Traditional Pairwise Meta-analysis Research Articles

Non-pharmacological interventions to prevent PICS in critically ill adult patients: a protocol for a systematic review and network meta-analysis

BackgroundPostintensive care syndrome (PICS) is common in critically ill adults who were treated in the intensive care unit (ICU). Although comparative analyses between types of non-pharmacological measures and usual care to prevent PICS have been performed, it remains unclear which of these potential treatments is the most effective for prevention.MethodsTo obtain the best evidence for non-pharmaceutical interventions in preventing PICS, a systematic review and Bayesian network meta-analyses (NMAs) will be conducted by searching nine electronic databases for randomized controlled trials (RCTs). Two reviewers will carefully screen the titles, abstracts, and full-text papers to identify and extract relevant data. Furthermore, the research team will meticulously check the bibliographic references of the selected studies and related reviews to discover any articles pertinent to this research. The primary focus of the study is to examine the prevalence and severity of PICS among critically ill patients admitted to the ICU. The additional outcomes encompass patient satisfaction and adverse effects related to the preventive intervention. The Cochrane Collaboration’s risk-of-bias assessment tool will be utilized to evaluate the risk of bias in the included RCTs. To assess the efficacy of various preventative measures, traditional pairwise meta-analysis and Bayesian NMA will be used. To gauge the confidence in the evidence supporting the results, we will utilize the Confidence in NMA tool.DiscussionThere are multiple non-pharmacological interventions available for preventing the occurrence and development of PICS. However, most approaches have only been directly compared to standard care, lacking comprehensive evidence and clinical balance. Although the most effective care methods are still unknown, our research will provide valuable evidence for further non-pharmacological interventions and clinical practices aimed at preventing PICS. The research is expected to offer useful data to help healthcare workers and those creating guidelines decide on the most effective path of action for preventing PICS in adult ICU patients.Systematic review registrationPROSPERO CRD42023439343.Graphical

Analgesia for the treatment of acute pancreatitis: a protocol for a systematic review and network meta-analysis

IntroductionGastrointestinal hospitalisations in the USA cause over US$130 billion in expenditures, and acute pancreatitis is a leading cause of these hospitalisations. Adequate pain control is one of the primary treatment...

Comparative efficacy of telehealth interventions on promoting cancer screening: A network meta-analysis of randomized controlled trials.

Cancer screening is a pivotal method for reducing mortality from disease, but the screening coverage is still lower than expected. Telehealth interventions demonstrated significant benefits in cancer care, yet there is currently no consensus on their impact on facilitating cancer screening or on the most effective remote technology. A network meta-analysis was conducted to detect the impact of telehealth interventions on cancer screening and to identify the most effective teletechnologies. Six English databases were searched from inception until July 2023 to yield relevant randomized controlled trials (RCTs). Two individual authors completed the literature selection, data extraction, and methodological evaluations using the Cochrane Risk of Bias tool. Traditional pairwise analysis and network meta-analysis were performed to identify the overall effects and compare different teletechnologies. Thirty-four eligible RCTs involving 131,644 participants were enrolled. Overall, telehealth interventions showed statistically significant effects on the improvement of cancer screening. Subgroup analyses revealed that telehealth interventions were most effective for breast and cervical cancer screening, and rural populations also experienced benefits, but there was no improvement in screening for older adults. The network meta-analysis indicated that mobile applications, video plus telephone, and text message plus telephone were associated with more obvious improvements in screening than other teletechnologies. Our study identified that telehealth interventions were effective for the completion of cancer screening and clarified the exact impact of telehealth on different cancer types, ages, and rural populations. Mobile applications, video plus telephone, and text message plus telephone are the three forms of teletechnologies most likely to improve cancer screening. More well-designed RCTs involving direct comparisons of different teletechnologies are needed in the future. Telehealth interventions should be encouraged to facilitate cancer screening, and the selection of the optimal teletechnology based on the characteristics of the population is also necessary.

