Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Zhu, Gui‐Qi; Zou, Zhuolin; Zheng, Ji-Na; Chen, Da-Zhi; Zou, Tiantian; Shi, Ke‐Qing; Zheng, Ming‐Hua

doi:10.1097/md.0000000000003004

Cited by 23 publications

(8 citation statements)

References 55 publications

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“…Cure rates >90% have been reported by many studies using different combinations of DAAs in chronic HCV patients ( Del Bello et al, 2016 ; Welzel et al, 2016 ; Zhu et al, 2016 ; Belperio et al, 2019 ; Mushtaq et al, 2020 ). Given the high SVR rates with DAAs, virological failure cases were relatively low due to effective treatment strategies and the right drug combinations ( Buti et al, 2015 ; Benítez-Gutiérrez et al, 2016 ; Soriano et al, 2016 ; Mushtaq et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, initial real-world results supported these findings, but the efficacy tends to be lower over time mainly due to the predictors associated with a lower SVR rate. Furthermore, DAAs success have been compromised by doctor’s limited expertise using new DAAs combinations ( Dieterich et al, 2014 ; Jensen et al, 2014 ; Backus et al, 2015 ; Del Bello et al, 2016 ; Soriano et al, 2016 ; Sulkowski et al, 2016 ; Zhu et al, 2016 ; Arias et al, 2017 ). Similarly, in our study, patients who failed treatment were 6% (76/1388).…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and Safety of Generic Sofosbuvir Plus Daclatasvir and Sofosbuvir/Velpatasvir in HCV Genotype 3-Infected Patients: Real-World Outcomes From Pakistan

et al. 2020

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Background Direct-acting antivirals (DAAs) therapeutic regimens are highly effective against chronic hepatitis C virus (HCV) infection. However, HCV patients with genotype 3 (GT3) respond in a suboptimal way. This study aims to identify which of the DAAs-based therapeutic regimens are the best option for GT3. Methods Multiple governments and private tertiary care hospitals were involved in this real-life study of HCV-GT3 patients treated with DAAs. The efficacy and safety of generic sofosbuvir+daclatasvir±ribavirin (SOF+DCV±RBV) and sofosbuvir/velpatasvir±ribavirin (SOF/VEL±RBV) were assessed under the National Hepatitis C Program of Pakistan. Results Out of 1,388 participants, 70% of patients received SOF+DCV in government tertiary care hospitals and 30% received SOF/VEL in private tertiary care hospitals. The overall sustained virological responses (SVR) was 95.5%. The SVR rates at 12 weeks were comparable between SOF+DCV (94.4%) and SOF/VEL (94.7%) in chronic HCV patients. However, The SVR rates at 24 weeks were high in cirrhotic patients treated with SOF/VEL+RBV (88%) then SOF+DCV+RBV (83%). Non-responders were high in SOF-DCV than SOF-VEL (4.1 vs 3.8%, P = 0.05) regimen. In multivariate models, the significant predictors of non-SVR were age >60 years (odds ratio [OR] 4.46; 95% CI, 2.35–8.46, P = <0.001) and cirrhosis (OR 53.91; 95% CI, 26.49–109.6, P = <0.001). Skin rash (51 vs 44%) and oral ulcers (45 vs 40%) were high in patients receiving SOF-DCV then SOF-VEL. Conclusions Overall, the generic SOF+DCV ±RBV and SOF/VEL ± RBV achieved equally high SVR12 rates. However, SOF/VEL+RBV achieved a high SVR rate in cirrhotic patients then SOF+DCV+RBV. Old age and cirrhosis were significant predictors of reduced odds of SVR regardless of the regimen. Furthermore, the regimens were well tolerated in chronic HCV patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Generic Sofosbuvir Plus Daclatasvir and Sofosbuvir/Velpatasvir in HCV Genotype 3-Infected Patients: Real-World Outcomes From Pakistan

et al. 2020

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“…Then a network meta-analysis within a Bayesian framework was conducted using Markov chain Monte Carlo methods in WinBUGS (Medical Research Council Biostatistics Unit, Cambridge, United Kingdom). The methods of pairwise meta-analysis and network meta-analysis were detailed in our previous publications [ 61 – 65 ].…”

