AIM: To evaluate the effect of internal limiting membrane(ILM) peeling with indocyanine green(ICG), brilliant blue G(BBG), triamcinolone acetonide(TA), trypan blue(TB), or without dye for the treatment of idiopathic m...AIM: To evaluate the effect of internal limiting membrane(ILM) peeling with indocyanine green(ICG), brilliant blue G(BBG), triamcinolone acetonide(TA), trypan blue(TB), or without dye for the treatment of idiopathic macular hole(IMH). METHODS: A search was conducted using Pub Med, EMBASE, and CENTRAL(Cochrane Central Register of Controlled Trials) for related studies published before October 2018. RESULTS: A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye. CONCLUSION: BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.展开更多
AIMTo compare different antibiotics for eradicating the carriage of Neisseria meningitidis （N. meningitidis ）, and to investigate heterogeneity and evidence inconsistency.METHODSFrom a search of PubMed and publishe...AIMTo compare different antibiotics for eradicating the carriage of Neisseria meningitidis （N. meningitidis ）, and to investigate heterogeneity and evidence inconsistency.METHODSFrom a search of PubMed and published systematic reviews, we identifed 23 trials evaluating 15 antibiotics that could be connected in a trial network. The outcome of interest is the eradication of N. meningitidis . We used WinBUGS to conduct random-effects, mixed treatment comparisons. Heterogeneity and evidence inconsistency was investigated by meta-regression modelling and examining characteristics of trial participants and inter-ventions evaluated.RESULTS Rifampin, ciprofloxacin, minocycline, ceftriaxone, and azythromycin were statistically significantly （P 〈 0.05） more effective than placebo. The probability of being the best was 67.0% for a combination of rifampin and minocycline, 25.0% for ceftriaxone, 1.7% for azythromycin, and below 1% for the remaining regimens. Signifcant inconsistency between the direct and indirect estimates was observed for the comparison of rifampin and ciprofoxacin （ P 〈 0.01）, which may be caused by different types of carriers and different doses of ciprofoxacin.CONCLUSIONA range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages, and treatment choice will depend on the individual priorities of the patients and physicians. In clinical situations where complete eradication is considered to be of the utmost importance, a combination of rifampin and minocycline seems to offer the highest likelihood of success. Ceftriaxone as a single intramuscular injection is also likely to be more effective as compared with the other two antibiotics （ciprofoxacin or rifampin） recommended by the current guidelines.展开更多
Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A datab...Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A database of randomized controlled trials was retrieved from published papers. Network meta-analysis was used to compare efficacy on day 28 and day 42 after initiation of treatment. Age covariate effect on treatment outcome was assessed, and a modeling approach to reduce heterogeneity among trials was evaluated under the hypothesis of consistency in a meta-regression. Safety and adverse events were compared among different ACTs. A Bayesian analysis was performed to implement the consistency models using WinBUGS software. The results were compared to those of the frequentist approach using the R software. Results: Eighty-one articles, in which a total of 15 different ACTs were tested in more than 36,000 patients, were included. On day 28, dihydroartemisinin-piperaquine (DHPP) was more effective than artemether-lumefantrine (AL) before (odds ratio [OR], 1.83;95% confidence interval [CI], 1.31 - 2.56) and after age-covariate adjustment (OR, 1.70;95% CI, 1.20 - 2.43). The result was similar on day 42. DHPP occupied the top rank. The risk of having cough, diarrhoea or headache post-treatment was significantly lower with DHPP than AL. Artesunate-mefloquine (ASMQ) was associated with a significantly lower prevalence of vomiting or nausea (OR, 0.80;95% CI, 0.48 - 1.30) and headache (OR, 0.53;95% CI, 0.40 - 0.68) compared to AL. On the contrary, vomiting and nausea occurred more frequently after fixed-dose artesunate-amodiaquine formulation (ASAQf) than with AL (OR, 1.45;95% CI, 1.18 - 1.78). The risk of anaemia was higher with ASAQf and co-blistered artesunate-amodiaquine (ASAQc) than with AL. There was no significant difference in risk of anaemia (P > 0.05) between AL and different formulations of ASAQ. Conclusions: Based on the available evidence, this study demonstrated the superiority of DHPP, followed by AL, among currently recommended ACTs in terms of efficacy and tolerance. Network meta-analysis could be an alternative analytical tool but needs more data input from therapeutic efficacy studies. The determination of the best available therapy requires data triangulation and data science.展开更多
OBJECTIVE:To assess the clinical efficacy and safety of ginkgo injections(GIs)combined with conventional treatment(CT)against angina pectoris(AP)due to coronary heart disease(CH D).METHODS:Randomized controlled trials...OBJECTIVE:To assess the clinical efficacy and safety of ginkgo injections(GIs)combined with conventional treatment(CT)against angina pectoris(AP)due to coronary heart disease(CH D).METHODS:Randomized controlled trials(RCTs)that used GIs to treat AP were searched in SinoMed,PubMed,China National Knowledge Infrastructure Database,Chinese Scientific Journals Database,Wanfang Database,Embase and Cochrane Library until March 2017.The Cochrane "risk of bias" method was used to evaluate the methodological quality of RCTs.Data were analyzed using Stata v13.1 and WinBUGS v1.4.3.RESULTS:A total of 73 RCTs involving 7621 patients were included.A Bayesian network Meta-analysis of RCTs was undertaken,and the advantages of four types of Gl-supplemented CT in AP treatment were determined.CONCLUSION:Gl-assisted CT was more effective against AP than CT alone.However,based on the limitations of the study,additional high-quality RCTs are required to confirm our findings.展开更多
