Drug Coated Balloons for Dysfunctional Haemodialysis Venous Access: A Patient Level Meta-Analysis of Randomised Controlled Trials

Fong, Khi Yung; Zhao, Joseph J; Tan, Eelin; Syn, Nicholas; Sultana, Rehena; Zhuang, Kun; Chua, Jasmine Ming Er; Patel, Ankur; Irani, Farah Gillan; Tay, Kiang Hiong; Tan, Bien Soo; Too, Chow Wei

doi:10.1016/j.ejvs.2021.06.006

Cited by 15 publications

(9 citation statements)

References 62 publications

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“…A meta-analysis of studies comparing these methods for the treatment of dysfunctional haemodialysis venous access concluded that DCB is favoured over PTA. 36 Based on these findings, postreintervention patency was likely greater among patients who underwent DCB angioplasty in our study. Because a very small fraction of our patients underwent DCB, we are confident that our results were not affected by this inconsistency.…”

Section: Discussionsupporting

confidence: 55%

“…While standard PTA was the predominant angioplasty method used to treat patients in our cohort, a small number underwent drug-coated balloon (DCB) angioplasty. A meta-analysis of studies comparing these methods for the treatment of dysfunctional haemodialysis venous access concluded that DCB is favoured over PTA 36. Based on these findings, postreintervention patency was likely greater among patients who underwent DCB angioplasty in our study.…”

Section: Discussionsupporting

confidence: 51%

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Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study

Tarng

Yang

et al. 2022

BMJ Open

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ObjectivesMaintenance of vascular access (VA) patency after percutaneous transluminal angioplasty (PTA) is important and remains a challenge despite VA monitoring and surveillance. The aim of this study was to examine factors affecting the post-PTA arteriovenous access (AVA) patency in patients who have been on close VA monitoring and surveillance for access flow.DesignRetrospective cohort study.SettingA single medical centre in Taiwan.ParticipantsRecords of patients who received chronic haemodialysis between 1 January 2017 and 31 December 2018 were retrospectively reviewed. Patients were divided into two groups (without or with PTA intervention on AVA).Primary and secondary outcomePatients were followed until reintervention PTA, termination or abandoned VA or end of study. In addition to routine monitoring, VA flow surveillance was performed every 3 months for detection of VA dysfunction adhering to Kidney Disease Outcomes Quality Initiative guidelines.ResultsA total of 508 patients were selected for study inclusion (with PTA, n=231; without PTA, n=277). At baseline, variables that differed between groups included malignancy and levels of albumin, uric acid, potassium, phosphorous, high-density lipoprotein, total bilirubin and ferritin (all p<0.05). Significant between-group differences were observed for β-adrenergic blocking agents (with PTA, 49.8%; without PTA, 37.5%; p, 0.007) and ADP inhibitors (with PTA, 23.8%; without PTA, 11.2%; p<0.001). Among patients with PTA, those with acute myocardial infarction, high ferritin level or arteriovenous graft (AVG) had a significantly higher risk of reintervention post-PTA (p<0.05). Dipeptidyl peptidase-4 inhibitors, thiazolidinediones, ADP inhibitors, and warfarin use were predictors of post-PTA patency (p<0.05).ConclusionsAVG access type, acute myocardial infarction, and high ferritin levels are risk factors for re-intervention post-PTA. These findings may be useful in the development of prophylactic strategies for monitoring VA function and tailoring surveillance programs for these dialysis patients.

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Section: Discussionsupporting

confidence: 55%

Section: Discussionsupporting

confidence: 51%

Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study

Tarng

Yang

et al. 2022

BMJ Open

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“…Hence, an online software application 18 that implemented analytical methods outlined by Guyot et al 19 was used to attain information on survival from device‐free complications of individual patients and pool them under an individual patient data (IPD) meta‐analysis, which is recognized as the gold standard approach for evidence synthesis. 20 , 21 , 22 , 23 , 24 Images of Kaplan–Meier curves from included studies were digitized to obtain step function values and step timings. Survival information of individual patients was then recovered based on the numerical solutions to the inverted Kaplan–Meier product‐limit equations and provided risk tables.…”

Section: Methodsmentioning

confidence: 99%

Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta‐Analysis of Randomized Trials and Propensity Score–Matched Studies

