1.The effectiveness and tolerability of the high dose Donepezil at 23 mg tablet per day for Alzheimer’s disease: A meta-analysis of randomized controlled trials
Adrian I. Espiritu ; Alvin Rae F. Cenina
Acta Medica Philippina 2020;54(3):296-304
Objective:
To assess the effectiveness and tolerability of the 23 mg tablet donepezil in patients with Alzheimer’s disease (AD) using meta-analysis of randomized controlled trials.
Methods:
Major healthcare databases were searched from May to September 2016. Evaluation of relevant trials, assessment of risk of bias, collection and analyses of data were performed.
Results:
A total of 1,774 adult participants with AD were pooled from the two trials included. Pooled data showed that after 24 weeks of treatment, no significant difference was noted between Donepezil 23 mg/day and Donepezil 10 mg/day in terms of cognitive function (1.06 SIB points [-0.13, 2.26]; 1704 participants) and in terms of global clinical assessment (-0.02 CIBIC+ points [-0.13, 0.09]; 1705 participants). The participants who took the higher dose were at higher risk to experience “any adverse event” than those who received the lower dose (1.17 RR [1.09, 1.26]; 1785 participants).
Conclusion
Current evidences do not support the routine use of Donepezil 23 mg tablet for the improvement of cognitive function and global clinical status of patients with AD. The higher dose is also marked with an increased incidence of adverse events compared to the lower dose.
Meta-analysis
2.Why Perform Meta-Analysis?.
Hanyang Medical Reviews 2015;35(1):1-2
No abstract available.
Meta-Analysis as Topic
3.Overview of film-coating drugs
Pharmaceutical Journal 1999;274(2):15-22
I. Introduction of film-coating technique; II. Materials: films, pigments and solvents; III. Equipment: Modified coater, Fluidized-bed coater; IV. Formulating solution: Formulating, Calculating amount of solution; V. Types of film: Protective film, Bowel dissoluble film, longer releasing film; IV. Film coating technique using water instead of organic solvent; VII. Testing quality of film coat: Testing polymer and formula, Testing protective, bowel dissoluble and longer releasing film.
Pharmaceutical Preparations
;
Meta-Analysis
5.How to conduct a systematic review and meta-analysis.
Krysten Marie R. Yayen ; John Michael D. Deblois ; Ma. Rosario Bernardo-Lazaro
The Filipino Family Physician 2024;62(1):51-66
Systematic reviews and meta-analysis combine results and analysis of data from different primary studies (e.g. cross-sectional studies, case-control studies, cohort studies) conducted on similar or related research topics. They are secondary studies that guide clinical decision-making, delivery of care and policy development. This article aims to discuss how to conduct a systematic review and meta-analysis. The steps in conducting a systematic review and meta-analysis include: 1) Identify the purpose including formulating the research question and validating the purpose of the literature scan, 2) Formulate the objectives, 3) Literature search including selection of studies based on population, intervention, comparison and outcome, 4) Retrieval of full text articles, 5) Critical appraisal of articles, 6) Data extraction, 7) Data analysis and 8) Writing the final report. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is a useful guide in conducting and write systematic review and meta-analysis. While ethics approval is not usually required for systematic review and meta-analysis, authors of such study should still observe good practices including avoiding plagiarism, maintaining transparency and ensuring data accuracy.
Systematic Review ; Meta-analysis
6.Effects of topical application of virgin coconut oil on infection, mortality and dermal maturation in preterm newborns: Systematic review and meta-analysis
Kristel Magne C. Zaraspe-Quizon ; Daisy O. Sanchez-Mostiero
Philippine Journal of Health Research and Development 2023;27(4):47-55
Background:
Preterm birth is an important health concern in countries with limited resources and healthcare access. Topical therapy may be effective for improving outcomes in preterm neonates whose skin barriers are compromised due to immaturity.
Objectives:
To systematically review the topical VCO's effects in preterm infants on infection, mortality, and dermal maturity.