OBJECTIVE: To undertake a systematic review and network meta-analysis(NMA) to compare the effectiveness among the different regimens of Salvia miltiorrhiza injection classes(SMICs) for unstable angina pectoris(UAP) tr...OBJECTIVE: To undertake a systematic review and network meta-analysis(NMA) to compare the effectiveness among the different regimens of Salvia miltiorrhiza injection classes(SMICs) for unstable angina pectoris(UAP) treatment.METHODS: A systematic retrieval was conducted in several literature databases to identify randomized controlled trials focusing on the different regimens of SMICs for UAP treatment until January2016. The quality assessment was accomplished according to the Cochrane risk of bias tool. Pair-wise meta-analyses were carried out by Rev Man 5.3. A random-effects model of NMA was used to compare the different regimens of SMICs with regard to efficacy by STATA 13.0.RESULTS: A total of 111 studies involving 10 500patients were included in the NMA. The methodological quality of included studies was not high.Current evidence shows that salvianolate(SI) is the optimal treatment for UAP in improving the total efficacy against UAP. Guanxingning(GXN) is the optimal treatment for UAP for improving the total effectiveness of electrocardiography.CONCLUSION: SMICs have advantages in preventing cardiovascular events. GXN, SI, and Danhong had the greatest probability of being the best treatment in the total efficacy against UAP and for improving the total effectiveness of electrocardiography.展开更多
BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory. AIM To deter...BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory. AIM To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients. METHODS This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data. RESULTS A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.CONCLUSION This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.展开更多
OBJECTIVE:The aim of this study was to evaluate the effectiveness of Chinese herbal medicines for invigorating the kidney(CHMIK)on senile osteoporosis.METHODS:We searched for studies in English-language databases(Pub ...OBJECTIVE:The aim of this study was to evaluate the effectiveness of Chinese herbal medicines for invigorating the kidney(CHMIK)on senile osteoporosis.METHODS:We searched for studies in English-language databases(Pub Med,the Cochrane Library,and Web of Science)and Chinese-language databases(China National Knowledge Infrastructure,Wan Fang Data,VIP Chinese periodical service platform),and China Biology Medicine disc from their inception to September 2017.Randomized controlled trials comparing the effectiveness of Traditional Chinese Medicine therapies(alone or in combination)and conventional clinical medicine therapies among older adult patients with osteoporosis were identified.We conducted a network Meta-analysis with a Bayesian hierarchical random-effects model using RStudio software,Version 3.4.1.RESULTS:Forty-three randomized controlled trials assessing the differences between Traditional Chinese Medicine and conventional clinical medicine were identified,including 15 treatments and involving 3316 patients.The results of the network Meta-analysis indicated that alendronate(odds ratio[OR]=0.20,95%confidence interval[CI]:0.047-0.73)and calcium(OR=0.18,95%CI:0.11-0.30)are significantly more effective if combined with oral CHMIK.CHMIK alone is significantly more effective than both alendronate(OR=0.34,95%CI:0.10-1.0)and calcium(OR=0.13,95%CI:0.056-0.28).Moreover,CHMIK+tuina+calcium is more effective than CHMIK+calcium+vitamin D+alendronate(OR=18.0,95%CI:1.1-2.7 e+02).CONCLUSION:The present network Meta-analysis found that alendronate and calcium are more effective if combined with oral CHMIK and that oral CHMIK alone may be more effective than alendronate or calcium.Tuina may have an advantage over oral medicines.Oral CHMIK and calcitonin show the most potential for treating senile osteoporosis.展开更多
Objective: To assess and compare the clinical efficacy and safety of cognitive enhancers(donepezil, galantamine, rivastigmine, and memantine) on cognition, behavior, function, and global status in patients with vascul...Objective: To assess and compare the clinical efficacy and safety of cognitive enhancers(donepezil, galantamine, rivastigmine, and memantine) on cognition, behavior, function, and global status in patients with vascular cognitive impairment.Data sources: The initial literature search was performed with PubMed, EMBASE, the Cochrane Methodology Register, the Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health(CINAHL) from inception to January 2018 for studies regarding donepezil, galantamine, rivastigmine, and memantine for treatment of vascular cognitive impairment.Data selection: Randomized controlled trials on donepezil, galantamine, rivastigmine, and memantine as monotherapy in the treatment of vascular cognitive impairment were included. A Bayesian network meta-analysis was conducted. Outcome measures: Efficacy was assessed by changes in scores of the Alzheimer's Disease Assessment Scale, cognitive subscale, Mini-Mental State Examination, Neuropsychiatric Inventory scores and Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input, Activities of Daily Living, the Clinical Dementia Rating scale. Safety was evaluated by mortality, total adverse events(TAEs), serious adverse events(SAEs), nausea, vomiting. diarrhea, or cerebrovascular accidents(CVAs). Results: After screening 1717 citations, 12 randomized controlled trials were included. Donepezil and rivastigmine(mean difference(e) = –0.77, 95% confidence interval(CI): 0.25–1.32; MD = 1.05, 95% CI: 0.18–1.79) were significantly more effective than placebo in reducing Mini-Mental State Examination scores. Donepezil, galantamine, and memantine(MD = –1.30, 95% CI: –2.27 to –0.42; MD = –1.67, 95% CI: –3.36 to –0.06; MD = –2.27, 95% CI: –3.91 to –0.53) showed superior benefits on the Alzheimer's Disease Assessment Scale–cognitive scores compared with placebo. Memantine(MD = 2.71, 95% CI: 1.05–7.29) improved global status(Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input) more than the placebo. Safety results revealed that donepezil 10 mg(odds ratio(OR) = 3.04, 95% CI: 1.86–5.41) contributed to higer risk of adverse events than placebo. Galantamine(OR = 5.64, 95% CI: 1.31–26.71) increased the risk of nausea. Rivastigmine(OR = 16.80, 95% CI: 1.78–319.26) increased the risk of vomiting. No agents displayed a significant risk of serious adverse events, mortality, cerebrovascular accidents, or diarrhea.Conclusion: We found significant efficacy of donepezil, galantamine, and memantine on cognition. Memantine can provide significant efficacy in global status. They are all safe and well tolerated.展开更多
Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medlin...Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medline,Embase,the Cochrane Library,and clinicaltrials.gov(www.clinicaltrials.gov)were searched for randomized controlled trials(RCTs).Standard pairwise meta-analysis and network meta-analysis(NMA)were both carried out.The risk of bias(ROB)tool recommended by the Cochrane handbook was used to assess the quality of studies.Subgroup analysis,sensitivity analysis,meta-regression,and quality evaluation based on the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)were also performed.Results A total of 292 trials were included in this study.Compared with placebo,dipeptidyl-peptidase IV inhibitors(DPP-4 Is)increased weight slightly by 0.31 kg[95%confidence interval(CI):0.05,0.58]and had negligible effects on BMI and WC.Compared with placebo,glucagon-like peptide-1 receptor agonists(GLP-1 RAs)lowered weight,BMI,and WC by-1.34 kg(95%CI:-1.60,-1.09),-1.10 kg/m2(95%CI:-1.42,-0.78),and-1.28 cm(95%CI:-1.69,-0.86),respectively.Conclusion GLP-1 RAs were more effective than DPP-4 Is in lowering the three indicators.Overall,the effects of GLP-1 RAs on weight,BMI,and WC were favorable.展开更多
AIM:To compare the outcomes of four adjuvants used for internal limiting membrane(ILM)peeling in macular hole surgery,including indocyanine green(ICG),brilliant blue G(BBG),triamcinolone(TA)and trypan blue(TB),through...AIM:To compare the outcomes of four adjuvants used for internal limiting membrane(ILM)peeling in macular hole surgery,including indocyanine green(ICG),brilliant blue G(BBG),triamcinolone(TA)and trypan blue(TB),through systematic review and random-effects Bayesian network Meta-analysis.METHODS:PubMed,Cochrane library databases and Web of Science were searched until August 2018 for clinical trials comparing the above four adjuvants.ORs for postoperative best corrected visual acuity(BCVA)improvement and primary macular hole closure rates were compared between the different adjuvants.RESULTS:Twenty-seven eligible articles were included.For postoperative BCVA improvement,results of BBGassisted peeling were significantly more favorable than those of ICG(WMD 0.08,95%credible interval 0.01-0.16)and TA ranked highest.No significant differences were found between any other two groups in postoperative BCVA improvement.For postoperative primary macular hole closure rates,BBG ranked highest.However,no significant differences were shown between any two groups.CONCLUSION:TA and BBG are the optimum adjuvants for achieving postoperative BCVA improvement macular hole surgery with adjuvant-assisted ILM peeling.Among all adjuvants,the use of BBG is associated with the highest postoperative macular hole closure rate.展开更多
BACKGROUND Pancreatic cancer is one of the most common and lethal malignancies worldwide. The common treatment options for resectable pancreatic cancer include surgery alone, neoadjuvant chemotherapy (CT), neoadjuvant...BACKGROUND Pancreatic cancer is one of the most common and lethal malignancies worldwide. The common treatment options for resectable pancreatic cancer include surgery alone, neoadjuvant chemotherapy (CT), neoadjuvant chemoradiotherapy (CRT), adjuvant CT, and adjuvant CRT. However, the optimal treatment is still controversial. AIM To identify the most effective approach for pancreatic cancer using network meta-analysis. METHODS Eligible studies were searched from PubMed, MEDLINE, EMBASE, Cochrane database, and Google scholar. We searched and included randomized controlled trials reporting on neoadjuvant and adjuvant therapies. For direct comparisons, standard pairwise meta-analysis was performed using the inverse variance DerSimonian-Laird random-effects model. For indirect comparisons, Bayesian network meta-analysis was used to combine direct and indirect evidence. We used relative hazard ratios (HRs) to estimate death difference of different treatments, and relative odds ratios (ORs) for toxic effects. Treatment effects were ranked based on their efficacy for improving survival or reducing toxicity using rankogram. The quality of evidence of estimates from direct comparison and network meta-analysis was evaluated following the GRADE approach. RESULTS We included 13 high quality trials with 1591 participants in this network metaanalysis. Compared with surgery alone [pooled HR = 0.7, 95% confidence interval (CI): 0.62-0.79] and surgery with adjuvant CRT (pooled HR = 0.6, 95%CI: 0.54-0.72), surgery with adjuvant CT had a higher rate of overall survival. In contrast, standard pairwise meta-analysis showed a statistically significant survival advantage of surgery with adjuvant CT compared with surgery alone (pooled HR = 0.75, 95%CI: 0.63-0.89;P < 0.001). Rankogram showed that surgery with adjuvant CT was most likely to rank the best in terms of overall survival (probability: 94.2%), followed by surgery alone (probability: 5.8%). No significant differences in overall toxicity or haematological toxicity were found between all the therapies. High quality evidence supported surgery with adjuvant CT over surgery alone for increasing overall survival. Moderate quality evidence supported surgery with adjuvant CT over surgery with adjuvant CRT for increasing overall survival. CONCLUSION Surgery with adjuvant CT prolongs overall survival compared with surgery alone and surgery with adjuvant CRT, suggesting surgery with adjuvant CT is the optimal treatment for resectable pancreatic cancer.展开更多
