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Results for “Meta- analysis”

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PubMed2004

Meta-analysis of cephalosporins versus penicillin for treatment of group A streptococcal tonsillopharyngitis in adults.

We conducted a meta-analysis of 9 randomized controlled trials (involving 2113 patients) comparing cephalosporins with penicillin for treatment of group A beta -hemolytic streptococcal (GABHS) tonsillopharyngitis in adults. The summary odds ratio (OR) for bacteriologic cure rate significantly favored cephalosporins, compared with penicillin (OR,1.83; 95% confidence interval [CI], 1.37-2.44); the bacteriologic failure rate was nearly 2 times higher for penicillin therapy than it was for cephalosporin therapy (P=.00004). The summary OR for clinical cure rate was 2.29 (95% CI, 1.61-3.28), significantly favoring cephalosporins (P<.00001). Sensitivity analyses for bacterial cure significantly favored cephalosporins over penicillin in trials that were double-blinded and of high quality, trials that had a well-defined clinical status, trials that performed GABHS serotyping, trials that eliminated carriers from analysis, and trials that had a test-of-cure culture performed 3-14 days after treatment. This meta-analysis indicates that the likelihood of bacteriologic and clinical failure in the treatment of GABHS tonsillopharyngitis is 2 times higher for oral penicillin than for oral cephalosporins.

Adult↗

PubMed1991

A meta-analysis of depressive symptomatology and alcohol consumption over time.

Meta-analysis (eight general population longitudinal studies) describes the relationships (regressions) between quantity per occasion and depressive symptomatology over time. Quantity and depression are the strongest and most consistent predictors of final levels of themselves in all data sets. Age significantly and consistently predicts quantity for both sexes combined (the general pattern is replicated among males only). Depression significantly predicts quantity and quantity significantly predicts depression for females. Controlling for interval between measurements produces stronger prediction (more consistent over shorter intervals) for males. Depression only predicts quantity over longer intervals and quantity only predicts depression over shorter intervals for females. Explicit control for age found stronger relationships between initial and final measurement quantity, and depression for males. Quantity and depression significantly predict quantity and depression among young females. The relationship between quantity and depression among females illustrates the importance of controlling for age and sex. Methodological considerations are discussed.

Adult↗

PubMed2005

Protective effect of breastfeeding against obesity in childhood. Can a meta-analysis of observational studies help to validate the hypothesis?

The relationship between breast-feeding and childhood obesity is of great interest. Since 2000, sixteen studies have been published with conflicting data regarding the potential protective effect of breast-feeding on childhood obesity. A narrative review of Dewey in 2003 suggested a protective effect of breast-feeding, but an editorial in the British Medical Journal later that year cited two more recent studies without such an effect and stated there was inconclusive evidence A recent meta-analysis, however, has suggested a small, but significant, protective effect of breast-feeding. This paper summarizes this meta-analysis and discusses the strengths and limitations of the meta-analysis approach.

Breast Feeding↗

PubMed1998

A meta-analysis of eight randomized, double-blind, controlled clinical trials of mirtazapine for the treatment of patients with major depression and symptoms of anxiety.

BACKGROUND: Patients diagnosed with major depression and prominent symptoms of anxiety often have a poor prognosis for recovery. A meta-analysis was performed to assess the efficacy of mirtazapine in comparison with placebo and amitriptyline for the relief of anxiety/agitation or anxiety/somatization in patients with major depressive illness. METHOD: A meta-analysis of eight randomized, double-blind, placebo-controlled clinical trials was conducted for 161 mirtazapine-treated and 132 placebo-treated patients with a DSM-III diagnosis of major depression, baseline Hamilton Rating Scale for Depression (HAM-D) scores > or = 18, and a baseline score > or = 6 for the sum of HAM-D items 9, 10, and 11 (anxiety/agitation). Four of the clinical trials included an amitriptyline control group (N = 92). RESULTS: Mirtazapine-treated patients demonstrated a statistically significant (p < or = .05) reduction in the sum of HAM-D items 9, 10, and 11 (anxiety/agitation) compared with placebo-treated patients at Weeks 1, 2, 4, and 6 and at the endpoint. There was no statistically significant difference between the mirtazapine- and amitriptyline-treated patients at Weeks 1, 3, 4, 5, and 6 and at the endpoint. Similar results were found for the analysis of the mean of HAM-D items 10, 11, 12, 13, 15, 17 (anxiety/somatization or HAM-D Factor Score I) using all treated patients with a post-baseline evaluation in all 8 studies. Mirtazapine-treated patients demonstrated a statistically significant (p < or = .03) greater reduction at Weeks 1-6 compared with placebo, and improvement in the mirtazapine group was comparable to improvement in the amitriptyline group at Weeks 1-6. CONCLUSION: In this meta-analysis of eight randomized, double-blind, controlled clinical trials, mirtazapine was found to be superior to placebo and comparable to amitriptyline for the treatment of patients with major depression with symptoms of anxiety/agitation or anxiety/somatization.

