meta-analysis

Obesity Management Pharmacotherapies and Lifestyle Treatment for Pediatric Obesity Management A Systematic Review and Network Meta-Analysis

Nathan Hinkle — Wed, 09 Sep 2026 05:00:00 +0000

Date Added:

September 9, 2026

Journal/Publication:

JAMA Pediatrics

Publisher:

The American Medical Association

Publication Date:

June 22, 2026

Issue:

Volume:

180

Pages:

961-974

URL:

Obesity Management Pharmacotherapies and Lifestyle Treatment for Pediatric Obesity Management A Systematic Review and Network Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines, Community-Based Research Results

Format:

Article

DOI (1):

doi:10.1001/jamapediatrics.2026.2248

Keywords

pediatric obesity

pharmacotherapy

meta-analysis

MeSH

Pediatric Obesity* / prevention & control

body mass index

RPR Commentary: A review of the evidence regarding management of obesity in children . James W. Mold, MD, MPH

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Abstract
Importance Pediatric obesity is a global health challenge. Although health behavior and lifestyle treatment (HBLT) is foundational, the comparative effectiveness of HBLT, various pharmacotherapies, and their combinations remains unclear.

Objective To compare the effectiveness of obesity management pharmacotherapies, structured lifestyle treatment, and their combinations on weight management outcomes in children and adolescents living with obesity.

Data Sources A systematic search was conducted in 4 electronic databases (Embase, CENTRAL, PsycINFO, and PubMed) from inception to June 17, 2025.

Data Selection Randomized clinical trials (RCTs) involving children and adolescents (aged 10-19 years) with obesity were selected. Interventions included lifestyle treatment (HBLT and counseling), obesity management pharmacotherapies (glucagon-like peptide-1 receptor agonists, metformin, orlistat, phentermine topiramate), or their combination vs control.

Data Extraction and Synthesis Data were extracted and validity assessed according to PRISMA guidelines. A random-effects network meta-analysis was used to pool data. Meta-regression was used to explore outcome moderators.

Main Outcomes and Measures Primary outcomes were body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) and BMI z score; secondary outcomes included waist circumference (WC), fat mass (FM), and lean mass (LM).

Results A total of 42 RCTs with 3835 participants (median [IQR] age, 14.5 [13.3-15.1] years; 2270 female [59.2%]) were included. Treatments combining pharmacotherapy and lifestyle treatment demonstrated the greatest efficacy across all adiposity-related outcomes. Semaglutide plus counseling was associated with the largest BMI reduction (mean difference, −8.31; 95% CI, −12.33 to −4.28) and BMI z score reduction (mean difference, −1.80; 95% CI, −2.39 to −1.21), although this estimate was based on a limited number of studies. All pharmacological treatments were more effective when paired with lifestyle treatment, associated with significantly greater BMI and BMI z score reductions than the same medications alone. Based on the primary analysis, HBLT as monotherapy was associated with substantial decreases in BMI (mean difference, −3.85; 95% CI, −4.91 to −2.80) and BMI z score (mean difference, −0.89; 95% CI, −1.17 to −0.61) vs control.

Conclusions and Relevance Finding of this systematic review and network meta-analysis suggest that combining lifestyle treatment with obesity management medications was associated with the greatest short-term (typically 6 to 12 months) weight reduction in adolescents with obesity. HBLT remained an indispensable component of any effective weight management, delivering meaningful weight loss and healthier body composition on its own. Combined with lifestyle treatment, pharmacotherapy was a key component, not solely an adjunct, associated with the greatest BMI and BMI z score improvements, and long-term sustainability and safety were monitored.

Author/s:

Ke-wen Wan, Evander Fung-chau Lei, Ying Liu, Asefa Adimasu Taddese, Patrick lp, Gabriel Torbahn, Daniel Weghuber, Wendy Y. Huang, Bjorn T.Tam

Exacerbation risk in patients with bronchiectasis receiving DPP-1 inhibitors vs placebo: A meta-analysis of RCTs

Megan George — Tue, 03 Feb 2026 14:17:01 +0000

Date Added:

February 3, 2026

Journal/Publication:

Respiratory Medicine

Publication Date:

January 31, 2026

URL:

Exacerbation risk in patients with bronchiectasis receiving DPP-1 inhibitors vs placebo: A meta-analysis of RCTs

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1016/j.rmed.2025.108607

Keywords

Bronchiectasis

DPP-1 inhibitor

Dipeptidyl-peptidases and tripeptidyl-peptidases

meta-analysis

PMID (1):

41443427

MeSH

Bronchiectasis* / drug therapy

Bronchiectasis* / physiopathology

Dipeptidyl-Peptidase IV Inhibitors* / therapeutic use

Disease Progression

Forced Expiratory Volume / drug effects

Randomized Controlled Trials as Topic

GLP-1 inhibitors appear to benefit patients with bronchiectasis apart from their weight reduction effect. James W. Mold, MD, MPH

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Background: No therapies have been approved to alter bronchiectasis progression. Dipeptidyl peptidase-1 (DPP-1) inhibitors, which target neutrophil serine protease activation, are under investigation as potential disease-modifying agents.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing DPP-1 inhibitors versus placebo in patients with non-cystic fibrosis bronchiectasis. PubMed, Cochrane, EMBASE, Web of Science, Scopus, ClinicalTrials.gov, and ICTRP were searched from inception until April 26, 2025. Primary outcomes included time to first exacerbation and proportion of patients remaining exacerbation-free. Secondary outcomes included post-bronchodilator % Forced Expiratory Volume in 1 s (FEV1), Quality of Life-Bronchiectasis (QoL-B) questionnaire scores, and rate of adverse events. Time-to-event outcome was analyzed using Kaplan-Meier (KM)-estimated individual patient data (IPD), whereas random-effects meta-analyses were performed for remaining outcomes.