目的基于贝叶斯网状Meta分析系统评价不同血管化骨瓣在下颌骨缺损修复重建中的存活率。方法计算机检索PubMed、EBSCO、Scopus、Web of Science、Cochrane Library、WanFang Data和CNKI数据库,搜集与研究目的相关的临床研究,检索时限均...目的基于贝叶斯网状Meta分析系统评价不同血管化骨瓣在下颌骨缺损修复重建中的存活率。方法计算机检索PubMed、EBSCO、Scopus、Web of Science、Cochrane Library、WanFang Data和CNKI数据库,搜集与研究目的相关的临床研究,检索时限均从建库至2024年2月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R软件进行贝叶斯网状Meta分析。结果共纳入24项研究,包括1615名患者。Meta分析结果显示腓骨游离瓣、旋髂深动脉髂骨瓣、肩胛骨瓣及携带桡骨的前臂桡侧皮瓣用于下颌骨重建的术后存活率分别为95.62%、94.09%、98.16%和93.75%。网状Meta分析结果显示各组织瓣术后存活率之间的差异均无统计学意义。结论当前证据表明,不同血管化骨瓣在下颌骨缺损修复重建中的存活率相似。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。展开更多
Background:The current standard of care for advanced human epidermal growth factor receptor 2(HER2)‐positive breast cancer is pertuzumab plus trastuzumab and docetaxel as first‐line therapy.However,with the developm...Background:The current standard of care for advanced human epidermal growth factor receptor 2(HER2)‐positive breast cancer is pertuzumab plus trastuzumab and docetaxel as first‐line therapy.However,with the development of newer treatment regimens,there is a lack of evidence regarding which is the optimal treatment strategy.The aim of this network meta‐analysis was to evaluate the efficacy and safety of first‐line regimens for advanced HER2‐positive breast cancer by indirect comparisons.Methods:A systematic review and Bayesian network meta‐analysis were conducted.The PubMed,EMBASE,and Cochrane Library databases were searched for relevant articles published through to December 2023.The hazard ratio(HR)and 95%credible interval(CrI)were used to compare progressionfree survival(PFS)between treatments,and the odds ratio and 95%CrI were used to compare the objective response rate(ORR)and safety.Results:Twenty randomized clinical trials that included 15 regimens and 7094 patients were analyzed.Compared with the traditional trastuzumab and docetaxel regimen,PFS was longer on the pyrotinib and trastuzumab plus docetaxel regimen(HR:0.41,95%CrI:0.22–0.75)and the pertuzumab and trastuzumab plus docetaxel regimen(HR:0.65,95%CrI:0.43–0.98).Consistent with the results for PFS,the ORR was better on the pyrotinib and trastuzumab plus docetaxel regimen and the pertuzumab and trastuzumab plus docetaxel regimen than on the traditional trastuzumab and docetaxel regimen.The surface under the cumulative ranking curve indicated that the pyrotinib and trastuzumab plus docetaxel regimen was most likely to rank first in achieving the best PFS and ORR.Comparable results were found for grade≥3 AE rates of≥10%.Conclusions:Our results suggest that the pyrotinib and trastuzumab plus docetaxel regimen is most likely to be the optimal first‐line therapy for patients with HER2‐positive breast cancer.展开更多
目的:系统评价活血化瘀类中成药治疗冠心病PCI术后心绞痛的临床疗效及安全性。方法:计算机检索Pubmed、The Cochrane Library、Embase、Web of Science、中国知网、维普、万方、中国生物医学数据库,搜集中成药联合常规西药治疗冠心病PC...目的:系统评价活血化瘀类中成药治疗冠心病PCI术后心绞痛的临床疗效及安全性。方法:计算机检索Pubmed、The Cochrane Library、Embase、Web of Science、中国知网、维普、万方、中国生物医学数据库,搜集中成药联合常规西药治疗冠心病PCI术后心绞痛的随机对照试验(RCT),检索时限设定为建库至2023年6月25日,制定纳入排除标准后,由2名研究者独立筛选文献、提取资料、评价纳入研究的偏倚风险后,采用Stata 15.1软件进行网状Meta分析。结果:共纳入35个RCTs,包括3448例患者、9种中成药(丹蒌片、地奥心血康软胶囊、复方丹参滴丸、冠心丹参滴丸、冠心舒通胶囊、麝香保心丸、通心络胶囊、养心氏片、银丹心脑通软胶囊)。网状Meta分析疗效排序结果显示:(1)在提高总有效率方面,SUCRA排序为:常规治疗联合通心络胶囊(SUCRA=96.8%)>联合丹蒌片(SUCRA=68.8%)>联合复方丹参滴丸(SUCRA=65.4%)>联合麝香保心丸(SUCRA=65.2%)>联合冠心丹参滴丸(SUCRA=50.0%)>联合地奥心血康软胶囊(SUCRA=40.0%)>联合冠心舒通胶囊(SUCRA=34.6%)>联合养心氏片(SUCRA=28.6%)。(2)在减少心绞痛每周发作频率方面,SUCRA排序为:常规治疗联合冠心舒通胶囊(SUCRA=77.7%)>联合麝香保心丸(SUCRA=69.3%)>联合银丹心脑通软胶囊(SUCRA=64.1%)>联合地奥心血康软胶囊(SUCRA=60.9%)>联合通心络胶囊(SUCRA=56.5%)>联合复方丹参滴丸(SUCRA=32.9%)>联合养心氏片(SUCRA=30.9%)。(3)在减少心绞痛每分钟持续时间方面,SUCRA排序为:常规治疗联合银丹心脑通软胶囊(SUCRA=88.0%)>联合麝香保心丸(SUCRA=78.9%)>联合冠心舒通胶囊(SUCRA=61.9%)>联合地奥心血康软胶囊(SUCRA=52.7%)>联合通心络胶囊(SUCRA=43.6%)>联合复方丹参滴丸(SUCRA=40.5%)>联合养心氏片(SUCRA=23.3%)。(4)降低hs-CRP方面,SUCRA排序为:常规治疗联合麝香保心丸(SUCRA=98.5%)>联合地奥心血康软胶囊(SUCRA=84.8%)>联合丹蒌片(SUCRA=66.0%)>联合复方丹参滴丸(SUCRA=50.0%)>联合通心络胶囊(SUCRA=27.9%)>联合冠心舒通胶囊(SUCRA=20.2%)。(5)降低ET-1方面,SUCRA排序为:常规治疗联合通心络胶囊(SUCRA=80.8%)>联合冠心丹参滴丸(SUCRA=75.8%)>联合地奥心血康软胶囊(SUCRA=50.6%)>联合复方丹参滴丸(SUCRA=48.0%)>联合冠心舒通胶囊(SUCRA=39.8%)。(6)在升高NO方面,SUCRA排序为:常规治疗联合冠心丹参滴丸(SUCRA=86.7%)>联合复方丹参滴丸(SUCRA=65.1%)>联合通心络胶囊(SUCRA=53.4%)>联合冠心舒通胶囊(SUCRA=49.6%)>联合地奥心血康软胶囊(SUCRA=37.8%)。结论:当前证据显示,在常规西药治疗的基础上联合活血化瘀类中成药可改善冠心病PCI术后的心绞痛症状,减轻血管内皮细胞受损,不良反应较少,且在不同的结局指标中各有优势和侧重。因纳入研究的数量和质量欠佳,上述研究结论待更多高质量研究予以验证。展开更多
基金Supported by the National Natural Science Foundation of China (No.81870686)the Natural Science Foundation of Beijing Municipal (No.7184201)the Capital’s Funds for Health Improvement and Research (No.2018-12021)
文摘AIM: To evaluate the effect of internal limiting membrane(ILM) peeling with indocyanine green(ICG), brilliant blue G(BBG), triamcinolone acetonide(TA), trypan blue(TB), or without dye for the treatment of idiopathic macular hole(IMH). METHODS: A search was conducted using Pub Med, EMBASE, and CENTRAL(Cochrane Central Register of Controlled Trials) for related studies published before October 2018. RESULTS: A total of 29 studies and 2514 eyes were included in this network Meta-analysis. For IMH closure, the rank from the best to the worse treatment was: BBG, TB, TA, ICG, and no dye. There was a significant difference in postoperative IMH closure rate between BBG and no dye. The rank of the best to the worse treatment to improve visual acuity was: BBG, TB, no dye, TA, and ICG. The improvement rate of visual acuity after using BBG was significantly higher than ICG. The improvement rate of visual acuity was more favorable with TB than ICG, TA, and no dye. CONCLUSION: BBG can contribute to better anatomical and functional outcomes compared to other dyes for ILM peeling in patients with IMH. The results show that the best treatment of ILM peeling with dyes is BBG.