Current updates relating to treatment for interstitial cystitis/bladder pain syndrome: systematic review and network meta-analysis

BackgroundDespite the publication of several meta-analyses regarding the efficacy of certain therapies in helping individuals with interstitial cystitis (IC) / bladder pain syndrome (BPS), these have not provided a comprehensive review of therapeutic strategies. The study aimed to determine the efficacy of various therapies for IC/BPS and identify potential moderating factors using randomized controlled trials (RCTs).MethodsWe queried the PubMed, Cochrane, and Embase databases to identify prospective RCTs using inclusion criteria: 1) patients diagnosed with IC, 2) interventions included relevant treatments, 3) comparisons were a specified control or placebo, 4) outcomes were mean differences for individual symptoms and structured questionnaires. The pairwise meta-analysis and network meta-analysis (NMA) were performed to compare the treatments used in IC/BPS. Hedges’ g standardized mean differences (SMDs) were used for improvement in all outcomes using random-effects models. Efficacy outcomes included individual symptoms such as pain, frequency, urgency, and nocturia, as well as structured questionnaires measuring IC/BPS symptoms.ResultsA comprehensive literature search was conducted which identified 70 RCTs with 3,651 patients. The analysis revealed that certain treatments, such as instillation and intravesical injection, showed statistically significant improvements in pain and urgency compared to control or placebo groups in traditional pairwise meta-analysis. However, no specific treatment demonstrated significant improvement in all outcomes measured in the NMA. The results of moderator analyses to explore influential variables indicated that increasing age was associated with increased nocturia, while longer follow-up periods were associated with decreased frequency.ConclusionThis systematic review and meta-analysis provide insights into the efficacy of various treatments for IC. Current research suggests that a combination of therapies may have a positive clinical outcome for patients with IC, despite the fact that treatment for this condition is not straightforward.Trial registrationPROSPERO CRD42022384024

Understanding network meta-analysis methodology for the ophthalmologist.

Over the past decade, the number of studies published using network meta-analyses (NMAs) has rapidly increased, and there have been continued advancements to further advance this analysis approach. Due to the fast moving and changing landscape in the infancy of NMA methodology, there is a lack of consistency and standardization for this approach. This article aims to summarize the crucial components of an NMA for both future readers, and for potential NMA authors. Key components of NMAs include, but are not limited to, reporting the proposed analysis methods, assessment of risk of bias within the included studies, reporting the overall quality of the available evidence, and defining the parameters in which the results will be presented. Although NMA allows for a comprehensive evaluation of all available treatment options for a given condition, we believe that there is importance in ensuring clear understanding and appropriate interpretation of results to inform clinical practice. While many components of NMA mirror those of traditional pairwise meta-analysis, there are many novel methodologies that are specific to this approach. It is imperative that future NMAs follow guidance from key methodology groups, as these provide valuable tools for conducting and reporting NMAs.

Efficacy of nonpharmacological interventions for severe radiation-induced oral mucositis among head and neck cancer patients: A network meta-analysis of randomised controlled trials.

To assess the effectiveness of different nonpharmacological treatments for severe radiation-induced oral mucositis in patients with head and neck cancer. Radiation-induced oral mucositis is highly prevalent in patients with head and neck cancer. Current medications for radiation-induced oral mucositis are limited in effectiveness and susceptible to side effects, and while there is an increasing adoption of nonpharmacological interventions, the optimal one remains unclear. Systematic review and network meta-analysis based on the PRISMA-NMA guidelines. Six databases were searched. Two authors independently performed the literature screening, data extraction and methodological quality assessment of the included studies. Traditional pairwise meta-analysis was performed by R Studio. A network meta-analysis was then conducted to assess the effects of nonpharmacological interventions for severe radiation-induced oral mucositis in patients with head and neck cancer. Fifty-two studies involving seven types of nonpharmacological interventions were enrolled. The network meta-analysis indicated that natural plant-based therapies might be the most effective, health education interventions might be the second most effective, and honey might be the third most effective interventions for reducing the incidence of severe radiation-induced oral mucositis. For reducing the incidence of severe oral mucositis-related pain, the pairwise meta-analysis showed that only natural plant-based therapies and health education interventions were effective. Nonpharmacological interventions are effective in the management of severe radiation-induced oral mucositis among patients with head and neck cancer. Nonpharmacological interventions are a category of safe and effective adjunctive therapies that should be encouraged in clinical practice. CRD42023400745.