Results: 2523 patients from four RCTs were included, of whom 1689 (66.9 %) received DPP-1 inhibitors. Compared with placebo, DPP-1 inhibitors prolonged the time to first exacerbation (HR 0.79; 95 % CI: 0.71 to 0.88) and increased the proportion of patients remaining exacerbation-free (RR 1.33; 95 % CI 1.12 to 1.58). A slower decline in post-bronchodilator % FEV1 was observed (MD 1.1 %; 95 % CI 0.05 to 2.15), but no difference in QoL-B scores (MD 1.35; 95 % CI -0.72 to 3.42). The safety profile of DPP-1 inhibitors was acceptable and comparable to placebo. Moderate certainty was found across endpoints.

Conclusions: DPP-1 inhibitors prolong time to first exacerbation and reduce exacerbation rates in patients with bronchiectasis, with an acceptable safety profile. These findings support their potential as a disease-modifying strategy.

Registration: PROSPERO (CRD420251042542).

Keywords: Bronchiectasis; DPP-1 inhibitor; Dipeptidyl-peptidases and tripeptidyl-peptidases; Meta-analysis; Randomized controlled trials; Systematic review.

Author/s:

Giulia Carvalhal, Júlia Moreira Diniz, Larissa Calixto Hespanhol, David Curi Barbosa Izoton Cabral, Jafar Aljazeeri

The effectiveness and safety of methotrexate in the intervention of osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Megan George — Tue, 14 Oct 2025 13:08:01 +0000

Date Added:

October 14, 2025

Journal/Publication:

Medicine

Publication Date:

October 10, 2025

URL:

The effectiveness and safety of methotrexate in the intervention of osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1097/MD.0000000000044994

Keywords

MeSH

The findings of this meta-analysis suggest that methotrexate is both safe and effective for treatment of pain and joint stiffness in patients with osteoarthritis. James W. Mold, MD, MPH

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Background:
Osteoarthritis (OA) is a prevalent chronic joint disorder among middle-aged and older adults, characterized by progressive cartilage degeneration, subchondral bone remodeling, and osteophyte formation, leading to joint pain, stiffness, dysfunction, and reduced quality of life. With the global aging population, OA imposes a growing socioeconomic burden, yet no disease-modifying therapy is currently available—particularly for moderate-to-severe stages. Emerging evidence implicates synovial inflammation as a central contributor to OA symptoms and progression, raising interest in methotrexate (MTX), a well-established, low-dose anti-inflammatory agent used safely in rheumatoid arthritis. Preliminary studies suggest MTX may alleviate OA-related pain, but findings from randomized controlled trials (RCTs) have been inconsistent and limited in number. Given recent new RCTs and the heterogeneity of existing outcomes, an updated systematic review and meta-analysis is urgently needed to clarify the efficacy and safety of MTX in OA and inform future clinical trial design.

Methods:
PubMed, ClinicalTrials, Web of Science, Cochrane Library and other databases were searched to find randomized controlled trials (RCT) of MTX treatment of OA. Methodological quality was assessed using the Cochrane "risk of bias" assessment tool, and the meta-analysis was conducted using Review Manager (RevMan) version 5.3 (The Cochrane Collaboration, London, UK).

Results:
Fifteen RCTs involving 1591 participants were included in this review. The meta-analysis results showed that the ineffective rate in the experimental group was lower [RR: 0.40 (0.24, 0.67), P = .004]; the VAS in the experimental group was lower [WMD: −0.66 (−1.08, −0.24), P = .002]; the WOMAC score-stiffness in the experimental group was lower [WMD: −0.72 (−1.04, −0.41), P < .00001]; the WOMAC score-function in the experimental group was lower [WMD: −7.72 (−13.56, −1.87), P = .01]. The adverse events in the experimental group were not statistically significant compared with the control group [RR: 1.04 (0.77, 1.42), P = .78].

Conclusion:
MTX demonstrates potential in effectively alleviating pain, improving joint function, and slowing disease progression in patients with OA. Its safety profile is comparable to that of control treatments, making it a viable and reliable therapeutic option worthy of broader clinical application.

