Background This article is a meta-analysis aiming to systematically assess the efficacy and safety profiles of PD-1/PD-L1 inhibitors in patients with advanced or metastatic bladder cancer. Methods We extracted and examined data from phase I, II, and III clinical trials from the Medline, Embase, and the Cochrane Library, which included patients with metastatic bladder cancer who were treated with PD-1/PD-L1 inhibitors. We performed a meta-analysis to investigate several indexes of efficacy and safety, including the objective response rate (ORR), 1-year overall survival (OS) rate, 1-year progression-free survival (PFS) rate, and adverse event (AE) rate of immune checkpoint inhibitors. The material data were calculated and pooled using The R Project for Statistical Computing and Review Manager 5.3. Results After excluding ineligible records, 14 clinical trials were included in our analysis. The pooled frequencies of all-grade AEs and grade ≥3 AEs were 0.63 (95% CI 0.61–0.65, P =0.34) and 0.14 (95% CI 0.11–0.17, P =0.0072), respectively. The summary ORR was 0.21 (95% CI 0.18–0.24 P =0.07), and the 1-year OS and 1-year PFS rates were 0.48 (95% CI 0.42–0.54 P =0.0013) and 0.21 (95% CI 0.16–0.26 P =0.04), respectively. The OR of ORR between the PD-L1-positive and -negative groups was 3.09 (95% CI 2.01–4.75, P =0.08). Conclusion The PD-1/PD-L1 therapy showed appropriate efficacy and acceptable incidence of treatment-related AEs. In addition, the level of discrimination of PD-L1 expression might be related to the effect of the PD-1/PD-L1 inhibitors, and patients displaying positive expression might experience a better curative effect than patients displaying negative expression.
Objective: To systematically evaluate the efficacy index and adverse reactions of dezocine in postoperative pain relief, provide statistical theoretical support for guiding clinical application. Methods: We extracted and analyzed multiple data of patients from the PubMed, Embase, The Cochrane Library and China National Knowledge Infrastructure (CNKI) for use in randomized controlled trials of various surgical postoperative pain relief. We used meta-analysis to study several measures of efficacy and safety of dezocine, including visual analogue score (VAS), Ramsay sedation score, mean arterial pressure (MAP), heart rate (HR), Pulse Oxygen Saturation (SpO2) and the incidence of adverse events(AEs). The material data were calculated and analyzed using Review Manager 5.3. Results: After exclusion of literature that did not meet the inclusion criteria, our analysis included 14 randomized controlled trials. The Mean Difference (MD) of VAS at 1 h/6 h/24h between the dezocine group and the placebo group was -1.37 (95% CI -2.07,-0.67, P=0.0001),-0.52 (95% CI -1.04,0.01, P=0.05),-0.10 (95% CI -0.39,0.20, P=0.52), respectively. The MD of Ramsay sedation score at 2h/8h was 1.21 (95% CI 0.67,1.75, P<0.0001) and -0.17 (95% CI -0.59,0.26, P=0.44). The MD of MAP at T0/T1/T2 was -0.28 (95% CI -2.46,1.89, P=0.80),-2.66 (95% CI -5.07,-0.25, P=0.03),-4.53 (95% CI -6.17,-2.89, P<0.00001). The MD of HR at T0/T1/T2 was -2.26(95% CI -4.32,-0.21, P=0.03),-3.58(95% CI -5.21,-1.96, P<0.0001),-3.75 (95% CI -11.55,4.04, P=0.35). The MD of SpO2 at T0/T1 was -0.90(95% CI -1.77,-0.03, P=0.04) and 0.36(95% CI 0.02,0.71, P=0.04).The odds ratio (OR) of AEs was 0.53(95% CI 0.39,0.71, P<0.0001). Conclusion: Dezocine shows appropriate anesthetic efficacy and fewer adverse effects, which can reduce postoperative pain effectively.
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