Adolescent↗

PubMed2026

Long-term efficacy of cognitive behavioural therapy for insomnia (CBT-I) on depressive symptoms: A systematic review and meta-analysis of randomised controlled trials.

Depressive symptoms are common in individuals with persistent insomnia. Previous meta-analyses of randomised controlled trials (RCTs) showed that cognitive behavioural therapy for insomnia (CBT-I) can reduce depressive symptoms at post-treatment. However, the long-term maintenance of these improvements has never been systematically examined. To fill-in this gap, we conducted a systematic review and meta-analysis of the long-term (≥3 months) effects of CBT-I on depressive symptoms. The review was registered in PROSPERO (CRD420251146061). Only RCTs in adults with insomnia were considered. Pubmed, Scopus, Psycinfo, CINAHL, and Medline were searched up to 12 September 2025 with no predefined time constraints. From 5359 records initially retrieved, we included 53 articles reporting on 13,608 individuals. After outliers removal, random effects meta-analysis showed that CBT-I was superior to control conditions in reducing depressive symptoms at 3 [k = 29, d = -.35, [95% CI: -.49 to -.21], p < .001], 6 [k = 29, d = -.32, [95% CI: -.59 to -.05], p = .018], and 12 [k = 10, d = -.25, [95% CI: -.39 to -.12], p < .001] months follow-ups. Results demonstrate that the effects of CBT-I on depressive symptoms are sustained throughout the year following treatment, although effects may decline over time.

Humans↗

PubMed2006

Weekly docetaxel as second line chemotherapy for advanced non-small-cell lung cancer: meta-analysis of randomized trials.

BACKGROUND: Docetaxel has to be considered as the reference control arm for second line chemotherapy for advanced NSCLC. Weekly docetaxel has been compared to standard 3-weekly schedule in a randomized fashion to determine if such schedule improves survival and quality of life. We performed a literature-based meta-analysis of all randomized clinical trials (RCTs) comparing weekly over 3-weekly docetaxel in advanced NSCLC. METHODS: All randomized trials were considered eligible. A literature-based meta-analysis was accomplished, and event-based relative risk ratios (RR) with 95% confidence interval (CI) were derived. A fixed- and a random-effect model according to the inverse variance and the Mantel-Haenszel method were applied. Heterogeneity test was applied as well. RESULTS: We found six RCTs (three phase III, two phase II, 1018 patients), in which data for overall survival (OS), overall response rate (ORR) and grade 3-4 (G3-4) WHO neutropenia were available. When considering only phase III RCTs, OS did not significantly differ between the two arms (RR 1.01, 95% CI 0.76, 1.42, p=0.785) with no significant heterogeneity (p=0.42). Regarding activity, no significant differences in favour of weekly docetaxel were found, although a trend for 3-weekly schedule was observed (RR 0.81, 95% CI 0.47, 1.40, p=0.485), with no significant heterogeneity (p=0.27). No differences were found in the overall population also considering the phase II trials. Regarding G3-4 neutropenia, a significant homogenous advantage in favour of weekly docetaxel was found, with an absolute benefit of 15-19%. CONCLUSIONS: Although considering all drawbacks related to literature-based meta-analyses, weekly docetaxel seems not to improve survival when compared to 3-weekly docetaxel. The significant benefit in grade 3-4 neutropenia seems to suggest this approach in patients with NSCLC pretreated for advanced disease. The quality of life of both schedules needs to be evaluated in an individual patient data meta-analysis.

Antineoplastic Agents, Phytogenic↗

PubMed2001

Creutzfeldt-Jakob disease and blood transfusions: a meta-analysis of case-control studies.

