BACKGROUND Spontaneous bacterial peritonitis(SBP)is an important prognostic factor for outcomes in patients with cirrhosis.Antibiotic prophylaxis is recommended in patients at high risk for developing SBP,but the choi...BACKGROUND Spontaneous bacterial peritonitis(SBP)is an important prognostic factor for outcomes in patients with cirrhosis.Antibiotic prophylaxis is recommended in patients at high risk for developing SBP,but the choice of antibiotics remains unclear.AIM To evaluate the efficacy of various antibiotics for prophylaxis of SBP based on randomized control trials(RCTs).METHODS Electronic databases were searched through November 2018 for RCTs evaluating the efficacy of therapies for primary or secondary prophylaxis of SBP.The primary outcome was the development of SBP.Sensitivity analyses limited to studies of primary or secondary prophylaxis and studies reported after 2010 were performed.The secondary outcome was the risk of all-cause mortality or transplant.The outcomes were assessed by rank of therapies based on network meta-analyses.Individual meta-analyses were also performed.RESULTS Thirteen RCTs(1742 patients)including norfloxacin,ciprofloxacin,rifaximin,trimethoprim-sulfamethoxazole(TMP-SMX),or placebo/no comparator were identified.Individual meta-analyses showed superiority of rifaximin over norfloxacin as well as norfloxacin and TMP-SMX over placebo.Network metaanalysis demonstrated the rank of efficacy in reducing the risk of SBP as:Rifaximin,ciprofloxacin,TMP-SMX,norfloxacin,and placebo/no comparator.Rifaximin ranked highest in sensitivity analyses limited to studies of primary or secondary prophylaxis and studies reported after 2010.Similarly,rifaximin ranked highest in reducing the risk of death/transplant.CONCLUSION The present comprehensive network meta-analysis provides RCT based evidence for superior efficacy of rifaximin compared to other antibiotics for the prophylaxis of SBP and reducing risk of death/transplant.Further RCTs are warranted to confirm our findings.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:The landscape of metastatic castration-resistant prostate cancer(mCRPC)treatment has evolved greatly;however,limited data are available regarding its relative efficacy and safety.We conducted a systematic r...Background:The landscape of metastatic castration-resistant prostate cancer(mCRPC)treatment has evolved greatly;however,limited data are available regarding its relative efficacy and safety.We conducted a systematic review and network meta-analysis to analyze and compare the effectiveness and safety of first-line therapies for mCRPC,particularly doublet therapy and monotherapy.Methods:The PubMed,Embase,and Cochrane Library databases were searched from their inception until June 6,2023.ClinicalTrials.gov and congress abstracts were also searched.We selected randomized controlled trials(RCTs)in English that reported the first-line treatment outcomes of mCRPC.The primary efficacy outcomes included radiographic progression-free survival(rPFS),overall survival(OS),and safety outcomes included any adverse events(AEs)and grade 3 or higher AEs(grade≥3 AEs).Considering only trials that used therapies without docetaxel(Doc)assess rPFS and no common arm between therapies with or without Doc in terms of OS and safety outcomes,two separate pairwise meta-analyses were conducted.We performed subgroup,metaregression,and sensitivity analyses to identify moderators and account for heterogeneity.The Cochrane risk-of-bias assessment tool was used to evaluate the quality of each study.Results:Thirty-five RCTs with 24,400 patients comparing 30 treatments were analyzed.In the non-Doc group,poly(adenosine diphosphate-ribose)polymerase inhibitor(PARPi)doublet with androgen receptor signaling inhibitor(ARSI)conferred rPFS and OS improvements in patients with mCRPC,especially with alterations in homologous recombination repair(HRR)genes.In the Doc group,combination therapies showed no significant difference in OS compared to Doc.Regarding safety outcomes,ra-223 plus abiraterone and estramustine plus docetaxel showed the lowest risks of AEs in the non-Doc and Doc groups,respectively.The PARPi doublet with the ARSI had a relatively low ranking.Conclusion:While raising concerns about safety profiles,our findings highlight that the PARPi doublet with ARSI probably has the greatest benefit in mCRPC patients with HRR gene alterations.展开更多
Inflammatory bowel disease,particularly ulcerative colitis(UC),poses significant treatment challenges due to its chronic nature and potential for severe complications.This editorial reviews a recent network meta-analy...Inflammatory bowel disease,particularly ulcerative colitis(UC),poses significant treatment challenges due to its chronic nature and potential for severe complications.This editorial reviews a recent network meta-analysis that evaluated the efficacy of and highlighted the superior outcomes achieved by combining each of five traditional Chinese medicine(TCM)formulations with mesalazine for the adjuvant treatment of UC.Clinical outcomes included enhanced mucosal healing,improved quality of life,and reduced recurrence rates.Additionally,the combination therapy resulted in a lower incidence of adverse reactions compared with mesalazine monotherapy.Despite these promising results,limitations such as variability in study quality and TCM dosage highlight the need for further highquality,large-sample,multicenter randomized controlled trials.This editorial underscores the potential of TCM in enhancing UC management and calls for more rigorous research to substantiate these findings and refine clinical guidelines.展开更多