Author/s:

Wan, Lifei, Yang, Qianyue, Yang, Kailin, Zeng, Liuting, Sun, Lingyun

Effects of Tai Chi and Qigong on cognitive and physical functions in older adults: systematic review, meta-analysis, and meta-regression of randomized clinical trials

Aubrey Delammermore — Wed, 14 Jun 2023 05:00:00 +0000

Date Added:

June 14, 2023

Journal/Publication:

BMC Geriatrics

Publisher:

BioMed Central

Publication Date:

June 6, 2023

Issue:

Volume:

Pages:

352

URL:

Effects of Tai Chi and Qigong on cognitive and physical functions in older adults: systematic review, meta-analysis, and meta-regression of randomized clinical trials

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s12877-023-04070-2

Keywords

PMID (1):

37280512

MeSH

Qigong

Tai Chi

Confidence Intervals

Effect Modifier, Epidemiologic

Electronics

More evidence that we should all be doing Tai Chi, at least those of us of a certain age. James W. Mold, MD, MPH

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Background: Older adults experience age-related declines in physical and cognitive functions due to interactions between aging and chronic diseases. Tai Chi and Qigong (TCQ) might be beneficial in improving the physical function and delaying the cognitive decline of this population. The potential underlying mechanism was explored to determine the effects of TCQ on cognitive function via direct or indirect pathways.

Purpose: The objective of this systematic review was to determine the effects of TCQ on cognitive and physical functions in older adults using meta-analysis, and to determine the impact of TCQ on cognitive function while controlling for physical function using a meta-regression approach.

Methods: A systematic search of 13 electronic databases (in English, Korean, and Chinese languages) identified 10,292 potentially eligible studies published between inception and May 2022. The bias in individual studies was assessed using the Cochrane Risk of Bias (version 2.0) tool. The heterogeneity of the studies was evaluated using a 95% prediction interval, and the meta-analysis and meta-regression were implemented using the Comprehensive Meta-Analysis (version 3) software.

Results: Our search identified 17 randomized studies (n = 2,365, mean age = 70.3 years). The results of the meta-analysis that used a random-effects model indicated that TCQ had significant effects on both cognitive (Hedges' g = 0.29, 95% confidence interval [CI] = 0.17 to 0.42) and physical (Hedges' g = 0.32, 95% CI = 0.19 to 0.44) functions. We used meta-regression to explore the effect size of TCQ in association with physical function level. The regression model was significant (Q = 25.01, p = .070), and 55% of the heterogeneity was explained by physical function as a moderator variable. The effects of TCQ on cognitive function remained significant in this model when controlling for the effect of physical function (β = 0.46, p = .011).

Conclusion: This meta-regression of 17 randomized studies strongly suggests that TCQ has beneficial effects on physical and cognitive functions in older adults. The effect of TCQ on cognitive function remained significant after taking into account the significant effects of physical function as a moderator. The findings imply the potential health benefits of TCQ by promoting cognitive function in older adults directly and indirectly through enhancing physical function. PROSPERO REGISTRATION NUMBER: *PROSPERO international prospective register of systematic reviews, registration ID CRD42023394358.

Author/s:

Park, M., Song, R., Ju, K., Shin, J. C., Sea, J., Fan, X., Gao, X., Ryu, A., Li, Y.

Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis

Aubrey Delammermore — Thu, 08 Sep 2022 05:00:00 +0000

Date Added:

September 8, 2022

Journal/Publication:

Heart

Publisher:

BMJ Publishing Group

Publication Date:

August 9, 2022

Pages:

1-8

URL:

Effects of salt substitutes on clinical outcomes: a systematic review and meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1136/heartjnl-2022-321332

Keywords

PMID (1):

35945000

MeSH

Randomized Controlled Trials as Topic

Odds Ratio

body mass index

Salt substitutes, when compared to use of regular salt, reduce BP, CV mortality, and all-cause mortality.

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Objectives The Salt Substitute and Stroke Study (SSaSS) recently reported blood pressure-mediated benefits of a potassium-enriched salt substitute on cardiovascular outcomes and death. This study assessed the effects of salt substitutes on a breadth of outcomes to quantify the consistency of the findings and understand the likely generalisability of the SSaSS results.

Methods We searched PubMed, Embase and the Cochrane Library up to 31 August 2021. Parallel group, step-wedge or cluster randomised controlled trials reporting the effect of salt substitute on blood pressure or clinical outcomes were included. Meta-analyses and metaregressions were used to define the consistency of findings across trials, geographies and patient groups.

Results There were 21 trials and 31 949 participants included, with 19 reporting effects on blood pressure and 5 reporting effects on clinical outcomes. Overall reduction of systolic blood pressure (SBP) was −4.61 mm Hg (95% CI −6.07 to −3.14) and of diastolic blood pressure (DBP) was −1.61 mm Hg (95% CI −2.42 to −0.79). Reductions in blood pressure appeared to be consistent across geographical regions and population subgroups defined by age, sex, history of hypertension, body mass index, baseline blood pressure, baseline 24-hour urinary sodium and baseline 24-hour urinary potassium (all p homogeneity >0.05). Metaregression showed that each 10% lower proportion of sodium choloride in the salt substitute was associated with a −1.53 mm Hg (95% CI −3.02 to −0.03, p=0.045) greater reduction in SBP and a −0.95 mm Hg (95% CI −1.78 to −0.12, p=0.025) greater reduction in DBP. There were clear protective effects of salt substitute on total mortality (risk ratio (RR) 0.89, 95% CI 0.85 to 0.94), cardiovascular mortality (RR 0.87, 95% CI 0. 81 to 0.94) and cardiovascular events (RR 0.89, 95% CI 0.85 to 0.94).