基金Supported by Partly the UK Medical Research Council,No.G0701607
文摘AIMTo compare different antibiotics for eradicating the carriage of Neisseria meningitidis （N. meningitidis ）, and to investigate heterogeneity and evidence inconsistency.METHODSFrom a search of PubMed and published systematic reviews, we identifed 23 trials evaluating 15 antibiotics that could be connected in a trial network. The outcome of interest is the eradication of N. meningitidis . We used WinBUGS to conduct random-effects, mixed treatment comparisons. Heterogeneity and evidence inconsistency was investigated by meta-regression modelling and examining characteristics of trial participants and inter-ventions evaluated.RESULTS Rifampin, ciprofloxacin, minocycline, ceftriaxone, and azythromycin were statistically significantly （P 〈 0.05） more effective than placebo. The probability of being the best was 67.0% for a combination of rifampin and minocycline, 25.0% for ceftriaxone, 1.7% for azythromycin, and below 1% for the remaining regimens. Signifcant inconsistency between the direct and indirect estimates was observed for the comparison of rifampin and ciprofoxacin （ P 〈 0.01）, which may be caused by different types of carriers and different doses of ciprofoxacin.CONCLUSIONA range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages, and treatment choice will depend on the individual priorities of the patients and physicians. In clinical situations where complete eradication is considered to be of the utmost importance, a combination of rifampin and minocycline seems to offer the highest likelihood of success. Ceftriaxone as a single intramuscular injection is also likely to be more effective as compared with the other two antibiotics （ciprofoxacin or rifampin） recommended by the current guidelines.
文摘Background: Several artemisinin-based combination therapies (ACT) are available to treat uncomplicated malaria in Africa. The present study aimed to assess the ranking of their efficacy and tolerance. Methods: A database of randomized controlled trials was retrieved from published papers. Network meta-analysis was used to compare efficacy on day 28 and day 42 after initiation of treatment. Age covariate effect on treatment outcome was assessed, and a modeling approach to reduce heterogeneity among trials was evaluated under the hypothesis of consistency in a meta-regression. Safety and adverse events were compared among different ACTs. A Bayesian analysis was performed to implement the consistency models using WinBUGS software. The results were compared to those of the frequentist approach using the R software. Results: Eighty-one articles, in which a total of 15 different ACTs were tested in more than 36,000 patients, were included. On day 28, dihydroartemisinin-piperaquine (DHPP) was more effective than artemether-lumefantrine (AL) before (odds ratio [OR], 1.83;95% confidence interval [CI], 1.31 - 2.56) and after age-covariate adjustment (OR, 1.70;95% CI, 1.20 - 2.43). The result was similar on day 42. DHPP occupied the top rank. The risk of having cough, diarrhoea or headache post-treatment was significantly lower with DHPP than AL. Artesunate-mefloquine (ASMQ) was associated with a significantly lower prevalence of vomiting or nausea (OR, 0.80;95% CI, 0.48 - 1.30) and headache (OR, 0.53;95% CI, 0.40 - 0.68) compared to AL. On the contrary, vomiting and nausea occurred more frequently after fixed-dose artesunate-amodiaquine formulation (ASAQf) than with AL (OR, 1.45;95% CI, 1.18 - 1.78). The risk of anaemia was higher with ASAQf and co-blistered artesunate-amodiaquine (ASAQc) than with AL. There was no significant difference in risk of anaemia (P > 0.05) between AL and different formulations of ASAQ. Conclusions: Based on the available evidence, this study demonstrated the superiority of DHPP, followed by AL, among currently recommended ACTs in terms of efficacy and tolerance. Network meta-analysis could be an alternative analytical tool but needs more data input from therapeutic efficacy studies. The determination of the best available therapy requires data triangulation and data science.
基金Supported by National Natural Science Foundation of China(Study on the Key Influencing Factors of Anaphylaxis in Traditional Chinese Medicine Injection No.81473547and Multidimensional Clinical Evaluation Model of Salvia Injection for the Treatment of Unstable Angina Pectoris,No.81673829)
文摘OBJECTIVE:To assess the clinical efficacy and safety of ginkgo injections(GIs)combined with conventional treatment(CT)against angina pectoris(AP)due to coronary heart disease(CH D).METHODS:Randomized controlled trials(RCTs)that used GIs to treat AP were searched in SinoMed,PubMed,China National Knowledge Infrastructure Database,Chinese Scientific Journals Database,Wanfang Database,Embase and Cochrane Library until March 2017.The Cochrane "risk of bias" method was used to evaluate the methodological quality of RCTs.Data were analyzed using Stata v13.1 and WinBUGS v1.4.3.RESULTS:A total of 73 RCTs involving 7621 patients were included.A Bayesian network Meta-analysis of RCTs was undertaken,and the advantages of four types of Gl-supplemented CT in AP treatment were determined.CONCLUSION:Gl-assisted CT was more effective against AP than CT alone.However,based on the limitations of the study,additional high-quality RCTs are required to confirm our findings.