Methodology:
Systematic review and meta-analysis of RCTs of topical VCO in preterm infants were conducted. Databases included PubMed, Google Scholar, Clinical trials.gov, Trip, Cochrane Library, and HERDIN. The risk of bias was assessed by two authors independently. RR with 95% CI was used for the pooled estimate of dichotomous outcomes including infection prevention, mortality reduction, and skin irritation. Mean differences with 95% CI were used for the pooled estimate of weight loss and NSCS.
Results:
Of 110 records identified, 3 RCTs with 2440 patients were included. Prevention of infection had a trend toward VCO (RR = 0.90, [95% CI: 0.64, 1.27] while the results for mortality reduction were inconclusive (RR = 0.45, [95% CI: 0.06, 3.38]. NSC scores showed a beneficial trend toward VCO (RR = -0.03, [95% CI: -0.16, 0.09]. Both secondary outcomes of skin irritation and weight loss had inconclusive results.
Conclusions
This review showed the lack of evidence of the effectiveness of topical VCO in improving various outcomes in premature infants. The effects on infection prevention and dermal maturation were favorable. However, its effects on preventing mortality, skin irritation, and weight loss were inconclusive.
Meta-Analysis
;
Infections
;
Mortality
7.Meta-analysis on the role of Pregabalin in Fibromyalgia
Andri Reza Rahmadi ; Guntur Darmawan ; Laniyati Hamijoyo
Philippine Journal of Internal Medicine 2021;59(4):307-312
Background:
Fibromyalgia is a difficult-to-treat chronic musculoskeletal pain and tenderness syndrome. It is considered due to augmented pain processing in central nervous system. Interest in antiepileptic drugs, included pregabalin, for treatment of fibromyalgia is currently growing. This study aimed to investigate the effectiveness of pregabalin for fibromyalgia.
Methods:
We conducted the study according to the meta-analysis PRISMA guideline. Relevant randomized controlled
trials (RCTs) were identified from a search of PubMed and Cochrane databases. Quality of selected studies was assessed using Jadad score for randomized placebo-controlled trials (RCT). Primary outcome was pain score reduction (30% and 50% reduction) and secondary outcome was patient global impression of change. Statistical analysis was performed using Review Manager 5.3.
Results:
Six international, multicenter, high-quality RCTs with 8-15 weeks duration of treatment met inclusion criteria. Four studies used different fixed dose (300 mg/d, 450 mg/d, 600mg/d) and 2 studies used titrated dose in evaluating the efficacy of pregabalin. There was statistically significant benefit of pregabalin over placebo in mean pain score reduction [odds ratio (OR) 1.81, 95% confidence interval (CI) 1.56-2.10 p < 0.00001 in fixed dose pregabalin 30% pain reduction; OR 2.06 95% CI 1.66-2.56 p < 0.00001 in fixed dose pregabalin 50% pain reduction; OR 1.53 95% CI 1.10-2.13 p 0.01 in titrated dose pregabalin 30% pain reduction; OR 1.80 95% CI 1.12-2.88 p 0.01 in titrated dose pregabalin 50% pain reduction]. Pregabalin also demonstrated significantly better patient global impression of change than placebo. No heterogeneity was seen in most groups. No publication bias was observed.
Conclusion
Our study showed pregabalin monotherapy was effective for pain treatment associated with fibromyalgia.
Further studies with longer treatment duration are needed to confirm the long-term effectiveness of pregabalin for fibromyalgia treatment.
Fibromyalgia
;
Pregabalin
;
Meta-Analysis
8.Effectiveness of family-focused intervention in patients with schizophrenia in family and community practice – A meta-analysis study
Cherry Louise M. Orfanel, MD ; Marinol B. Villafuerte, MD
The Filipino Family Physician 2023;61(1):108-116
Background:
Schizophrenia is a pervasive, chronic mental disorder that negatively impacts the biological, socioeconomic and family well being of the patient. Active involvement of family members and other significant individuals appears to benefit overall management.