Conclusions The beneficial effects of salt substitutes on blood pressure across geographies and populations were consistent. Blood pressure-mediated protective effects on clinical outcomes are likely to be generalisable across population subgroups and to countries worldwide.

Author/s:

Yin, X., Rodgers, A., Perkovic, A., Huang, L., Li, K., Yu, J., Wu, Y., Wu, J. H. Y., Marklund, M., Huffman, M. D., Miranda, J. J., Di Tanna, G. L., Labarthe, D., Elliott, P., Tian, M., Neal, B.

The effect of lead exposure on IQ test scores in children under 12 years: a systematic review and meta-analysis of case-control studies

Saige Blanchard — Tue, 14 Jun 2022 05:00:00 +0000

Date Added:

June 14, 2022

Journal/Publication:

Systematic Reviews

Publisher:

BioMed Central Ltd

Publication Date:

May 30, 2022

Issue:

Volume:

URL:

The effect of lead exposure on IQ test scores in children under 12 years: a systematic review and meta-analysis of case-control studies

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s13643-022-01963-y

Keywords

PMID (1):

35637522

MeSH

Quantification of the impact of lead exposure in children on IQ scores. James W. Mold, MD, MPH

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An inevitable exposure to the toxic heavy metal such as lead in our environmental can have irreversible effects on children's mental performance.In this study, 3316 children in 8 case-control studies were selected for review. The case group was exposed to a concentration of lead above 10 μg/dL, and the control group was exposed to a concentration of less than 10 μg/dL, but the duration of exposure was different among studies, and the subgroup analysis was performed based on this variable.In the subgroup with duration of exposure less than the average of 4.5 years, the difference of IQ test score between two groups was significant (MD = -3.53) (P-value <0.05). Also, in the subgroup with more than 4.5 years of duration, the difference of IQ test score was significant (MD = -22.63) (P-value < 0.001).This study demonstrates that the concentration and duration of lead exposure have a large effect on mental function in children.

Author/s:

Heidari, S., Mostafaei, S., Razazian, N., Rajati, M., Saeedi, A., Rajati, F.

Association of Influenza Vaccination With Cardiovascular Risk: A Meta-analysis

Saige Blanchard — Tue, 10 May 2022 05:00:00 +0000

Date Added:

May 10, 2022

Journal/Publication:

JAMA Network Open

Publisher:

JAMA Network Open

Publication Date:

April 29, 2022

Issue:

Volume:

Pages:

1-9

URL:

Association of Influenza Vaccination With Cardiovascular Risk: A Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2022.8873

Keywords

PMID (1):

35486404

MeSH

influenza vaccines

acute coronary syndrome

Odds Ratio

COVID-19

follow-up studies

It appears that the influenza vaccine somehow reduces the risk of cardiovascular events over the subsequent year by almost 2%, which is about as effective as lowering blood pressure in older people. At the very least, it could be another way to convince people to get immunized. James W. Mold, MD, MPH

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Importance: Influenza infection is associated with increased cardiovascular hospitalization and mortality. Our prior systematic review and meta-analysis hypothesized that influenza vaccination was associated with a lower risk of cardiovascular events.

Objective: To evaluate, via an updated meta-analysis, if seasonal influenza vaccination is associated with a lower risk of fatal and nonfatal cardiovascular events and assess whether the newest cardiovascular outcome trial results are consistent with prior findings.

Data sources: A previously published meta-analysis of randomized controlled trials (RCTs) and a large 2021 cardiovascular outcome trial.

Study selection: Studies with RCTs published between 2000 and 2021 that randomized participants to either influenza vaccine or placebo/control. Eligible participants were inpatients and outpatients recruited for international multicenter RCTs and randomized to receive either influenza vaccine or placebo/control.

Data extraction and synthesis: PRISMA guidelines were followed in the extraction of study details, and risk of bias was assessed using the Cochrane Collaboration tool. Trial quality was evaluated using Cochrane criteria. Data were analyzed January 2020 and December 2021.

Main outcomes and measures: Random-effects Mantel-Haenszel risk ratios (RRs) and 95% CIs were derived for a composite of major adverse cardiovascular events and cardiovascular mortality within 12 months of follow-up. Where available, analyses were stratified by patients with and without recent acute coronary syndrome (ACS) within 1 year of randomization.

Results: Six published RCTs comprising a total of 9001 patients were included (mean age, 65.5 years; 42.5% women; 52.3% with a cardiac history). Overall, influenza vaccine was associated with a lower risk of composite cardiovascular events (3.6% vs 5.4%; RR, 0.66; 95% CI, 0.53-0.83; P < .001). A treatment interaction was detected between patients with recent ACS (RR, 0.55; 95% CI, 0.41-0.75) and without recent ACS (RR, 1.00; 95% CI, 0.68-1.47) (P for interaction = .02). For cardiovascular mortality, a treatment interaction was also detected between patients with recent ACS (RR, 0.44; 95% CI, 0.23-0.85) and without recent ACS (RR, 1.45; 95% CI, 0.84-2.50) (P for interaction = .006), while 1.7% of vaccine recipients died of cardiovascular causes compared with 2.5% of placebo or control recipients (RR, 0.74; 95% CI, 0.42-1.30; P = .29).