文摘BACKGROUND Spontaneous bacterial peritonitis(SBP)is an important prognostic factor for outcomes in patients with cirrhosis.Antibiotic prophylaxis is recommended in patients at high risk for developing SBP,but the choice of antibiotics remains unclear.AIM To evaluate the efficacy of various antibiotics for prophylaxis of SBP based on randomized control trials(RCTs).METHODS Electronic databases were searched through November 2018 for RCTs evaluating the efficacy of therapies for primary or secondary prophylaxis of SBP.The primary outcome was the development of SBP.Sensitivity analyses limited to studies of primary or secondary prophylaxis and studies reported after 2010 were performed.The secondary outcome was the risk of all-cause mortality or transplant.The outcomes were assessed by rank of therapies based on network meta-analyses.Individual meta-analyses were also performed.RESULTS Thirteen RCTs(1742 patients)including norfloxacin,ciprofloxacin,rifaximin,trimethoprim-sulfamethoxazole(TMP-SMX),or placebo/no comparator were identified.Individual meta-analyses showed superiority of rifaximin over norfloxacin as well as norfloxacin and TMP-SMX over placebo.Network metaanalysis demonstrated the rank of efficacy in reducing the risk of SBP as:Rifaximin,ciprofloxacin,TMP-SMX,norfloxacin,and placebo/no comparator.Rifaximin ranked highest in sensitivity analyses limited to studies of primary or secondary prophylaxis and studies reported after 2010.Similarly,rifaximin ranked highest in reducing the risk of death/transplant.CONCLUSION The present comprehensive network meta-analysis provides RCT based evidence for superior efficacy of rifaximin compared to other antibiotics for the prophylaxis of SBP and reducing risk of death/transplant.Further RCTs are warranted to confirm our findings.
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.
基金funded by Beijing Physician Scientist Training Project,Beijing,China(No.BJPSTP-2024-20)for data acquisition.
文摘Background:The landscape of metastatic castration-resistant prostate cancer(mCRPC)treatment has evolved greatly;however,limited data are available regarding its relative efficacy and safety.We conducted a systematic review and network meta-analysis to analyze and compare the effectiveness and safety of first-line therapies for mCRPC,particularly doublet therapy and monotherapy.Methods:The PubMed,Embase,and Cochrane Library databases were searched from their inception until June 6,2023.ClinicalTrials.gov and congress abstracts were also searched.We selected randomized controlled trials(RCTs)in English that reported the first-line treatment outcomes of mCRPC.The primary efficacy outcomes included radiographic progression-free survival(rPFS),overall survival(OS),and safety outcomes included any adverse events(AEs)and grade 3 or higher AEs(grade≥3 AEs).Considering only trials that used therapies without docetaxel(Doc)assess rPFS and no common arm between therapies with or without Doc in terms of OS and safety outcomes,two separate pairwise meta-analyses were conducted.We performed subgroup,metaregression,and sensitivity analyses to identify moderators and account for heterogeneity.The Cochrane risk-of-bias assessment tool was used to evaluate the quality of each study.Results:Thirty-five RCTs with 24,400 patients comparing 30 treatments were analyzed.In the non-Doc group,poly(adenosine diphosphate-ribose)polymerase inhibitor(PARPi)doublet with androgen receptor signaling inhibitor(ARSI)conferred rPFS and OS improvements in patients with mCRPC,especially with alterations in homologous recombination repair(HRR)genes.In the Doc group,combination therapies showed no significant difference in OS compared to Doc.Regarding safety outcomes,ra-223 plus abiraterone and estramustine plus docetaxel showed the lowest risks of AEs in the non-Doc and Doc groups,respectively.The PARPi doublet with the ARSI had a relatively low ranking.Conclusion:While raising concerns about safety profiles,our findings highlight that the PARPi doublet with ARSI probably has the greatest benefit in mCRPC patients with HRR gene alterations.
文摘Inflammatory bowel disease,particularly ulcerative colitis(UC),poses significant treatment challenges due to its chronic nature and potential for severe complications.This editorial reviews a recent network meta-analysis that evaluated the efficacy of and highlighted the superior outcomes achieved by combining each of five traditional Chinese medicine(TCM)formulations with mesalazine for the adjuvant treatment of UC.Clinical outcomes included enhanced mucosal healing,improved quality of life,and reduced recurrence rates.Additionally,the combination therapy resulted in a lower incidence of adverse reactions compared with mesalazine monotherapy.Despite these promising results,limitations such as variability in study quality and TCM dosage highlight the need for further highquality,large-sample,multicenter randomized controlled trials.This editorial underscores the potential of TCM in enhancing UC management and calls for more rigorous research to substantiate these findings and refine clinical guidelines.