A gentle introduction to network meta-analysis for orthodontists

Network meta-analysis has been widely used to address the limitations of traditional pairwise meta-analysis. Network meta-analysis incorporates all available evidence into a general statistical framework for comparing multiple treatments. The original Bayesian approach offers a statistical framework to address heterogeneity in the evidence and complexity in the data structure when clinical trials with more than two treatment groups are included. Alternative frequentist approaches have been developed and implemented in commonly used statistical software. The aim of this article is to provide a non-technical introduction to the statistical models and assumptions of network meta-analysis, such as consistency and transitivity, for the orthodontics and dental research community. An example was used to demonstrate how to conduct a network meta-analysis and how to use GRADE and CINeMA tools for placing confidence in the NMA effect estimates in a network meta-analysis. The statistical theory behind network meta-analysis is complex, so we strongly encourage close collaboration between orthodontists and experienced statisticians when planning and conducting a network meta-analysis. Network meta-analysis has been proven to be a very useful tool for evidence synthesis because it improves the efficiency of comparative effectiveness research and the quality of decision-making.

OGC P33 Comparison of the post-operative outcomes of surgical and chemical interventions on the gastric pylorus during oesophagectomy: A systematic review and meta-analysis

Abstract Background Oesophagectomy can lead to gastric dysmotility and pyloric dysfunction, causing delayed gastric emptying (DGE). DGE is associated with significant postoperative morbidity, namely aspiration pneumonia and anastomotic leak. Surgical drainage and botox injections (BI) on pylorus were described to combat DGE. Pyloric interventions however can increase risk of bile reflux, oesophagitis, dumping syndrome and pyloric leaks. Current literature showed equivocal short- and long-term outcomes of pyloric drainage procedures, with no consensus on the necessity of such procedures. We aim to evaluate the latest literature, comparing effects of different pylorus surgical drainage methods, BI and watch-and-wait approach on the pylorus during oesophagectomy Methods The OVID database was searched systematically. Articles were screened with the Rayyan software. Inclusion Criteria of articles are as follows: • RCT and comparative cohort studies (retrospective and prospective) which included any drainage methods, performed at the same time as oesophagectomy • Oesophagectomy for benign or malignant conditions • Studies of adult human subjects ≥ age of 18 years old • Studies published in English language • Studies published within the last 25 years Primary outcomes evaluated were DGE and pulmonary complication rates. A traditional pairwise meta-analysis was performed with Revman 5.4, utilizing a random effects model for analysis of the pooled outcome measures. Results Data of 3925 patients from 27 publications evaluating up to ten pyloric interventions were analyzed. Most studies were retrospective in nature (24 studies). Due to heterogeneity of reported outcomes, pooled meta-analyses were only performed on limited studies. Pooled analyses showed pyloric interventions reduced DGE rates in 19 studies and pulmonary complications in 11 studies. Relative risks (95% CI; p value) were 0.95 (0.7,1.29; p=0.74) and 0.88 (0.72,1.08; p=0.22), respectively.Figure 1:Forrest plot comparing DGE rates of Pyloric Interventions vs No Intervention Figure 2:Forrest plot comparing rates of Pulmonary Morbidity of Pyloric Interventions vs No Intervention Conclusions Our systematic review and meta-analysis did not observe statistically significant and conclusive evidence favouring pyloric drainage procedures to none. High quality comparative studies and inconsistent scrutinization of post operative outcomes were lacking. Prospectively designed RCT or propensity matched cohort studies comparing surgical pyloric drainage, BI and no intervention should be conducted to produce standardized comparison. We suggest analyzing post operative outcomes by measuring data which could be objectively recorded (DGE utilizing the latest definition, pulmonary morbidity, anastomotic leak, biliary reflux rates, radiographic or endoscopic findings etc.) combined with subjective measurement of patient symptoms, where a patient-centred questionnaire could be performed.