Conclusions and relevance: In this study, receipt of influenza vaccination was associated with a 34% lower risk of major adverse cardiovascular events, and individuals with recent ACS had a 45% lower risk. Given influenza poses a threat to population health during the COVID-19 pandemic, it is integral to counsel high-risk patients on the cardiovascular benefits of influenza vaccination.

Author/s:

Behrouzi, B., Bhatt, D. L., Cannon, C. P., Vardeny, O., Lee, D. S., Solomon, S. D., Udell, J. A.

Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment A Systematic Review and Meta-analysis

Saige Blanchard — Tue, 10 May 2022 05:00:00 +0000

Date Added:

May 10, 2022

Journal/Publication:

JAMA Internal Medicine

Publisher:

American Medical Association

Publication Date:

March 14, 2022

Issue:

Volume:

182

Pages:

474-481

URL:

Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2022.0134

Keywords

PMID (1):

35285850

MeSH

Hydroxymethylglutaryl-CoA Reductase Inhibitors

cholesterol

LDL

Numbers Needed to Treat

risk

Cl 22

Consensus

As for many of our most common interventions, the actual impact of statins on cardiovascular event rates and mortality are small unless the pre-intervention risk of such events is quite high or unless the intervention is reliably continued for long periods of time. As we knew, the effect of statins is not entirely related to LDL cholesterol reduction. James W. Mold, MD, MPH

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Importance: The association between statin-induced reduction in low-density lipoprotein cholesterol (LDL-C) levels and the absolute risk reduction of individual, rather than composite, outcomes, such as all-cause mortality, myocardial infarction, or stroke, is unclear.

Objective: To assess the association between absolute reductions in LDL-C levels with treatment with statin therapy and all-cause mortality, myocardial infarction, and stroke to facilitate shared decision-making between clinicians and patients and inform clinical guidelines and policy.

Data sources: PubMed and Embase were searched to identify eligible trials from January 1987 to June 2021.

Study selection: Large randomized clinical trials that examined the effectiveness of statins in reducing total mortality and cardiovascular outcomes with a planned duration of 2 or more years and that reported absolute changes in LDL-C levels. Interventions were treatment with statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) vs placebo or usual care. Participants were men and women older than 18 years.

Data extraction and synthesis: Three independent reviewers extracted data and/or assessed the methodological quality and certainty of the evidence using the risk of bias 2 tool and Grading of Recommendations, Assessment, Development and Evaluation. Any differences in opinion were resolved by consensus. Meta-analyses and a meta-regression were undertaken.

Main outcomes and measures: Primary outcome: all-cause mortality. Secondary outcomes: myocardial infarction, stroke.

Findings: Twenty-one trials were included in the analysis. Meta-analyses showed reductions in the absolute risk of 0.8% (95% CI, 0.4%-1.2%) for all-cause mortality, 1.3% (95% CI, 0.9%-1.7%) for myocardial infarction, and 0.4% (95% CI, 0.2%-0.6%) for stroke in those randomized to treatment with statins, with associated relative risk reductions of 9% (95% CI, 5%-14%), 29% (95% CI, 22%-34%), and 14% (95% CI, 5%-22%) respectively. A meta-regression exploring the potential mediating association of the magnitude of statin-induced LDL-C reduction with outcomes was inconclusive.

Conclusions and relevance: The results of this meta-analysis suggest that the absolute risk reductions of treatment with statins in terms of all-cause mortality, myocardial infarction, and stroke are modest compared with the relative risk reductions, and the presence of significant heterogeneity reduces the certainty of the evidence. A conclusive association between absolute reductions in LDL-C levels and individual clinical outcomes was not established, and these findings underscore the importance of discussing absolute risk reductions when making informed clinical decisions with individual patients.

Author/s:

Byrne, P., Demasi, M., Jones, M., Smith, S. M., O'Brien, K. K., DuBroff, R.

Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis

Saige Blanchard — Thu, 10 Mar 2022 06:00:00 +0000

Date Added:

March 22, 2022

Journal/Publication:

JAMA Internal Medicine

Publisher:

American Medical Association

Publication Date:

March 14, 2022

URL:

Evaluating the Association Between Low-Density Lipoprotein Cholesterol Reduction and Relative and Absolute Effects of Statin Treatment: A Systematic Review and Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2022.0134

Keywords

PMID (1):

35285850

MeSH

male

female

Hydroxymethylglutaryl-CoA Reductase Inhibitors

cholesterol, LDL

Numbers Needed to Treat

The relatively small reductions in risk of CV events and death by statins appears to be unrelated to LDL cholesterol lowering. James W. Mold, MD, MPH

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Data sources: PubMed and Embase were searched to identify eligible trials from January 1987 to June 2021.

Main outcomes and measures: Primary outcome: all-cause mortality. Secondary outcomes: myocardial infarction, stroke.

Author/s:

Byrne, P., Demasi, M., Jones, M., Smith, S. M., O'Brien, K. K., DuBroff, R.