Fong

Wang

et al. 2022

JAHA

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Background Subcutaneous implantable cardioverter‐defibrillators (S‐ICDs) have been of great interest as an alternative to transvenous implantable cardioverter‐defibrillators (TV‐ICDs). No meta‐analyses synthesizing data from high‐quality studies have yet been published. Methods and Results An electronic literature search was conducted to retrieve randomized controlled trials or propensity score–matched studies comparing S‐ICD against TV‐ICD in patients with an implantable cardioverter‐defibrillator indication. The primary outcomes were device‐related complications and lead‐related complications. Secondary outcomes were inappropriate shocks, appropriate shock, all‐cause mortality, and infection. All outcomes were pooled under random‐effects meta‐analyses and reported as risk ratios (RRs) and 95% CIs. Kaplan–Meier curves of device‐related complications were digitized to retrieve individual patient data and pooled under a 1‐stage meta‐analysis using Cox models to determine hazard ratios (HRs) of patients undergoing S‐ICD versus TV‐ICD. A total of 5 studies (2387 patients) were retrieved. S‐ICD had a similar rate of device‐related complications compared with TV‐ICD (RR, 0.59 [95% CI, 0.33–1.04]; P =0.070), but a significantly lower lead‐related complication rate (RR, 0.14 [95% CI, 0.07–0.29]; P <0.0001). The individual patient data–based 1‐stage stratified Cox model for device‐related complications across 4 studies yielded no significant difference (shared‐frailty HR, 0.82 [95% CI, 0.61–1.09]; P =0.167), but visual inspection of pooled Kaplan–Meier curves suggested a divergence favoring S‐ICD. Secondary outcomes did not differ significantly between both modalities. Conclusions S‐ICD is clinically superior to TV‐ICD in terms of lead‐related complications while demonstrating comparable efficacy and safety. For device‐related complications, S‐ICD may be beneficial over TV‐ICD in the long term. These indicate that S‐ICD is likely a suitable substitute for TV‐ICD in patients requiring implantable cardioverter‐defibrillator implantation without a pacing indication.

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“…Extraction of Individual Patient Data Precise statistical methods are needed to quantify comparisons among different systemic therapies in the rapidly changing field of aHCC therapy. Hence, a graphical reconstructive algorithm devised by Liu et al [12] based on principles outlined by Guyot et al [13][14][15][16] was used to attain information on OS and PFS of individual patients in each trial arm. Images of Kaplan-Meier curves from included studies were digitized using WebPlotDigitizer (https://automeris.io/WebPlotDigitizer/) to obtain step function values and step timings.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

First-Line Systemic Therapies for Advanced Hepatocellular Carcinoma: A Systematic Review and Patient-Level Network Meta-Analysis

et al. 2022

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Introduction: Sorafenib was historically the standard of care for advanced hepatocellular carcinoma (aHCC) until it was superseded by the combination of atezolizumab and bevacizumab. Thereafter, several novel first-line combination therapies have demonstrated favorable outcomes. The efficacies of these treatments in relation to current and previous standards of care are unknown, necessitating an overarching evaluation. Methods: A systematic literature search was conducted on PubMed, EMBASE, Scopus, and the Cochrane Controlled Register of Trials for phase III randomized controlled trials investigating first-line systemic therapies for aHCC. Kaplan-Meier curves for overall survival (OS) and progression-free survival (PFS) were graphically reconstructed to retrieve individual patient-level data. Derived hazard ratios (HRs) for each study were pooled in a random-effects network meta-analysis (NMA). NMAs were also conducted using study-level HRs for various subgroups, according to viral etiology, Barcelona Clinic Liver Cancer (BCLC) staging, alpha-fetoprotein (AFP) levels, macrovascular invasion, and extrahepatic spread. Treatment strategies were ranked using P-scores. Results: Among 4,321 articles identified, 12 trials and 9,589 patients were included for analysis. Only two therapies showed OS benefit over sorafenib: combined anti-programmed-death and anti-VEGF pathway inhibitor monoclonal antibodies (Anti-PD-(L)1/VEGF Ab), including atezolizumab-bevacizumab and sintilimab-bevacizumab biosimilar (HR=0.63, 95%CI=0.53-0.76), and tremelimumab-durvalumab (HR=0.78, 95%CI=0.66-0.92). Anti-PD-(L)1/VEGF Ab showed OS benefit over all other therapies except tremelimumab-durvalumab. Low heterogeneity (I2=0%) and inconsistency (Cochran’s Q=0.52, p=0.773) was observed. P-scores for OS ranked Anti-PD-(L)1/VEGF Ab as the best treatment in all subgroups, except hepatitis B where atezolizumab-cabozantinib ranked highest for both OS and PFS, as well as nonviral HCC and AFP≥400μg/L where tremelimumab-durvalumab ranked highest for OS. Conclusion: This NMA supports Anti-PD-(L)1/VEGF Ab as the first-line therapy for aHCC, and demonstrates a comparable benefit for tremelimumab-durvalumab which also extends to certain subgroups. Results of the subgroup analysis may guide treatment according to baseline characteristics, while pending further studies.

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Drug Coated Balloons for Dysfunctional Haemodialysis Venous Access: A Patient Level Meta-Analysis of Randomised Controlled Trials

Cited by 15 publications

References 62 publications

Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study

Factors affecting arteriovenous access patency after percutaneous transluminal angioplasty in chronic haemodialysis patients under vascular access monitoring and surveillance: a single-centre observational study

Subcutaneous Versus Transvenous Implantable Defibrillator Therapy: A Systematic Review and Meta‐Analysis of Randomized Trials and Propensity Score–Matched Studies

First-Line Systemic Therapies for Advanced Hepatocellular Carcinoma: A Systematic Review and Patient-Level Network Meta-Analysis

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