Section: Methodsmentioning

confidence: 99%

Systematic review with network meta-analysis: Comparative efficacy of oral nucleos(t)ide analogues for the prevention of chemotherapy-induced hepatitis B virus reactivation

et al. 2016

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ObjectivesCurrently, no consensus exists regarding the optimal oral prophylactic regimens for hepatitis B surface antigen seropositive patients undergoing chemotherapy. We aimed to compare the efficacy of oral nucleos(t)ide analogues (NAs), including lamivudine, entecavir, adefovir, telbivudine and tenofovir, for the prevention of chemotherapy-induced hepatitis B virus (HBV) reactivation and its related morbidity and mortality in patients with chronic HBV (CHB) infection.ResultsFifty-two eligible articles consisting of 3892 participants were included. For HBV reactivation, prophylactic treatment with NAs were all significantly superior to no prophylaxis, with odds ratio (OR) from 0.00 (95% confidence interval [CI] 0.00~0.04) for the most effective intervention (tenofovir) to 0.10 (95% CI 0.06~0.14) for the least effective intervention (lamivudine). For secondary outcomes, prophylaxis with NAs also significantly outperformed observation. The results suggested that entecavir reduced the risk of HBV related hepatitis (predicted probability, 83%), HBV related death (68%) and all causes of hepatitis (97%) most efficaciously. It ranked second in decreasing all causes of death (34%).Materials and MethodsPubMed, Embase and Cochrane Library database were searched for controlled trials up to March 31, 2015. Primary outcome was the incidence of HBV reactivation. Secondary outcomes included the incidence of HBV-related hepatitis and death, all causes of hepatitis and death. Network meta-analysis combined direct and indirect evidence to estimate ORs for the clinical outcomes. A mean ranking and the probability of optimal therapeutic regime was obtained for each treatment based on clinical outcomes.ConclusionsAvailable evidence suggests that prophylatic therapy with tenofovir and entecavir may be the most potent interventions in prevention of HBV reactivation and HBV-related morbidity and mortality for CHB infection patients undergoing chemotherapy.

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“…However, the shortcomings extant in current conventional MAs and individual studies may be made up for by conducting a network meta-analysis (NMA) which offers indirect evidences between different regimens based on direct evidence provided by clinical trials. This new statistical method is now applied frequently in the field of pharmaceutical screening and evaluation 29 – 33 and has proven to be an effective way to recognize the overall superiority and inferiority of different interventions.…”

Section: Introductionmentioning

confidence: 99%

Network meta-analysis of success rate and safety in antibiotic treatments of bronchitis

Wang

Liu

et al. 2017

COPD

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The purpose of this study was to compare the relative efficacy and safety of different antibiotic drugs and recommend superior regimens in the treatment of bronchitis. With respect to the antibiotic comparisons against quinolones in terms of intention-to-treat patients, we concluded that quinolones had advantages over placebo, β-lactams, sulfonamides, and double β-lactams. Concerning treatment methods for clinically evaluable patients, quinolones demonstrated better performance than β-lactams and sulfonamides. The secondary effects of macrolides, quinolones, and double β-lactams were significantly more adverse than β-lactams with odds ratios (ORs) of 1.5 (95% credible interval [CrI] =1.1–2.0), 1.7 (95% CrI =1.2–2.3), and 2.7 (95% CrI =1.8–4.1), respectively. Significant differences in the prevalence of diarrhea as a secondary effect were only identified among the comparisons of double β-lactams against β-lactams and macrolides (OR =5.0, 95% CrI =2.1–12.0; OR =3.0, 95% CrI =1.7–5.4, respectively). Quinolones can be recommended as the superior treatment for bronchitis, in accordance with our cluster analysis with surface under the cumulative ranking curve. The primary outcomes of network meta-analysis indicated that quinolones showed the best performance among the 8 treatments studied, although β-lactams showed the lowest risk of adverse side effects. Quinolones are recommended as the primary treatment option for bronchitis patients, having taking into account the success rates and safety profiles of the eight drugs studied here.

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Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Abstract: Supplemental Digital Content is available in the text

Cited by 23 publications

References 55 publications

Efficacy and Safety of Generic Sofosbuvir Plus Daclatasvir and Sofosbuvir/Velpatasvir in HCV Genotype 3-Infected Patients: Real-World Outcomes From Pakistan

Efficacy and Safety of Generic Sofosbuvir Plus Daclatasvir and Sofosbuvir/Velpatasvir in HCV Genotype 3-Infected Patients: Real-World Outcomes From Pakistan

Systematic review with network meta-analysis: Comparative efficacy of oral nucleos(t)ide analogues for the prevention of chemotherapy-induced hepatitis B virus reactivation

Network meta-analysis of success rate and safety in antibiotic treatments of bronchitis

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