More than 50 long‑term effects of COVID‑19: a systematic review and meta‑analysis

Saige Blanchard — Fri, 13 Aug 2021 18:17:11 +0000

Date Added:

August 13, 2021

Journal/Publication:

Nature Portfolio

Publisher:

Springer Nature

URL:

More than 50 long‑term effects of COVID‑19: a systematic review and meta‑analysis

Keywords

MeSH

attention deficit disorder with hyperactivity

COVID-19

headache

Publications

The SARS-2 COVID-19 virus is a nasty little germ. It seems to cause a host of long-lasting symptoms. James W. Mold, MD, MPH

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COVID-19 can involve persistence, sequelae, and other medical complications that last weeks to
months after initial recovery. This systematic review and meta-analysis aims to identify studies
assessing the long-term efects of COVID-19. LitCOVID and Embase were searched to identify articles
with original data published before the 1st of January 2021, with a minimum of 100 patients. For
efects reported in two or more studies, meta-analyses using a random-efects model were performed
using the MetaXL software to estimate the pooled prevalence with 95% CI. PRISMA guidelines were
followed. A total of 18,251 publications were identifed, of which 15 met the inclusion criteria. The
prevalence of 55 long-term efects was estimated, 21 meta-analyses were performed, and 47,910
patients were included (age 17–87 years). The included studies defned long-COVID as ranging from 14
to 110 days post-viral infection. It was estimated that 80% of the infected patients with SARS-CoV-2
developed one or more long-term symptoms. The fve most common symptoms were fatigue (58%),
headache (44%), attention disorder (27%), hair loss (25%), and dyspnea (24%). Multi-disciplinary
teams are crucial to developing preventive measures, rehabilitation techniques, and clinical
management strategies with whole-patient perspectives designed to address long COVID-19 care.

Author/s:

S., Wegman-Ostrosky, T., Perelman, C., Sepulveda, R., Rebolledo, P. A., Cuapio, A., Villapol, S.

Lung Cancer Screening with Low-Dose CT: a Meta-Analysis

Carly Hughes — Wed, 21 Oct 2020 14:34:36 +0000

Date Added:

October 22, 2020

Journal/Publication:

Journal of General Internal Medicine

Publisher:

Society of General Internal Medicine

Publication Date:

June 24, 2020

Issue:

Volume:

Pages:

3015-3025

URL:

Lung Cancer Screening with Low-Dose CT: a Meta-Analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1007/s11606-020-05951-7

Keywords

low-dose computed tomography

lung cancer screening

lung neoplasms

meta-analysis

mortality

PMID (1):

32583338

MeSH

lung neoplasms

tomography, x-ray computed

Carcinoma

The abstract of a met-analysis showing that lung cancer screening with low-dose CT reduces the risk of lung cancer deaths with around 8% false positive screens and a very low rate of documented untoward effects of those false positives. James W. Mold, MD, MPH

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Background: Randomized controlled trials have evaluated the efficacy of low-dose CT (LDCT) lung cancer screening on lung cancer (LC) outcomes.

Objective: Meta-analyze LDCT lung cancer screening trials.

Methods: We identified studies by searching PubMed, Google Scholar, the Cochrane Registry, ClinicalTrials.gov , and reference lists from retrieved publications. We abstracted data on study design features, stage I LC diagnoses, LC and overall mortality, false positive results, harm from invasive diagnostic procedures, overdiagnosis, and significant incidental findings. We assessed study quality using the Cochrane risk-of-bias tool. We used random-effects models to calculate relative risks and assessed effect modulators with subgroup analyses and meta-regression.

Results: We identified 9 studies that enrolled 96,559 subjects. The risk of bias across studies was judged to be low. Overall, LDCT screening significantly increased the detection of stage I LC, RR = 2.93 (95% CI, 2.16-3.98), I2 = 19%, and reduced LC mortality, RR = 0.84 (95% CI, 0.75-0.93), I2 = 0%. The number needed to screen to prevent an LC death was 265. Women had a lower risk of LC death (RR = 0.69, 95% CI, 0.40-1.21) than men (RR = 0.86, 95% CI, 0.66-1.13), p value for interaction = 0.11. LDCT screening did not reduce overall mortality, RR = 0.96 (95% CI, 0.91-1.01), I2 = 0%. The pooled false positive rate was 8% (95% CI, 4-18); subjects with false positive results had < 1 in 1000 risk of major complications following invasive diagnostic procedures. The most valid estimates for overdiagnosis and significant incidental findings were 8.9% and 7.5%, respectively.

Discussion: LDCT screening significantly reduced LC mortality, though not overall mortality, with women appearing to benefit more than men. The estimated risks for false positive results, screening complications, overdiagnosis, and incidental findings were low. Long-term survival data were available only for North American and European studies limiting generalizability.