A meta-analysis of five published case-control studies that examined the association between previous blood transfusions and Creutzfeld-Jakob disease was performed. The results demonstrated that controls were more likely (p < 0.001, odds ratio = 1.56, 95% confidence interval, 1.22-1.98) to have received previous blood transfusions (18.7%) than Creutzfeld-Jakob disease patients (12.9%), suggesting that selection bias of the control populations had occurred.

Case-Control Studies↗

PubMed1998

A meta-analysis of implants in partial edentulism.

A meta-analytic technique was used to estimate the survival of implants supporting bridges or single crowns in partially edentulous patients. A survey of the literature revealed 66 studies, published between 1986 and 1996. Nine studies on single implants and 10 studies on fixed partial dentures met the inclusion criteria for the meta-analysis. Data from a total of 2686 implants, 570 single crowns (SC) and 2116 in fixed partial dentures (FPD), were analyzed. In order to calculate annual survival rates for individual studies a life-table analysis was conducted. Maximum follow-up time ranged between 1 and 8 years. After 1 year the success rate was calculated to be at least 85.7% for FPD and 97.2% for SC. When the results from the FPD studies were pooled the survival rate was 93.6% after 6-7 years. The corresponding value for SC was 97.5%.

Chi-Square Distribution↗

PubMed1998

Intracranial hemorrhage associated with idiopathic thrombocytopenic purpura: report of seven patients and a meta-analysis.

We present the results of a meta-analysis using clinical data obtained from seven of our patients and 24 previously reported patients with idiopathic thrombocytopenic purpura complicated by intracranial hemorrhage. Twenty-four had an intracerebral hemorrhage (ICH) and seven had a subdural hematoma (SDH). Mean age of the patients with ICH was significantly younger than those with SDH. The mortality rate of ICH associated with ITP was similar to that of spontaneous ICH. All seven patients with SDH improved without sequelae.

Adult↗

PubMed2000

Evaluation of an antihypertensive therapy utilising meta-analysis of a clinical trial database.

The emphasis on evidence-based medicine and the use of safe, cost-effective therapeutic strategies demands that management decisions be based upon evidence derived from clinical studies. Whilst prospective double blind clinical trials are regarded as the gold standard, there is no doubt that meta-analysis has proved valuable in defining the benefits of antihypertensive therapy. The antihypertensive efficacy of lacidipine has been assessed in a retrospective meta-analysis of a series of clinical studies in which the drug was compared with placebo and all the major classes of antihypertensive agent. All of the studies entered into the meta-analysis were parallel group double blind trials. Efficacy was based upon the reduction in both systolic and diastolic blood pressure and the effect on heart rate at trough immediately prior to dosing during maintenance therapy. In placebo controlled trials a clear dose response relationship was apparent with blood pressure reductions that were significantly greater than that observed with placebo at doses of 2 mg lacidipine and above. In active control trials, diastolic blood pressure reductions of 10-15 mmHg were observed at the end of the monotreatment phases (> 6-8 weeks) with a final reduction of 15-20 mmHg with the efficacy of lacidipine being equivalent to that of the comparator drug. Comparable results were also achieved for the response rates to therapy which varied between 70 and 85% at the end of the monotreatment phase and 82-98 when combination with other antihypertensive agents was permitted. There was no evidence of cardio-acceleration in any of the trials where significant blood pressure reduction was detected. This retrospective analysis in a large population base confirms the documented antihypertensive efficacy of lacidipine and demonstrates the suitability of the drug as a first line antihypertensive agent.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

[Clinical trials of statins and fibrates --a meta-analysis].

