofrequency treatments are commonly used to treat chronic LBP-related FJS that is refractory to conservative treatment, although evidence supporting this treatment is controversial. We explored the therapeutic effects of radiofrequency on FJS using a network meta-analysis (NMA). A comprehensive systematic search of multiple databases was conducted to identify randomized controlled trials (RCTs) that compared radiofrequency with other treatments (sham procedures, facet joint corticosteroid injection, and conservative treatment) for FJS. We searched PubMed, Embase, Web of Science, the Cochrane Database, and handsearching. The primary outcomes were pain score and Oswestry Disability Index (ODI). Statistical analysis included conventional pairwise meta-analysis and NMA using the frequentist method. The treatments were ranked using surface under the cumulative ranking curve (SUCRA) values. The search yielded 25 RCTs (1969 patients) and a mixed quality regarding the risk of bias, with most studies exhibiting a low risk of bias for most domains. Endoscopic neurotomy consistently ranked highest in terms of pain reduction and ODI score improvement at 1, 3, 6, and 12 months. At 1 and 6 months, endoscopic neurotomy had the highest SUCRA value for pain reduction (0.833 and 0.860, respectively), followed by medial branch thermal radiofrequency. This NMA demonstrates that endoscopic neurotomy is the most effective treatment for lumbar FJS, providing superior and sustained pain relief and functional improvement compared with other treatments. Further, high-quality RCTs are needed to confirm these findings and address the existing limitations. CRD42024524657.