No abstract

Summary Background:  Depression may affect patients’ recovery and even their survival rate after stroke, but it is often overlooked or inadequately managed; data regarding the prophylactic efficacy and safety of fluoxetine are inconsistent in this setting. Objective:  The objective of the study is to systematically assess the prophylactic efficacy and safety of fluoxetine for poststroke depression in patients with stroke. Methods:  We searched electronic databases up to December 2009 for studies evaluating the prophylactic efficacy of fluoxetine in patients with stroke. The pooled odds ratio (OR), weighted mean difference (WMD), incremental efficiency and 95% confidence intervals (95% CI) were calculated. Results:  We collected and evaluated a total of 385 patients identified from six trials. Meta‐analysis demonstrated that fluoxetine reduced the incidence of poststroke depression (PSD) (OR = 0.25, 95% CI 0.11 to 0.56), helped recovery in neurological function (WMD = −4.72, 95% CI −8.31 to −1.13) and improved independence in activities of daily living (WMD = −8.04, 95% CI −13.40 to −2.68); fluoxetine is relatively safe in spite of the adverse events (OR = 0.88, 95% CI 0.31 to 2.49, p = 0.82). However, fluoxetine groups and control groups did not differ in change of scores for depression (WMD = −3.97, 95% CI −9.85 to 1.90, p = 0.19). Conclusions:  Fluoxetine was beneficial for the prophylaxis of poststroke depression in patients with stroke but not in reducing symptom severity of PSD.

Recent evidence shows that moxifloxacin could exert an antimicrobial effect against Helicobacter pylori in both in vitro and in vivo models. To systematically evaluate whether moxifloxacin-containing triple therapy could improve eradication rates and reduce side effects in first-line or second-line anti-H. pylori treatment, eligible articles were identified by searches of electronic databases. We included all randomized trials comparing moxifloxacin-based triple therapy with standard triple or quadruple therapy during H. pylori eradication treatment. Statistical analysis was performed with Review Manager 5.0.10. Subanalysis/sensitivity analysis was also performed. We identified seven randomized trials (n=1263). Pooled H. pylori eradication rates were 79.03% (95%CI: 75.73-82.07) and 68.33% (95%CI: 64.44-72.04) for patients with moxifloxacin-based triple therapy or with standard triple or quadruple therapy, respectively (intention-to-treat analysis). The odds ratio (OR) was 1.82 (95%CI: 1.17-2.81), the occurrence of total side effects was 15.23% (95%CI: 12.58-18.20) and 27.17% (95%CI: 23.64-30.92) for groups with or without moxifloxacin, and the summary OR was 0.45 (95%CI: 0.26-0.77). In subgroup analyses, we noted that the second-line eradication rate in the moxifloxacin group was significantly higher than that in the quadruple therapy group (73.33 vs 60.17%, OR: 1.78, 95%CI: 1.16-2.73, P<0.001). However, there was no difference in first-line eradication treatment. Findings from this meta-analysis suggest that moxifloxacin-based triple therapy is more effective and better tolerated than standard triple or quadruple therapy. Therefore, a moxifloxacin-based triple regimen should be used in the second-line treatment of H. pylori infection.

No abstract

No abstract

Aims We reviewed randomized controlled trials (RCTs) to compare the efficacy and safety of initial dipeptidyl peptidase‐IV (DPP‐IV) inhibitors and metformin combination therapy with equal‐dosage metformin monotherapy in type 2 diabetes. Methods We conducted a systematic review of English articles using MEDLINE and EMBASE. Search terms included randomized controlled trial, controlled clinical trial, random allocation, sitagliptin, vildagliptin, saxagliptin, alogliptin, linagliptin, duotogliptin and dipeptidyl peptidase IV inhibitor. Double‐blinded RCTs comparing DPP‐IV inhibitors initially combined with metformin and metformin monotherapy in non‐pregnant drug‐naive adults with type 2 diabetes were included for this study. Extraction of articles was performed by two authors using predefined data fields. Meta‐analysis was used when studies were homogeneous enough, and data were shown and not combined if no formal meta‐analysis was performed. Results Five RCTs met the inclusion criteria. By analysis of different outcomes, patients receiving initial combination of DPP‐IV inhibitors and metformin showed a greater reduction in haemoglobinA1c (HbA1c) from baseline [weighted mean difference (WMD), −0.55%; 95% confidence interval (CI), −0.63 to −0.46%], a higher rate of achieving target of HbA1c < 7% [risk ratio (RR), 1.55; 95% CI, 1.43–1.67], a significantly lower fasting plasma glucose (FPG) (WMD, −0.97 mmol/l; 95% CI, −1.26 to −0.68 mmol/l),while the initial combination therapy and monotherapy did not show a significant difference in incidence of total adverse events (AEs, 51.8 vs. 53.7%, respectively; RR, 0.96; 95% CI, 0.91–1.02), gastrointestinal AEs (18.2 vs. 19.4%, respectively; RR, 0.94; 95% CI, 0.82–1.07), drug‐related AEs (RR, 0.88; 95% CI, 0.74–1.03) and discontinuation due to AEs (RR, 0.85; 95% CI, 0.61–1.20). The following outcomes were not included for meta‐analysis: change from baseline in postprandial glycaemia, β‐cell function, insulin sensitivity and body weight as well as incidence of hypoglycaemia. The analyses of these trials revealed that the change from baseline of the postprandial glycaemia and index of β‐cell function were greater while the RRs for incidence of hypoglycaemia and body weight increase had no statistical significance. Conclusions Compared with equal‐dosage metformin monotherapy, the initial combination of metformin and DPP‐IV inhibitors were more effective in glycaemic control without additional risk of AEs, therefore it can be considered as a beneficial therapeutic regimen for drug‐naive type 2 diabetes patients.

No abstract

No abstract