基金Supported by National Natural Science Foundation of China:Study on the Key Influencing Factors of Anaphylaxis in Traditional Chinese Medicine Injection(No.81473547)Multi-dimensional Clinical Evaluation Model of Salvia Injection for the Treatment of Unstable Angina Pectoris(No.81673829)
文摘OBJECTIVE: To undertake a systematic review and network meta-analysis(NMA) to compare the effectiveness among the different regimens of Salvia miltiorrhiza injection classes(SMICs) for unstable angina pectoris(UAP) treatment.METHODS: A systematic retrieval was conducted in several literature databases to identify randomized controlled trials focusing on the different regimens of SMICs for UAP treatment until January2016. The quality assessment was accomplished according to the Cochrane risk of bias tool. Pair-wise meta-analyses were carried out by Rev Man 5.3. A random-effects model of NMA was used to compare the different regimens of SMICs with regard to efficacy by STATA 13.0.RESULTS: A total of 111 studies involving 10 500patients were included in the NMA. The methodological quality of included studies was not high.Current evidence shows that salvianolate(SI) is the optimal treatment for UAP in improving the total efficacy against UAP. Guanxingning(GXN) is the optimal treatment for UAP for improving the total effectiveness of electrocardiography.CONCLUSION: SMICs have advantages in preventing cardiovascular events. GXN, SI, and Danhong had the greatest probability of being the best treatment in the total efficacy against UAP and for improving the total effectiveness of electrocardiography.
文摘BACKGROUND Prior studies indicate that doing breathing exercises improves physical performance and quality of life (QoL) in heart failure patients. However, these effects remain unclear and contradictory. AIM To determine the effects of machine-assisted and non-machine-assisted respiratory training on physical performance and QoL in heart failure patients. METHODS This was a systematic review and network meta-analysis study. A literature search of electronic databases was conducted for randomized controlled trials (RCTs) on heart failure. Respiratory training interventions were grouped as seven categories: IMT_Pn (inspiratory muscle training without pressure or < 10% maximal inspiratory pressure, MIP), IMT_Pl (inspiratory muscle training with low pressure, 10%-15% MIP), IMT_Pm (inspiratory muscle training with medium pressure, 30%-40% MIP), IMT_Ph (inspiratory muscle training with high pressure, 60% MIP or MIP plus aerobics), Aerobics (aerobic exercise or weight training), Qi_Ex (tai chi, yoga, and breathing exercise), and none. The four outcomes were heart rate, peak oxygen uptake (VO2 peak), 6-min walking distance test (6MWT), and Minnesota Living with Heart Failure QoL. The random-effects model, side-splitting model, and the surface under the cumulative ranking curve (SUCRA) were used to test and analyze the data. RESULTS A total of 1499 subjects from 31 RCT studies were included. IMT_Ph had the highest effect sizes for VO2 peak and 6MWT, IMT_Pm highest for QoL, and Qi_Ex highest for heart rate. Aerobics had the second highest for VO2 peak, Qi_Ex second highest for 6MWT, and IMT_Ph second highest for heart rate and QoL.CONCLUSION This study supports that high- and medium-intensity machine-assisted training improves exercise capacity and QoL in hospital-based heart failure patients. After hospital discharge, non-machine-assisted training continuously improves cardiac function.
基金Supported by the National Natural Science Foundation of China"Kidney Health Bone,Marrow Link Brain",a Study of Chinese Nourishing Kidney Herbs’Mechanism of Treatment of Osteoporosis Based on Neuropeptide Network"Too Salty to Hurt the Bone",A Study on the Molecular Mechanism of High Salt Affecting Bone Metabolism Based on Related Ion Channels and Intervention of A Compound Chinese Medicine for Reinforcing Kidney(No.81473509,81673837).
文摘OBJECTIVE:The aim of this study was to evaluate the effectiveness of Chinese herbal medicines for invigorating the kidney(CHMIK)on senile osteoporosis.METHODS:We searched for studies in English-language databases(Pub Med,the Cochrane Library,and Web of Science)and Chinese-language databases(China National Knowledge Infrastructure,Wan Fang Data,VIP Chinese periodical service platform),and China Biology Medicine disc from their inception to September 2017.Randomized controlled trials comparing the effectiveness of Traditional Chinese Medicine therapies(alone or in combination)and conventional clinical medicine therapies among older adult patients with osteoporosis were identified.We conducted a network Meta-analysis with a Bayesian hierarchical random-effects model using RStudio software,Version 3.4.1.RESULTS:Forty-three randomized controlled trials assessing the differences between Traditional Chinese Medicine and conventional clinical medicine were identified,including 15 treatments and involving 3316 patients.The results of the network Meta-analysis indicated that alendronate(odds ratio[OR]=0.20,95%confidence interval[CI]:0.047-0.73)and calcium(OR=0.18,95%CI:0.11-0.30)are significantly more effective if combined with oral CHMIK.CHMIK alone is significantly more effective than both alendronate(OR=0.34,95%CI:0.10-1.0)and calcium(OR=0.13,95%CI:0.056-0.28).Moreover,CHMIK+tuina+calcium is more effective than CHMIK+calcium+vitamin D+alendronate(OR=18.0,95%CI:1.1-2.7 e+02).CONCLUSION:The present network Meta-analysis found that alendronate and calcium are more effective if combined with oral CHMIK and that oral CHMIK alone may be more effective than alendronate or calcium.Tuina may have an advantage over oral medicines.Oral CHMIK and calcitonin show the most potential for treating senile osteoporosis.