The conservative management for improving Visual Analog Scale (VAS) pain scoring in greater trochanteric pain syndrome: a Bayesian analysis

BackgroundGreater trochanteric pain syndrome (GTPS) possesses a harmful influence on quality of life. Numerous conservative management modalities with varying success have been proposed for patients with GTPS. However, it is not clear which treatment is more effective for reducing pain. The purpose of this Bayesian analysis was to assess the current evidence for the effectiveness of conservative treatments on improving Visual Analog Scale (VAS) pain scoring of GTPS and to determine the most effective treatment protocol.MethodsA comprehensive study search was performed from inception until July 18, 2022, via the electronic databases PubMed, the Cochrane Library, and Web of Science for potential research. The risk of bias assessment for the included studies was independently performed based on the Cochrane Collaboration Risk of Bias Tool. Bayesian analysis was conducted by using ADDIS software (v1.16.5). The DerSimonian-Laird random effects model was used to perform the traditional pairwise meta-analysis.ResultsEight full-text articles with a total of 596 patients with GTPS were included in the analysis. In comparing ultrasound-guided platelet-rich plasma application (PRP-U) to ultrasound-guided corticosteroid injection (CSI-U), patients who received PRP therapy experienced reduced pain as the VAS decreased significantly (MD, -5.21; 95% CI, -6.24 to -3.64). VAS score in group of extracorporeal shockwave treatment (ESWT) was significant improved than that in exercise (EX) group (MD, -3.17; 95% CI, -4.13 to -2.15). There were no statistically significantly different VAS scores between the CSI-U group and the CSI under landmark (CSI-B) group. The treatment efficacy rankings of the different treatments on improving VAS scores showed that the most likely efficacious treatment was PRP-U (99%) followed by ESWT (81%), CIS-U (58%), usual care (48%), CIS-B (54%), and EX (84%).ConclusionBayesian analysis revealed that PRP injection and ESWT are relatively safe and effective in the treatment of GTPS. More multicenter high-quality randomized clinical trials with large sample sizes are still needed in the future to provide further evidence.

Efficacy of non-pharmacological interventions on depressive symptoms in patients with Parkinson’s disease: a study protocol for a systematic review and network meta-analysis

IntroductionDepression is the most dominant non-motor symptom of Parkinson’s disease (PD), with a prevalence of up to 50%, and can lead to a range of psychiatric and psychological problems that...

Efficacy of Imaging Methods in the Detection and Diagnosis of Cerebrospinal Fluid Rhinorrhea.

To assess the diagnostic efficacy of various imaging methods in patients with suspected cerebrospinal fluid (CSF) rhinorrhea. The PubMed, EMBASE, SCOPUS, Web of Science, Cochrane Trials, and Google Scholar databases were searched up to December 2021. Diagnostic accuracy was compared among seven radiological methods: computed tomography (CT), CT cisternography (CTC), magnetic resonance imaging (MRI), magnetic resonance cisternography (MRC), CT + MRI, radionuclide cisternography, and intrathecal gadolinium (Gd)-MRC. Sensitivity, specificity, and accuracy were used as outcomes of the analysis. Both a traditional pairwise meta-analysis and a network meta-analysis were performed. Twenty-three trials were included in the analysis. The results of a network meta-analysis performed on a network consisting of seven diagnostic methods showed that all imaging modalities had greater diagnostic accuracy than CT, with the exception of CTC, which had lower sensitivity. Only intrathecal Gd-MRC was significantly superior to other imaging methods with regard to sensitivity and accuracy. Gd-MRC also showed the greatest surface under the cumulative ranking curve values for all of the outcomes (sensitivity: 0.9200; specificity: 0.8364; accuracy: 0.8920). This network meta-analysis demonstrates that intrathecal Gd-MRC is the most useful diagnostic method to detect CSF rhinorrhea. Laryngoscope, 133:1281-1287, 2023.