Author/s:

Hoffman, Richard M., Atallah, Rami P., Struble, Roger D., Badgett, Robert G

Does Adding of Hydroxychloroquine to the Standard Care Provide Any Benefit in Reducing the Mortality Among COVID-19 Patients?: A Systematic Review

Brian Desmarais — Fri, 03 Jul 2020 19:31:09 +0000

Date Added:

July 3, 2020

Journal/Publication:

Journal of Neuroimmune Pharmacology

Publication Date:

June 9, 2020

URL:

Does Adding of Hydroxychloroquine to the Standard Care Provide Any Benefit in Reducing the Mortality Among COVID-19 Patients?: A Systematic Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1007/s11481-020-09930-x

Keywords

In case any of you still believe that hydroxychloroquine helps COVID patients, this systematic reviews adds to the literature suggesting it doesn’t. James W. Mold, MD, MPH

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Hydroxychloroquine has been promoted for its use in treatment of COVID-19 patients based on in-vitro evidences. We searched the databases to include randomized and observational studies evaluating the effect of Hydroxychloroquine on mortality in COVID-19 patients. The outcome was summarized as odds ratios (OR) with a 95% confidence interval (CI).We used the inverse-variance method with a random effect model and assessed the heterogeneity using I2 test. We used ROBINS-I tool to assess methodological quality of the included studies. We performed the meta-analysis using 'Review manager software version 5.3'. We identified 6 observationalstudies satisfying the selection criteria. In all studies, Hydroxychloroquine was given as add on to the standard care and effect was compared with the standard care alone. A pooled analysis observed 251 deaths in 1331 participants of the Hydroxychloroquine arm and 363 deaths in 1577 participants of the control arm. There was no difference in odds of mortality events amongst Hydroxychloroquine and supportive care arm [1.25 (95% CI: 0.65, 2.38); I2 = 80%]. A similar trend was observed with moderate risk of bias studies [0.95 (95% CI: 0.44, 2.06); I2 = 85%]. The odds of mortality were significantly higher in patients treated with Hydroxychloroquine + Azithromycin than supportive care alone [2.34 (95% CI: 1.63, 3.34); I2 = 0%]. A pooled analysis of recently published studies suggests no additional benefit for reducing mortality in COVID-19 patients when Hydroxychloroquine is given as add-on to the standard care. Graphical Abstract.

Author/s:

Patel, T.K., Barvaliya, M, Kevadiya, B.D., Patel, P.B., Bhalla, H.L.

Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis

John Bayhi — Mon, 02 Mar 2020 18:25:43 +0000

Date Added:

March 2, 2020

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

January 12, 2016

Issue:

Volume:

315

Pages:

150-163

URL:

Mental Health Conditions Among Patients Seeking and Undergoing Bariatric Surgery: A Meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2015.18118

Keywords

PMID (1):

26757464

MeSH

Humans

weight loss

binge-eating disorder

In depressed adults who undergo bariatric surgery, there is some evidence that their depression improves. James W. Mold, MD, MPH

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IMPORTANCE:

Bariatric surgery is associated with sustained weight loss and improved physical health status for severely obese individuals. Mental health conditions may be common among patients seeking bariatric surgery; however, the prevalence of these conditions and whether they are associated with postoperative outcomes remains unknown.

OBJECTIVE:

To determine the prevalence of mental health conditions among bariatric surgery candidates and recipients, to evaluate the association between preoperative mental health conditions and health outcomes following bariatric surgery, and to evaluate the association between surgery and the clinical course of mental health conditions.

DATA SOURCES:

We searched PubMed, MEDLINE on OVID, and PsycINFO for studies published between January 1988 and November 2015. Study quality was assessed using an adapted tool for risk of bias; quality of evidence was rated based on GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria.

FINDINGS:

We identified 68 publications meeting inclusion criteria: 59 reporting the prevalence of preoperative mental health conditions (65,363 patients) and 27 reporting associations between preoperative mental health conditions and postoperative outcomes (50,182 patients). Among patients seeking and undergoing bariatric surgery, the most common mental health conditions, based on random-effects estimates of prevalence, were depression (19% [95% CI, 14%-25%]) and binge eating disorder (17% [95% CI, 13%-21%]). There was conflicting evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Neither depression nor binge eating disorder was consistently associated with differences in weight outcomes. Bariatric surgery was, however, consistently associated with postoperative decreases in the prevalence of depression (7 studies; 8%-74% decrease) and the severity of depressive symptoms (6 studies; 40%-70% decrease).

CONCLUSIONS AND RELEVANCE:

Mental health conditions are common among bariatric surgery patients-in particular, depression and binge eating disorder. There is inconsistent evidence regarding the association between preoperative mental health conditions and postoperative weight loss. Moderate-quality evidence supports an association between bariatric surgery and lower rates of depression postoperatively.

Author/s:

Dawes, AJ, Maggard-Gibbons, M, Maher, AR, Booth, MJ, Miake-Lye, I, Shekelle, PG

Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials

John Bayhi — Fri, 03 Jan 2020 17:40:28 +0000

Date Added:

January 3, 2020

Journal/Publication:

BMC Musculoskeletal Disorders

Publisher:

BioMed Central Ltd

Publication Date:

December 31, 2019

Issue:

Volume:

URL:

Craniosacral therapy for chronic pain: a systematic review and meta-analysis of randomized controlled trials

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s12891-019-3017-y

Keywords

chronic pain

Complementary Therapies

Craniosacral therapy

meta-analysis

systematic review

PMID (1):

31892357

MeSH

Craniosacral therapy is an apparently effective therapy, about which many of you may be unfamiliar, for patients with chronic pain syndromes. James W. Mold, MD, MPH

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OBJECTIVES:

To systematically assess the evidence of Craniosacral Therapy (CST) for the treatment of chronic pain.