基金supported by the Natural Science Foundation of Liaoning Province of China,No.20170541036(to HYL)
文摘Objective: To assess and compare the clinical efficacy and safety of cognitive enhancers(donepezil, galantamine, rivastigmine, and memantine) on cognition, behavior, function, and global status in patients with vascular cognitive impairment.Data sources: The initial literature search was performed with PubMed, EMBASE, the Cochrane Methodology Register, the Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health(CINAHL) from inception to January 2018 for studies regarding donepezil, galantamine, rivastigmine, and memantine for treatment of vascular cognitive impairment.Data selection: Randomized controlled trials on donepezil, galantamine, rivastigmine, and memantine as monotherapy in the treatment of vascular cognitive impairment were included. A Bayesian network meta-analysis was conducted. Outcome measures: Efficacy was assessed by changes in scores of the Alzheimer's Disease Assessment Scale, cognitive subscale, Mini-Mental State Examination, Neuropsychiatric Inventory scores and Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input, Activities of Daily Living, the Clinical Dementia Rating scale. Safety was evaluated by mortality, total adverse events(TAEs), serious adverse events(SAEs), nausea, vomiting. diarrhea, or cerebrovascular accidents(CVAs). Results: After screening 1717 citations, 12 randomized controlled trials were included. Donepezil and rivastigmine(mean difference(e) = –0.77, 95% confidence interval(CI): 0.25–1.32; MD = 1.05, 95% CI: 0.18–1.79) were significantly more effective than placebo in reducing Mini-Mental State Examination scores. Donepezil, galantamine, and memantine(MD = –1.30, 95% CI: –2.27 to –0.42; MD = –1.67, 95% CI: –3.36 to –0.06; MD = –2.27, 95% CI: –3.91 to –0.53) showed superior benefits on the Alzheimer's Disease Assessment Scale–cognitive scores compared with placebo. Memantine(MD = 2.71, 95% CI: 1.05–7.29) improved global status(Clinician's Interview-Based Impression of Change Scale Plus Caregiver's Input) more than the placebo. Safety results revealed that donepezil 10 mg(odds ratio(OR) = 3.04, 95% CI: 1.86–5.41) contributed to higer risk of adverse events than placebo. Galantamine(OR = 5.64, 95% CI: 1.31–26.71) increased the risk of nausea. Rivastigmine(OR = 16.80, 95% CI: 1.78–319.26) increased the risk of vomiting. No agents displayed a significant risk of serious adverse events, mortality, cerebrovascular accidents, or diarrhea.Conclusion: We found significant efficacy of donepezil, galantamine, and memantine on cognition. Memantine can provide significant efficacy in global status. They are all safe and well tolerated.
基金supported by the National Natural Science Foundation of China[No.81302508,71673003,81473067,and 91646107].
文摘Objective To evaluate the effects of incretin-based therapies on body weight as the primary outcome,as well as on body mass index(BMI)and waist circumference(WC)as secondary outcomes.Methods Databases including Medline,Embase,the Cochrane Library,and clinicaltrials.gov(www.clinicaltrials.gov)were searched for randomized controlled trials(RCTs).Standard pairwise meta-analysis and network meta-analysis(NMA)were both carried out.The risk of bias(ROB)tool recommended by the Cochrane handbook was used to assess the quality of studies.Subgroup analysis,sensitivity analysis,meta-regression,and quality evaluation based on the Grading of Recommendations Assessment,Development,and Evaluation(GRADE)were also performed.Results A total of 292 trials were included in this study.Compared with placebo,dipeptidyl-peptidase IV inhibitors(DPP-4 Is)increased weight slightly by 0.31 kg[95%confidence interval(CI):0.05,0.58]and had negligible effects on BMI and WC.Compared with placebo,glucagon-like peptide-1 receptor agonists(GLP-1 RAs)lowered weight,BMI,and WC by-1.34 kg(95%CI:-1.60,-1.09),-1.10 kg/m2(95%CI:-1.42,-0.78),and-1.28 cm(95%CI:-1.69,-0.86),respectively.Conclusion GLP-1 RAs were more effective than DPP-4 Is in lowering the three indicators.Overall,the effects of GLP-1 RAs on weight,BMI,and WC were favorable.
文摘AIM:To compare the outcomes of four adjuvants used for internal limiting membrane(ILM)peeling in macular hole surgery,including indocyanine green(ICG),brilliant blue G(BBG),triamcinolone(TA)and trypan blue(TB),through systematic review and random-effects Bayesian network Meta-analysis.METHODS:PubMed,Cochrane library databases and Web of Science were searched until August 2018 for clinical trials comparing the above four adjuvants.ORs for postoperative best corrected visual acuity(BCVA)improvement and primary macular hole closure rates were compared between the different adjuvants.RESULTS:Twenty-seven eligible articles were included.For postoperative BCVA improvement,results of BBGassisted peeling were significantly more favorable than those of ICG(WMD 0.08,95%credible interval 0.01-0.16)and TA ranked highest.No significant differences were found between any other two groups in postoperative BCVA improvement.For postoperative primary macular hole closure rates,BBG ranked highest.However,no significant differences were shown between any two groups.CONCLUSION:TA and BBG are the optimum adjuvants for achieving postoperative BCVA improvement macular hole surgery with adjuvant-assisted ILM peeling.Among all adjuvants,the use of BBG is associated with the highest postoperative macular hole closure rate.