INTRODUCTION: Several clinical trials of hypolipidemics showed a decrease in mortality by 30-40%, while others showed detrimental or no effects. The question remains: which trial should be the basis of clinical decision making in the choice of hypolipidemic therapy? MATERIAL AND METHODS: Meta-analysis is a method for combining research results of several studies. Effects of statins and fibrates with respect to placebo, were assessed by systematic literature review and meta-analysis. Medline and CENTRAL databases were searched using the following keywords: hyperlipoproteinemia, hypolipidemic agents and individual drug names. The main inclusion criteria were as follows: statin or fibrate, placebo controlled randomized trial, at least one year treatment on average, at least 100 patients per study arm and reported mortality. RESULTS: Fibrates showed almost complete absence of treatment effects on mortality with odds ratio of 0.99 and 95% confidence interval 0.80 - 1.11. The odds for statins were 0.87, 0.80 - 0.95. DISCUSSION: Despite the absence of treatment effects of fibrates, it is noteworthy that inclusion criteria of early fibrate trials focused mainly on cholesterol with recent identification of elevated triglycerides as an independent risk factor. As fibrates exert the most pronounced effect on triglycerides, they still may show effect in target populations. Effects of statins are confirmed, but they are noticeably lower than in individual trials which are given most publicity. CONCLUSION: Even after several decades of fibrate use, conclusive evidence of their beneficial effects still needs to be elucidated in appropriately designed trials. However, a beneficial effect of statins on mortality decrease has been proven. Meta-analysis has an important role in estimating true treatment effects and in the practice of evidence-based medicine.

Anticholesteremic Agents↗

PubMed2005

Dietary fiber and blood pressure: a meta-analysis of randomized placebo-controlled trials.

BACKGROUND: Dietary fiber is part of a healthy diet and may exert a protective effect in the cardiovascular system. The effect of fiber intake on blood pressure (BP) has not yet been established. METHODS: We performed a meta-analysis of randomized placebo-controlled trials to estimate the effect of fiber supplementation on BP overall and in population subgroups. Original articles published between January 1, 1966, and January 1, 2003, were retrieved for 24 trials that fulfilled criteria for meta-analysis. Data were abstracted on fiber dose, fiber type, BP changes, study design features, and study population characteristics. A random-effects model was used for meta-analysis. RESULTS: Fiber supplementation (average dose, 11.5 g/d) changed systolic BP by -1.13 mm Hg (95% confidence interval: -2.49 to 0.23) and diastolic BP by -1.26 mm Hg (-2.04 to -0.48). Reductions in BP tended to be larger in older (>40 years) and in hypertensive populations than in younger and in normotensive ones. CONCLUSION: Increasing the intake of fiber in Western populations, where intake is far below recommended levels, may contribute to the prevention of hypertension.

Adult↗

PubMed1993

Formaldehyde exposure and respiratory cancer--a meta-analysis of the epidemiologic evidence.

A recent meta-analysis by Blair and his co-workers stimulated the undertaking of a reanalysis of the epidemiologic evidence of an association between formaldehyde and respiratory cancer. Emphasis was placed on extracting the maximal amount of relevant data from the source studies. In close agreement with the original analysis, the aggregated evidence did not indicate an excess risk or an exposure-response gradient for lung cancer. An exposure-response gradient was seen for both sinonasal and nasopharyngeal cancers. The risk for substantial exposure was significantly elevated (odds ratio 1.7 for sinonasal and 2.7 for nasopharyngeal cancer). It is suggested that at least substantial levels of occupational exposure to formaldehyde are associated with a risk of these cancers. The excess risk would be of the order of 100% or more over background rates.

Epidemiologic Methods↗

PubMed2006

Impact of the suctioning system (open vs. closed) on the incidence of ventilation-associated pneumonia: Meta-analysis of randomized controlled trials.

OBJECTIVE: Ventilation-associated pneumonia (VAP) is a serious complication of patients in intensive care units (ICU) who require mechanical ventilation. The choice of suctioning system (open vs. closed) remains unresolved in evidence-based guidelines. This meta-analysis was carried out to analyze the effect of the type of suctioning system on the incidence of VAP. DESIGN: A search of the literature was used to identify randomized controlled trials addressing this question. A meta-analysis was then performed to calculate the relative risk of ventilation-associated pneumonia acquisition with the two suctioning systems. RESULTS: Nine trials were included, with 648 patients in the open suctioning group and 644 in the closed suctioning group. VAP occurred in 128 (20%) of the open suctioning group and in 120 (19%) in the closed suctioning group (relative risk 0.95). CONCLUSIONS: At a given pneumonia prevalence of 20% in ICU patients there was no significant advantage for the use of either suctioning system in this meta-analysis. The choice of suctioning system should therefore be based on handling, cost, and individual patient's disease until more data are available.

Cross Infection↗

PubMed1997

Beyond meta-analysis: a plea for a family systems view of attachment.