METHODS:

PubMed, Central, Scopus, PsycInfo and Cinahl were searched up to August 2018. Randomized controlled trials (RCTs) assessing the effects of CST in chronic pain patients were eligible. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for pain intensity and functional disability (primary outcomes) using Hedges' correction for small samples. Secondary outcomes included physical/mental quality of life, global improvement, and safety. Risk of bias was assessed using the Cochrane tool.

RESULTS:

Ten RCTs of 681 patients with neck and back pain, migraine, headache, fibromyalgia, epicondylitis, and pelvic girdle pain were included. CST showed greater post intervention effects on: pain intensity (SMD = -0.32, 95%CI = [- 0.61,-0.02]) and disability (SMD = -0.58, 95%CI = [- 0.92,-0.24]) compared to treatment as usual; on pain intensity (SMD = -0.63, 95%CI = [- 0.90,-0.37]) and disability (SMD = -0.54, 95%CI = [- 0.81,-0.28]) compared to manual/non-manual sham; and on pain intensity (SMD = -0.53, 95%CI = [- 0.89,-0.16]) and disability (SMD = -0.58, 95%CI = [- 0.95,-0.21]) compared to active manual treatments. At six months, CST showed greater effects on pain intensity (SMD = -0.59, 95%CI = [- 0.99,-0.19]) and disability (SMD = -0.53, 95%CI = [- 0.87,-0.19]) versus sham. Secondary outcomes were all significantly more improved in CST patients than in other groups, except for six-month mental quality of life versus sham. Sensitivity analyses revealed robust effects of CST against most risk of bias domains. Five of the 10 RCTs reported safety data. No serious adverse events occurred. Minor adverse events were equally distributed between the groups.

DISCUSSION:

In patients with chronic pain, this meta-analysis suggests significant and robust effects of CST on pain and function lasting up to six months. More RCTs strictly following CONSORT are needed to further corroborate the effects and safety of CST on chronic pain.

Author/s:

Haller, H, Lauche, R, Sundberg, T, Dobos, G, Cramer, H

Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis of data in euglycemic subjects, patients at risk of type 2 diabetes mellitus, and patients being treated for type 2 diabetes mellitus

Tracy Ashby — Tue, 09 Apr 2019 05:00:00 +0000

Date Added:

April 9, 2019

Journal/Publication:

The American Journal of Clinical Nutrition

Publisher:

American Society for Nutrition

Publication Date:

November 11, 2015

Issue:

Volume:

102

Pages:

1604-1614

URL:

Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis of data in euglycemic subjects, patients at risk of type 2 diabetes mellitus, and patients being treated for type 2 diabetes mellitus

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3945/ajcn.115.106989

Keywords

PMID (1):

26561625

MeSH

diabetes mellitus, type 2

glycated hemoglobin a

cholesterol

This 2015 meta-analysis found that the addition of 5 – 10 gm of psyllium husks taken before each meal reduced A1cs in type 2 diabetics by an average of 1%, comparable to most diabetes meds. Most patients will have to work their way up to that dose gradually I suspect. James W. Mold, MD, MPH

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BACKGROUND:

A number of health benefits are associated with intake of soluble, viscous, gel-forming fibers, including reduced serum cholesterol and the attenuation of postprandial glucose excursions.

OBJECTIVE:

We assess the effects of psyllium, which is a soluble, gel-forming, nonfermented fibersupplement, on glycemic control in patients who were being treated for type 2 diabetes mellitus (T2DM) and in patients who were at risk of developing T2DM.

DESIGN:

A comprehensive search was performed of available published literature (Scopus scientific database) and clinical records stored by Procter & Gamble with the use of key search terms to identify clinical studies that assessed the glycemic effects of psyllium in nondiabetic, pre-T2DM, and T2DM patients.

RESULTS:

We identified 35 randomized, controlled, clinical studies that spanned 3 decades and 3 continents. These data were assessed in 8 meta-analyses. In patients with T2DM, multiweek studies (psyllium dosed before meals) showed significant improvement in both the fasting blood glucose (FBG) concentration (-37.0 mg/dL; P < 0.001) and glycated hemoglobin (HbA1c) [-0.97% (-10.6 mmol/mol); P = 0.048]. Glycemic effects were proportional to baseline FBG; no significant glucose lowering was observed in euglycemic subjects, a modest improvement was observed in subjects with pre-T2DM, and the greatest improvement was observed in subjects who were being treated for T2DM.

CONCLUSIONS:

These data indicate that psyllium would be an effective addition to a lifestyle-intervention program. The degree of psyllium's glycemic benefit was commensurate with the loss of glycemic control. Because the greatest effect was seen in patients who were being treated for T2DM, additional studies are needed to determine how best to incorporate psyllium into existing prevention and treatment algorithms with concomitant hypoglycemic medications.

Author/s:

Gibb, Roger D., McRorie, Johnson W., Russell, Darrell A., Hasselblad, Vic, D'Alessio, David A.