Latest news with #metaanalysis
CBC
a day ago
- Health
- CBC
Dr. Peter Lin makes the case for avoiding infections
New medical research indicates common respiratory illnesses, like COVID-19 or the flu can potentially trigger dormant tumour cells for some breast cancer patients. The findings, published recently in The Journal of Nature, was based on mouse studies as well as meta-analysis of human patients. Dr. Lin explains the new research.
Medscape
04-08-2025
- Health
- Medscape
Rectal Cancer Survival Not Tied to pCR
TOPLINE: According to a meta-analysis of randomized clinical trials (RCTs), pathologic complete response (pCR) was not associated with overall or disease-free survival in patients with rectal cancer, suggesting that the use of pCR as a surrogate endpoint for survival should be reexamined. METHODOLOGY: Neoadjuvant trials in rectal cancer are increasingly using pCR as a surrogate endpoint for long-term outcomes, following recommendations by the FDA in 2012. However, while some research has shown an association between pCR and improved survival in rectal cancer on the patient level, consensus on the trial-level validity of pCR as a surrogate is lacking. Researchers conducted a systematic review and meta-analysis of 25 RCTs involving 11,882 patients with rectal cancer who underwent neoadjuvant therapies (mostly chemo radiation) followed by surgical resection. The researchers assessed the correlation between pCR and both overall survival and disease-free survival. TAKEAWAY: Across trials that reported overall survival, weighted regression analysis revealed no correlation between pCR and overall survival (β, 0.37; 95% CI, -0.98 to 1.71; P = .57). Similarly, across trials reporting disease-free survival, there was no correlation between pCR and disease-free survival (β, -0.84; 95% CI, -2.55 to 0.87; P = .32). A sensitivity analysis conducted after excluding two studies with a high risk for bias also yielded null associations. The researchers performed subgroup analyses excluding studies that evaluated neoadjuvant radiation alone or included patients who did not receive curative resection and again found no association between pCR and either disease-free or overall survival. IN PRACTICE: 'Our trial-level analysis did not reveal a correlation between pCR and [disease-free survival] or [overall survival] in rectal cancer RCTs,' the authors of the study concluded. 'Our study's findings suggest a recommendation against using pCR as a [surrogate endpoint] for neoadjuvant therapies in rectal cancer until conclusive trial-level evidence of its association with long-term outcomes is firmly established.' SOURCE: This study, led by Kavin Sugumar, MD, Tulane University, New Orleans, and Jessica Jin Lie, MD, MPH, University of British Columbia, Vancouver, British Columbia, Canada, was published online in JAMA Network Open. LIMITATIONS: A subgroup analysis of total neoadjuvant therapy trials was not feasible due to insufficient sample size. Additionally, postsurgical therapies in patients without pCR may have improved outcomes, potentially diluting its association with survival. Mediation analysis was not possible due to lack of patient-level data. DISCLOSURES: The authors did not disclose any funding information. One author disclosed receiving personal fees from Novartis, consulting fees from Boehringer Ingelheim, and grants from Eli Lilly and Company and Taiho, outside the submitted work. Another author reported receiving royalties as a coauthor on several chapters of UpToDate. No other disclosures were reported. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
23-07-2025
- Health
- Medscape
Point-of-Care Testing Cuts Antibiotic Use in Pharyngitis
TOPLINE: Point-of-care testing for group A beta-hemolytic Streptococcus (Strep A) significantly reduced antibiotic prescriptions in children and adults with signs of pharyngitis, even when used as the sole intervention. METHODOLOGY: Researchers performed a meta-analysis of eight randomized controlled trials conducted between 2007 and 2021, evaluating point-of-care testing for Strep A vs standard care. The analysis included 4249 children and adults with pharyngitis, cough, or sore throat who underwent point-of-care testing for Strep A either alone or alongside other interventions. Primary outcomes were the impacts on antibiotic prescriptions, clinical decisions, and patient health outcomes. Secondary endpoints assessed diagnostic accuracy of Strep A testing, including sensitivity and specificity measurements. TAKEAWAY: Point-of-care testing reduced antibiotic prescriptions by 38% compared with standard care (risk ratio [RR], 0.62; P < .0001) and by 41% when it was the sole intervention (RR, 0.59; P < .001). The implementation of point-of-care testing also led to a reduction in inappropriate antibiotic prescriptions (RR, 0.45; 95% CI, 0.31-0.97; P = .038). However, there were no significant differences in the patient health outcomes, such as days until pain resolution and days of school/work missed, the use of ancillary testing, or other medications such as analgesics with point-of-care testing. The reported diagnostic accuracy of Strep A point-of-care testing showed sensitivity ranging from 65% to 94% and specificity from 85% to 94%. IN PRACTICE: 'Physicians can therefore use Strep A POCTs [point-of-care tests] to inform their decisions on antibiotic prescribing without compromising patient health outcomes. In clinical practice, physicians must be aware of the limitations of Strep A POCTs, in particular, the limited sensitivity for detecting GAS [group A beta-hemolytic Streptococcus],' the authors of the study wrote. SOURCE: This study was led by Ann-Sophie Mägdefrau and Carolin Kathner-Schaffert, Jena University Hospital and InfectoGnostics Research Campus Jena, both in Jena, Germany. It was published online on July 9, 2025, in Open Forum Infectious Diseases. LIMITATIONS: High statistical heterogeneity in the meta-analyses limited the precision of the pooled effect estimates. Only three trials reported patient health outcomes, restricting evaluation of the effect of Strep A point-of-care tests on measures like recovery time. Additionally, none of the trials were blinded, introducing potential bias — particularly in evaluating subjective outcomes like pain and symptom resolution. DISCLOSURES: This study received funding from the German Federal Ministry of Education and Research. The authors reported having no relevant conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