De Wolff and van Ijzendoorn's (1997) meta-analysis of parental antecedents of infant attachment focuses almost entirely on maternal behavior. I argue here that although the meta-analysis method makes an important contribution to summarizing research studies, it limits the conceptual understanding of attachment to simple causal models, and ignores family systems models that could illuminate our understanding of the development of secure and insecure attachment in children.

Adult↗

PubMed1993

A look at the statistical overview (or meta-analysis)

In essence, the statistical overview (or meta-analysis) does little more than many medical scientists and practising clinicians have been attempting for years: estimating the average size of an effect from an apparently disparate medical literature. The statistical overview provides a method of pooling the results of comparable trials (or observational studies) which, on their own, may be too small to demonstrate a 'statistically significant' effect. The role for the overview is obvious, the method is relatively simple, but the findings have to be interpreted cautiously, since joining the hypothesis post hoc contravenes one of the essential principles of scientific enquiry. The use of the statistical overview and some of its pros and cons are illustrated in four clinical examples.

Cholesterol↗

PubMed1997

Efficacy of hypertonic 7.5% saline and 6% dextran-70 in treating trauma: a meta-analysis of controlled clinical studies.

BACKGROUND: Individual trials of small-volume resuscitation of 7.5% NaCl (HS) with and without 6% dextran 70 (HSD) for the treatment of trauma have failed to provide convincing evidence of efficacy. We performed a meta-analysis to evaluate the effects of HS and HSD on survival until discharge or for 30 days. We identified eight double-blinded, randomized controlled trials of HSD and six trials of HS. In all cases, administration of 250 ml of HSD or HS was compared with a control group administration of 250 ml of isotonic crystalloid for the treatment of hypotension either in the field or at admission to the emergency department. METHODS: A fixed-effects meta-analysis was performed with the Mantel-Haenszel method of combining results from multiple studies. RESULTS: Overall, HS was not effective in improving survival with a weighted mean difference in survival of the HS group versus the isotonic control group equal to 0.6%. The results with HSD were more positive, with an increase in survival in seven of eight trials. The mean difference in survival rates favoring HSD (n = 615) over controls (n = 618) was 3.5% (p = 0.14, two-tailed; p = 0.07, one-tailed). The odds ratio was estimated to be 1.20 in favor of HSD with a 95% confidence interval of 0.94 to 1.57. CONCLUSIONS: The meta-analysis of the available data shows that HS is not different from the standard of care and that HSD may be superior.

Controlled Clinical Trials as Topic↗

PubMed2006

A meta-analysis of controlled clinical studies with diacerein in the treatment of osteoarthritis.

BACKGROUND: This systematic meta-analysis on randomized controlled trials with diacerein was performed to provide an evidence-based assessment of its symptomatic efficacy in the treatment of osteoarthritis. METHODS: Electronic databases were searched for randomized controlled trials with diacerein. A manual review of the literature, abstracts, and posters was also conducted. Unpublished final reports were obtained from the manufacturer. Only studies performed in knee and/or hip osteoarthritis were chosen for review. Study inclusion, quality scoring, and data extraction were performed by 2 reviewers independently. Objectives for analysis comprised pain, function, escape medication use, global efficacy, and safety ratings by patients and investigators. Specific study periods, such as the active treatment period and the treatment-free follow-up period (when present), were analyzed. Statistical analyses were based on the intention-to-treat principle as far as possible, and acknowledged tests were used for data analysis. RESULTS: A total of 23 studies were identified, 19 of which were included. Diacerein was significantly superior to placebo during the active treatment phase (Glass score, 1.50 [95% confidence interval, 0.80-2.20]). Both diacerein and nonsteroidal anti-inflammatory drugs (NSAIDs) were similarly efficacious during the treatment period; however, diacerein, but not NSAIDs, showed a carryover effect, persisting up to 3 months after treatment, with a significant analgesic-sparing effect during the follow-up period (Glass score, 2.06 [95% confidence interval, 0.66-3.46]). Tolerability assessment revealed no differences between diacerein and NSAIDs, although the latter showed more severe events. CONCLUSION: This systematic meta-analysis provides evidence for the symptomatic efficacy of diacerein in the treatment of knee and hip osteoarthritis, with reasonable tolerability.

Anthraquinones↗