Comparative efficacy and acceptability of drug treatments for Parkinson’s disease with depression: A systematic review with network meta-analysis

Depressive symptom is the prevailing non-motor symptom of Parkinson’s disease (PD). Drug treatments for depressed PD (dPD) can mitigate the symptoms of patients. However, the results are discordant and need further analysis. This systematic review with network meta-analysis aims to evaluate the drug treatments for dPD. We included double-blind, randomized controlled trials to compare antidepressants with placebo or other antidepressants in dPD. We performed traditional pairwise analysis and network meta-analysis concerning the efficacy, acceptability, depression score, and adverse effect. The surface under the cumulative ranking curve was to assess the ranking probabilities of the enrolled agents. We enrolled 62 studies, including 12,353 subjects, to analyze these estimates. For the traditional pairwise meta-analysis, dopamine agonist (DOP; OR = 2.20 [95% CI, 1.46 to 3.33]) and selective serotonin reuptake inhibitor (SSRI; OR = 2.30 [95% CI, 1.15 to 4.60]) were observed to improve the efficacy compared with placebo. For network meta-analysis, DOP was observed to improve the efficacy compared with placebo (OR = −0.84 [95% CI, −1.20 to −0.48]). Both direct and indirect evidence showed that several treatments, e.g., DOP, monoamine-oxidase inhibitor, serotonin-norepinephrine reuptake inhibitors, SSRI, and tricyclic antidepressants, significantly improved depressive symptoms. DOP and SSRI had good efficacy and improved symptoms considerably in dPD, but the adverse effect of these agents was needed to follow closely.

Effectiveness of interventions for middle-aged and ageing population with neck pain: a systematic review and network meta-analysis protocol

IntroductionNeck pain (NP) is a common musculoskeletal complaint and is increasing in prevalence. Current clinical practice guidelines and systematic reviews recommended conservative, pharmacological and invasive interventions for individuals with NP....

The Association Between Antidiabetic Agents and Clinical Outcomes of COVID-19 Patients With Diabetes: A Bayesian Network Meta-Analysis

AimsThis study aimed to assess the impact of different antidiabetic agents on individuals with diabetes and COVID-19.MethodsWe searched PubMed, Web of Science, Embase, and Cochrane Library databases from inception to October 31, 2021 and included seven antidiabetic agents. The data were pooled via traditional pairwise meta-analysis and Bayesian network meta-analysis.ResultsThe pairwise meta-analysis included 35 studies. Metformin (odds ratio (OR), 0.74; P=0.001), dipeptidyl peptidase-4 inhibitors (DPP4i) (OR, 0.88; P=0.04), sodium-glucose cotransporter-2 inhibitors (SGLT2i) (OR, 0.82; P=0.001), and glucagon-like peptide-1 receptor agonists (GLP1RA) (OR, 0.91; P=0.02) treatment were associated with lower COVID-19 mortality in individuals with diabetes compared to respective non-users. However, insulin treatment resulted in higher mortality (OR, 1.8; P=0.001). Mortality did not significantly differ in sulfonylurea (OR, 0.97; P=0.56) and thiazolidinediones (TZDs) (OR, 1.00; P=0.96) users. Furthermore, due to limited data, we analyzed five antidiabetic agents (metformin, DPP4i, sulfonylurea, insulin, and SGLT2i) and found no association between them and severe disease risk (all P>0.05). The Bayesian network meta-analysis included 18 studies. GLP1RA and SGLT2i had the highest first and second rank probability (67.3% and 62.5%, respectively). Insulin showed the maximum probability of ranking seventh (97.0%). Metformin had the third and fourth highest rank probability of 44.8% and 38.9%, respectively. Meanwhile, DPP4i had the fifth-highest rank probability of 42.4%, followed by sulfonylurea at 45.1%.ConclusionMetformin, DPP4i, SGLT2i, and GLP1RA treatments were highly possible to reduced COVID-19 mortality risk in individuals with diabetes, while insulin might be related to increased mortality risk. Sulfonylurea and TZDs treatments were not associated with mortality. None of the antidiabetic agents studied were associated with the risk of severe disease. Additionally, GLP1RA probably had the most significant protective effect against death, followed by SGLT2i and metformin.Systematic Review RegistrationPROSPERO (CRD42021288200)

Comparative efficacy and safety of statins for osteoporosis: a study protocol for a systematic review and network meta-analysis.

