In rectal cancer patients with a cCR following neoadjuvant chemoradiotherapy, a Watch and Wait policy appears feasible and safe. Robust surveillance with early detection of regrowths allows a high rate of successful salvage surgery, without an increase in the risk of systemic disease, or adverse survival outcomes.
AimsAnaemia is increasingly recognised as having an independent impact upon patient outcomes in cardiac disease. The role of novel iron therapies to treat anaemia is increasing. This systematic review and meta-analysis assesses the efficacy and safety of iron therapies for the treatment of adults with anaemia.
Methods and ResultsElectronic databases and search engines were searched as per Cochrane methodology. Randomised controlled trials (RCTs) of iron versus inactive control or placebo, as well as alternative formulations, doses and routes in anaemic adults without chronic kidney disease or in the peri-partum period were eligible. The primary outcome of interest was mortality at one year.Secondary outcomes were blood transfusion, haemoglobin levels, quality of life, serious adverse events and length of hospital stay. 64 RCTs (including five studies of heart failure patients) including 9004 participants were included. None of the studies were at a low risk of bias. There were no statistically significant differences in mortality between iron and inactive control. Both oral and parenteral iron significantly reduced the proportion of patients requiring blood transfusion compared to inactive control (risk ratio (RR) 0.66 (95% confidence interval (CI) 0.48 to 0.90) and RR 0.84 (95% CI 0.73 -0.97) respectively. Haemoglobin was increased more by both oral and parenteral iron compared to inactive control (mean difference (MD) 0.91 g/dL (95% CI 0.48 to 1.35) and MD 1.04 (95% CI 0.52 to 1.57) respectively), and Iron for Anaemic Adults 3 parenteral iron demonstrated a greater increase when compared to oral iron (MD 0.53 g/dL (95% CI 0.31 to 0.75)). In all comparisons there were no differences in the results comparing patients with and without heart failure.
ConclusionBoth oral and parenteral iron are shown to decrease the proportion of people who require blood transfusion and increase haemoglobin levels, without any benefit in mortality. Further trials at a low risk of bias, powered to measure clinically significant endpoints are still required. * This paper updates the findings of a Cochrane review first published December 2014 in The Cochrane Database of Systematic Reviews (CDSR) Issue 12 (http://www.thecochranelibrary.com).
Surgery for PA/FIA in children aged <2 years resulted in low recurrence rates and should be considered as the primary treatment. Topical tacrolimus was found to be an effective treatment for IBD associated FIA.
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