基金Supported by the Medical Scientific Research Foundation of Guangdong Province,No.A2017229
文摘BACKGROUND Pancreatic cancer is one of the most common and lethal malignancies worldwide. The common treatment options for resectable pancreatic cancer include surgery alone, neoadjuvant chemotherapy (CT), neoadjuvant chemoradiotherapy (CRT), adjuvant CT, and adjuvant CRT. However, the optimal treatment is still controversial. AIM To identify the most effective approach for pancreatic cancer using network meta-analysis. METHODS Eligible studies were searched from PubMed, MEDLINE, EMBASE, Cochrane database, and Google scholar. We searched and included randomized controlled trials reporting on neoadjuvant and adjuvant therapies. For direct comparisons, standard pairwise meta-analysis was performed using the inverse variance DerSimonian-Laird random-effects model. For indirect comparisons, Bayesian network meta-analysis was used to combine direct and indirect evidence. We used relative hazard ratios (HRs) to estimate death difference of different treatments, and relative odds ratios (ORs) for toxic effects. Treatment effects were ranked based on their efficacy for improving survival or reducing toxicity using rankogram. The quality of evidence of estimates from direct comparison and network meta-analysis was evaluated following the GRADE approach. RESULTS We included 13 high quality trials with 1591 participants in this network metaanalysis. Compared with surgery alone [pooled HR = 0.7, 95% confidence interval (CI): 0.62-0.79] and surgery with adjuvant CRT (pooled HR = 0.6, 95%CI: 0.54-0.72), surgery with adjuvant CT had a higher rate of overall survival. In contrast, standard pairwise meta-analysis showed a statistically significant survival advantage of surgery with adjuvant CT compared with surgery alone (pooled HR = 0.75, 95%CI: 0.63-0.89;P < 0.001). Rankogram showed that surgery with adjuvant CT was most likely to rank the best in terms of overall survival (probability: 94.2%), followed by surgery alone (probability: 5.8%). No significant differences in overall toxicity or haematological toxicity were found between all the therapies. High quality evidence supported surgery with adjuvant CT over surgery alone for increasing overall survival. Moderate quality evidence supported surgery with adjuvant CT over surgery with adjuvant CRT for increasing overall survival. CONCLUSION Surgery with adjuvant CT prolongs overall survival compared with surgery alone and surgery with adjuvant CRT, suggesting surgery with adjuvant CT is the optimal treatment for resectable pancreatic cancer.
文摘目的基于贝叶斯网状Meta分析系统评价不同血管化骨瓣在下颌骨缺损修复重建中的存活率。方法计算机检索PubMed、EBSCO、Scopus、Web of Science、Cochrane Library、WanFang Data和CNKI数据库,搜集与研究目的相关的临床研究,检索时限均从建库至2024年2月。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R软件进行贝叶斯网状Meta分析。结果共纳入24项研究,包括1615名患者。Meta分析结果显示腓骨游离瓣、旋髂深动脉髂骨瓣、肩胛骨瓣及携带桡骨的前臂桡侧皮瓣用于下颌骨重建的术后存活率分别为95.62%、94.09%、98.16%和93.75%。网状Meta分析结果显示各组织瓣术后存活率之间的差异均无统计学意义。结论当前证据表明,不同血管化骨瓣在下颌骨缺损修复重建中的存活率相似。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。
文摘目的运用网状Meta分析方法比较不同针灸疗法治疗类风湿关节炎(rheumatoid arthritis,RA)的临床疗效。方法计算机检索自2012年8月—2022年9月国内数据库:中国知网(CNKI)、万方(Wanfang)、维普(VIP)、中国生物医学文献数据库(SinoMed)及英文数据库:PubMed、Web of Science、Cochrane Library数据库以针灸治疗RA的临床研究文献,运用Cochrane风险评估工具进行质量评价,Stata16.0进行网状Meta分析。结果该研究共纳入17篇文献,其中针刺8篇,艾灸6篇,针刺+艾灸3篇。针刺、艾灸、针刺+艾灸联合常规西药治疗在临床疗效总有效率及DAS28方面均优于单独常规西药治疗(P<0.05),且针刺联合常规西药治疗成为最优治疗方法的可能性大[临床疗效总有效率曲线下面积(SUCRA)=0.713,P<0.05;DAS28曲线下面积(SUCRA)=0.979,P<0.05]。结论针刺治疗、艾灸、针刺联合艾灸治疗分别联合常规西药治疗相较于单独应用常规西药治疗能够提高临床疗效总有效率及降低DAS28评分,但文章中符合纳入标准的临床文献较少,针灸疗法较为单一,还需更多中心、大样本的随机对照试验对结果加以验证。
基金National Key Research and Development Program of China,Grant/Award Number:2021YFF1201300National Natural Science Foundation of China,Grant/Award Number:82230058。
文摘Background:The current standard of care for advanced human epidermal growth factor receptor 2(HER2)‐positive breast cancer is pertuzumab plus trastuzumab and docetaxel as first‐line therapy.However,with the development of newer treatment regimens,there is a lack of evidence regarding which is the optimal treatment strategy.The aim of this network meta‐analysis was to evaluate the efficacy and safety of first‐line regimens for advanced HER2‐positive breast cancer by indirect comparisons.Methods:A systematic review and Bayesian network meta‐analysis were conducted.The PubMed,EMBASE,and Cochrane Library databases were searched for relevant articles published through to December 2023.The hazard ratio(HR)and 95%credible interval(CrI)were used to compare progressionfree survival(PFS)between treatments,and the odds ratio and 95%CrI were used to compare the objective response rate(ORR)and safety.Results:Twenty randomized clinical trials that included 15 regimens and 7094 patients were analyzed.Compared with the traditional trastuzumab and docetaxel regimen,PFS was longer on the pyrotinib and trastuzumab plus docetaxel regimen(HR:0.41,95%CrI:0.22–0.75)and the pertuzumab and trastuzumab plus docetaxel regimen(HR:0.65,95%CrI:0.43–0.98).Consistent with the results for PFS,the ORR was better on the pyrotinib and trastuzumab plus docetaxel regimen and the pertuzumab and trastuzumab plus docetaxel regimen than on the traditional trastuzumab and docetaxel regimen.The surface under the cumulative ranking curve indicated that the pyrotinib and trastuzumab plus docetaxel regimen was most likely to rank first in achieving the best PFS and ORR.Comparable results were found for grade≥3 AE rates of≥10%.Conclusions:Our results suggest that the pyrotinib and trastuzumab plus docetaxel regimen is most likely to be the optimal first‐line therapy for patients with HER2‐positive breast cancer.