IntroductionOsteoporosis (OP) is a prevalent skeletal disease with high mortality and morbidity, followed by acute and chronic back pain, severe spinal deformity and dysfunction. First-line drugs for OP work through antiresorptive or anabolic mechanisms. Although with good efficacy, these drugs still have certain limitations in clinical application due to delivery routes, medication cycles and cost issues. Nowadays, statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) appear to be potentially promising drugs for OP. Despite the controversy, previous studies have shown the efficacy of statins in treating OP. Other studies have further indicated that the therapeutic effect of OP in statin-treated patients is dose dependent. However, scientists have not yet reached a consensus on the use of statins for the treatment or which statin to choose first. This study aims to review the literature, ascertaining the relative efficacy and safety of statins for patients with OP using a Bayesian network meta-analysis.Methods and analysisWe will systematically search the following databases: MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, Chinese BioMedical Literature Database and preprint servers to include randomised controlled trials that compare different statins for treating OP. Primary outcomes are the incidence of overall fractures and bone mineral density changes. Secondary outcomes contain adverse effects and bone turnover markers. All items of this review will comply with the Cochrane Handbook, and the quality of evidence will be evaluated by Grading of Recommendations Assessment, Development and Evaluation. A traditional pairwise meta-analysis and the Bayesian network meta-analysis will be performed to compare the efficacy of different statins.Ethics and disseminationEthical approval is not required since this is a protocol study for meta-analyses. Results will be submitted to a peer-reviewed journal.PROSPERO registration numberCRD42021242619.Search datesFrom database inception to February 2022.

Comparative Cardiovascular Outcomes of SGLT2 Inhibitors in Type 2 Diabetes Mellitus: A Network Meta-Analysis of Randomized Controlled Trials.

BackgroundA network meta-analysis of randomized controlled trials (RCTs) was conducted to explore the cardiovascular outcomes of all the kind and dosages of sodium-glucose cotransport-2 (SGLT2) inhibitors in type 2 diabetes mellitus (T2DM) patients.Method and ResultThe Cochrane Library, PubMed, and Embase databases were systematically searched for studies to compare the therapeutic effects of different SGLT2 inhibitors in T2DM patients. The effect measurements estimate chosen were odds ratios (ORs) and their corresponding 95% confidence interval (CI). Forty-seven RCTs involving a total of 70574 participants were eligible for direct and indirect comparisons. In direct comparison, treatment with dapagliflozin 5mg showed significantly lower risk of all-cause mortality compared with treatment with dapagliflozin 2.5mg (OR 0.09, 95% CI 0.01-0.70). According to NMA, interestingly, empagliflozin 10mg/25mg, and canagliflozin 100mg was associated with significantly lower risks of all-cause mortality compared with placebo (OR of 0.70, 95% CI 0.58-0.85; 0.69, 95% CI 0.57-0.84; and 0.83, 95% CI 0.73-0.95, respectively). Compared with placebo, dapagliflozin 10mg, empagliflozin 10mg and 25mg displayed the lower risks for cardiovascular events (OR 0.78, 95% CI 0.44-1.00; OR 0.47, 95% CI 0.22-0.93; and 0.43, 95% CI 0.24-0.74, respectively) by direct comparison. Moreover, canagliflozin 100/300mg showed significantly higher risks of cardiovascular events compared with empagliflozin 10mg (OR of 4.83, 95% CI 1.14-20.46 and 5.31, 95% CI 1.26-22.34, respectively) and empagliflozin 25mg (4.23, 95% CI 1.13-15.83 and 4.65, 95% CI 1.25-17.27, respectively) according to NMA. There were non-significant differences among all interventions in volume depletion in traditional pairwise meta-analysis. While in NMA, canagliflozin 100/300mg were associated with significantly increased risks of volume depletion compared with placebo (OR of 1.47, 95% CI 1.08-1.99 and 2.19, 95% CI 1.66-2.90, respectively).ConclusionIn the limitations of the NMA, this study showed that empagliflozin might be better than other SGLT2 inhibitors with low risks of all-cause mortality and cardiovascular events in patients with T2DM suggesting the need for ad hoc RCTs.