Objective:
To determine the effectiveness of family-focused intervention in improving symptoms of schizophrenia.
Methods:
The authors searched for eligible clinical trials in the PubMed, Cochrane Central Register of Controlled Trials, Research Gate, Google Scholar and grey literature databases. Participants should be patients diagnosed to have schizophrenia and interventions should involve the family or be labeled as ‘family therapy.’ The primary outcome considered was symptom improvement based on the Positive and Negative Symptom Scale (PANSS). Secondary outcomes included quality of life, family functioning and subjective experience of the treatment process. The authors used the RevMan 5.4 software for data analysis. Bias, subgroup and sensitivity analyses were performed. Strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework.
Results:
A total of 1,794 trials were initially identified, of which three publications were included in the review. Two studies used psychosocial approaches whereas one used cognitive behavioral therapy in conjunction with family intervention. Meta-analysis revealed the studies to be heterogeneous based on p values <0.10 and I2 >50%. Subgroup analysis by type of intervention showed no difference between the intervention and control groups, although there was a positive trend in favor of psychosocial intervention for improvement in PANSS score. Family-based intervention had a significant positive effect on quality of life.
Conclusion
Family-based interventions are effective in the management of schizophrenia, helping to improve quality of life, potentially reducing symptom burden and serving as an adjunct to health institution-based management.
schizophrenia
;
meta-analysis
9.Maternal and newborn impact of epidural dexamethasone as an adjuvant for labor analgesia: A meta-analysis
Crista Mae F. Fontanilla ; Joy Ann R. Lim
The Philippine Children’s Medical Center Journal 2023;19(2):32-55
Background:
Dexamethasone, an anti-inflammatory drug, has an assumed analgesic effect
when given epidurally, with less side effects5,7. Although numerous studies have evaluated
dexamethasone, there is a paucity of studies assessing its intrapartum use.
Objectives:
To determine the effectiveness of epidural dexamethasone when used as an
adjuvant for labor analgesia.
Materials and Methods:
A meta-analysis guided by the Cochrane handbook was
performed. Articles were searched through PubMed, MEDLINE, CENTRAL, Google Scholar and
ClinicalTrials.gov using search strategies such as keywords and MeSH terms. Cochrane version 2
risk-of-bias tool for randomized trials (RoB 2) was used to assess for quality. Quantitative data
were pooled and analyzed using Review Manager 5.4.1.
Results:
A total of five trials involving 309 women in labor were analyzed. The pooled mean
difference showed prolonged duration of epidural analgesia on patients who received epidural
dexamethasone; pooled risk ratio between the experimental and control group demonstrated no
significant maternal adverse events such as nausea and vomiting, shivering, hypotension, and
fever. Pooled risk ratio and mean difference also showed that epidural dexamethasone had no
significant effect on the neonatal APGAR and neonatal umbilical pH.
Conclusion
Present data demonstrated the potential role of dexamethasone as an adjuvant
to epidural solution during labor analgesia on providing local anesthetic dose sparing effect
through prolongation of the duration of epidural analgesia, with limited maternal and neonatal
adverse events. These results should be interpreted with caution before adopting this technique in
routine clinical practice.
Dexamethasone
;
Meta-Analysis
10.Using a systematic review and meta-analysis for clinical decision
Nenacia Ranali Nirena P. Mendoza ; Cherry Bernardo-Lazaro
The Filipino Family Physician 2022;60(1):42-47
A systematic review summarizes the results of a number of individual studies that address a focused clinical question. It may be accompanied by a meta-analysis, which is a quantitative method of combining the results of all these studies in order to come up with a summary statistic of the overall effect of an intervention. Single studies may be unrepresentative of the total body of evidence, that is why combining the results of several studies in a systematic review increases precision, provides better estimates of effect, and includes a greater range of patients thus facilitating better clinical decision making. This must be done in a systematic and reproducible manner.
Systematic Review
;
Meta-Analysis