Abstract P058: Comparative Effects Of Different Dietary Patterns On Biomarkers Of Non-Communicable Diseases: A Systematic Review And Network Meta-Analysis

Each year, there are millions non-communicable diseases (NCDs) related deaths that are attributed to dietary risk factors. Dietary pattern describes the overall combination of dietary components, therefore is a more proximate representation of real-world dietary intake. The comparisons of different dietary patterns have been largely limited by the traditional pair-wise meta-analysis. We conducted a systematic review and network meta-analysis of randomised trials with healthy participants to compare major dietary patterns in NCD prevention, using biomarkers of NCDs as outcomes. For each biomarker outcome, a random effects network meta-analysis was conducted to estimate all possible pair-wise relative effects and to obtain a relative ranking of the dietary patterns in a connected network. The relative effects were estimated by calculating the summary mean differences (MD) with corresponding 95% CI. The relative ranking was assessed using the distribution of the ranking probabilities and the surface under the cumulative ranking curves (SUCRA). Of the 4008 records identified from the systematic literature search, 72 articles met our inclusion criteria and 68 were included in the quantitative synthesis. We compared up to 11 dietary patterns (Mediterranean diet, DASH diet, Paleo diet, dietary guidelines-based diet, low GI / GL diet, plant based diet, low fat diet, low carbohydrate high fat diet, traditional Mexican diet, high GI / GL diet and western habitual diet) for their effects on 11 NCD biomarkers (HDL, TG, LDL, TC, glucose, insulin, hsCRP, apoB, apoA1, HOMA-IR, and IL-6). Compared to western habitual diet, the Mediterranean diet, DASH diet, dietary guidelines based diet, plant based diet and low fat diet reduced LDL, TC, and apoB (MD range: -0.29 to -0.17 mmol/L, -0.36 to -0.24 mmol/L, and -0.11 to -0.07 g/L, respectively, all p<0.05); the Paleo diet, plant based diet and dietary guidelines based diet reduced HOMA-IR (MD range: -0.95 to -0.35, all p<0.05). While no dietary pattern ranked consistently highest across all NCD biomarkers, the Mediterranean diet was best to improve lipid profile (LDL, HDL, TC, TG, apoB and apoA1 combined average SUCRA: 63.1%); low carbohydrate high fat diet was best for glycaemic control (glucose, insulin and HOMA-IR combined average SUCRA: 66.4%); and Paleo diet was best in inflammation reduction (hsCRP and IL-6 combined average SUCRA: 87.0%). The Paleo diet had the highest all-outcomes-combined ranking (average SUCRA: 63.1%), followed by the Mediterranean diet (58.9%) and DASH diet (58.8%), while the western habitual diet (37.8%) and high GI / GL diet (38.5%) received the lowest all-outcomes-combined SUCRAs. Our findings suggest that the Paleo diet may provide potential health benefit and warrants further consideration for NCD prevention.

Efficacy and Safety of "Three Chinese Patent Medicines and Three TCM Prescriptions" for COVID-19: A Systematic Review and Network Meta-Analysis.

Objective To systematically evaluate the efficacy, safety, and precision of TMTP for COVID-19. Methods Randomized controlled trials and retrospective studies were searched in 11 electronic databases. This network meta-analysis included trials using TMTP to treat patients with COVID-19. The traditional pairwise meta-analysis was done by using Stata 15, and Bayesian network meta-analysis was done with WinBUGS. Results 18 trials were included with 2036 participants and 7 drugs. The results showed that LHQW had the most significant effects on improving expectoration, shortness of breath, sore throat, nausea, emesis, inappetence, muscle soreness, and headache, and it could produce the least adverse reactions. XBJ was the best drug for fever, fatigue, and diarrhea, which showed great advantages in lowering WBC levels. XFBD was the most effective drug for cough and chest distress, which had the least exacerbation rate. JHQG was the most effective for rhinobyon and rhinorrhea, while QFPD was the best drug in decreasing CRP levels. Conclusion This study was the first most large-scale and comprehensive research of TMTP for COVID-19. The results showed that LHQW had good efficacy without obvious adverse reactions. Therefore, we believe that it should be firstly recommended for COVID-19 treatment. In addition, XBJ is recommended for patients with a severe fever, fatigue, and diarrhea, and JHQG is recommended for patients with obvious rhinobyon and rhinorrhea; then, XFBD is recommended for patients with cough and chest tightness as the main manifestation. Our findings will help experts develop new COVID-19 treatment guidelines to better guide clinical medication for protecting the health of COVID-19 patients.

EBNEO Commentary: A network meta-analysis of postnatal corticosteroids for bronchopulmonary dysplasia: Has the most appropriate treatment been revealed?

Ramaswamy VV, Bandyopadhyay T, Nanda D, Bandiya P, Ahmed J, Garg A, Roehr CC, Nangia S. Assessment of Postnatal Corticosteroids for the Prevention of Bronchopulmonary Dysplasia in Preterm Neonates: A Systematic Review and Network Meta-analysis. JAMA Pediatr 2021; 175(6): e206826. PMID 33720274. Systemic postnatal corticosteroids (PNCs) reduce the risk of bronchopulmonary dysplasia (BPD) in preterm infants but may contribute to long-term neurodevelopmental harm. The need to identify a treatment regimen with a reassuring risk-benefit balance remains.1 In an extraordinary feat of data aggregation, Ramaswamy and colleagues include 62 randomised clinical trials (RCTs) enrolling 5559 neonates in a systematic review and network meta-analysis (NMA) to determine which of 14 distinct PNC exposures (Table) may be most appropriate.2 The authors suggest moderately early-initiated medium cumulative dose systemic dexamethasone is the best regimen. Unlike traditional pairwise meta-analyses, NMAs compare multiple interventions, adding relevance to clinical scenarios with various alternative treatment options. NMAs also allow indirect comparisons between interventions, linking them through a common comparator.3 For example, no RCTs have compared early systemic hydrocortisone (EHC) to late-initiated low-cumulative dose systemic dexamethasone (LaLdDx), but a shared comparison to placebo in separate RCTs allows a relative risk estimation. The validity of NMA results relies on specific assumptions. A critical one is that the data linked to produce indirect evidence display ‘transitivity’.3 In essence, that aggregation may be justified by similarities in key population characteristics. Tools that guide this subjective judgement include assessment of whether the populations are similar on important effect modifiers and whether the indirect comparisons could be assessed in head-to-head trials. Extending the example above, we consider the tools against the PREMILOC (EHC) and DART (LaLdDx) trials.4, 5 A meta-regression identified the baseline risk of developing BPD as an important effect modifier for the effect of PNCs on death or cerebral palsy.6 The rates of death or BPD in the control groups of PREMILOC and DART were 49% and 91%, respectively, questioning their similarity.4, 5 In turn, a hypothetical trial of EHC versus LaLdDx would presumably compare prophylactic EHC to LaLdDx only amongst infants remaining on mechanical ventilation at 14 days. Exposing subjects to LaLdDx irrespective of respiratory status would raise ethical concerns. However, the indirect comparison generated by the NMA is not of prophylactic EHC versus expectant management with rescue LaLdDx. Though we focus on EHC versus LaLdDx as an example, these concerns extend to various comparisons. One could argue that transitivity is generally violated when comparing interventions applied in distinct stages of disease progression, and that use of PNCs as prophylaxis versus treatment of evolving severe BPD are distinct indications best suited to distinct comparisons.3 Lastly, we should avoid labelling the PNC regimen most effective against BPD as ‘most appropriate’. Although a reduction in BPD with various PNC regimens is probable, the avoidance of risk for adverse long-term neurodevelopmental outcomes is uncertain, and the latter will guide appropriateness. Further, as the authors acknowledge, the quality of evidence supporting the conclusion is low. Despite these points of caution, Ramaswamy and colleagues add a rich contribution to the literature, shining a helpful light on the path forward. Conclusively arriving at best practice will require additional high-quality research, followed by cautious data synthesis that prioritises long-term outcomes of importance to patients and their families. URL: https://ebneo.org/postnatal-corticosteroids-meta-analysis. None.

Role of maintenance strategies in advanced epithelial ovarian cancer: a systematic review, network meta-analysis and cost-effectiveness analysis protocol

IntroductionDifferent maintenance strategies have shown efficacy in patients with advanced ovarian cancer, but without drawing any conclusion on which strategy is preferred. Therefore, we will conduct a network meta-analysis and...