30-06-2025
- Health
- Medscape
Respiratory Training Shows Modest Benefits in ALS
TOPLINE: Respiratory muscle training moderately improved lung function, especially respiratory muscle strength, in patients with amyotrophic lateral sclerosis (ALS) compared with no intervention or sham training. METHODOLOGY: Researchers conducted a meta-analysis to assess the effect of respiratory muscle training on lung function and respiratory muscle strength in patients with ALS. They gathered data from five randomized controlled trials including 170 patients with ALS (mean age range, 53-63 years; 58.8%-69.2% men), majority of whom had spinal onset of the disease (72.9%-84.6%). Researchers assessed the role of standalone respiratory muscle training and compared it with control conditions — physical exercise, usual care, or no intervention — to gauge its unique impact. The outcomes included assessments of lung function, respiratory muscle strength, survival, functional capacity, and adverse events. TAKEAWAY: According to a meta-analysis of three trials, maximum expiratory pressure was superior in the group that underwent respiratory muscle training compared with control conditions (standardized mean difference [SMD], 19.53; P = .02). Similarly, respiratory muscle training significantly improved the maximum inspiratory pressure compared with control conditions (SMD, 13.96; P = .010). A meta-analysis of four trials found no significant difference in the forced vital capacity between the groups (SMD, 0.90; P = .14). No studies reported serious adverse effects, supporting respiratory muscle training as a safe intervention for patients with ALS. IN PRACTICE: 'RMT [respiratory muscle training] shows potential as an adjuvant intervention for patients with ALS,' the authors wrote. SOURCE: This study was led by María Jesús Benzo-Iglesias, Health Research Centre, Humanidades-498 Research Group, University of Almería, Almería, Spain. It was published online on June 09, 2025, in Therapeutic Advances in Respiratory Disease. LIMITATIONS: This study had a small sample size, which limited the generalizability of the findings. It comprised only five trials, which may have affected the findings' robustness and restricted the ability to perform sensitivity analyses. The wide CIs in the heterogeneity analysis indicated substantial heterogeneity. DISCLOSURES: This study did not receive any funding. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Medscape
29-05-2025
- General
- Medscape
Rifaximin Lowers Hepatic Encephalopathy Risk in Cirrhosis
Rifaximin significantly reduces the risk for hepatic encephalopathy (HE) in patients with cirrhosis, with greater effectiveness observed with longer treatment durations. METHODOLOGY: Rifaximin is recommended as an add-on therapy to lactulose for preventing the recurrence of HE, with its efficacy noted in a prior meta-analysis; however, few studies have examined its use for HE prevention. Researchers performed a systematic review and meta-analysis of randomized controlled trials involving patients with cirrhosis aged 18 years or older. Patients received either rifaximin or nonrifaximin interventions, such as nonabsorbable disaccharides, other antibiotics, L-ornithine-L-aspartate, or placebo. Primary outcomes included the incidence of HE, all-cause mortality, and adverse events. TAKEAWAY: Researchers included 12 randomized controlled trials involving 1939 patients. Compared with nonrifaximin interventions and placebo, rifaximin significantly reduced HE incidence (relative risk [RR], 0.58; P = .000), as analyzed from 10 studies. Rifaximin was significantly more effective than placebo (RR, 0.57; P = .000), but its effects were noncomparable to those of nonabsorbable disaccharides. = .000), as analyzed from 10 studies. Rifaximin was significantly more effective than placebo (RR, 0.57; = .000), but its effects were noncomparable to those of nonabsorbable disaccharides. Rifaximin treatment durations longer than 1 month were more effective in reducing HE risk (RR, 0.55; P = .000). = .000). In patients with prior HE episodes, rifaximin reduced recurrence risk by 51% compared with other interventions and placebo (five trials). Among patients receiving transjugular intrahepatic portosystemic stent shunt (TIPSS), rifaximin reduced HE risk by 30% compared with placebo ( P = .027; two trials). = .027; two trials). No significant differences were observed in all-cause mortality or adverse events between the groups, based on analyses of nine and six trials, respectively. IN PRACTICE: 'RFX [rifaximin] therapy is effective and well-tolerated in preventing HE and can be used as the first choice in the prophylaxis of HE after TIPSS,' the authors wrote. SOURCE: This study was led by Yangyang Hu, Hebei Medical University Third Hospital, Shijiazhuang, China, and published online in PLOS One . LIMITATIONS: The analysis excluded unpublished literature, potentially introducing publication and reporting bias. Only randomized controlled trials were included, and six lacked blinding, which could have affected the stability of the results. Variability in rifaximin interventions (eg, drug dosage and treatment duration) may have also affected the findings. DISCLOSURES: This study was supported by the Natural Science Foundation of Hebei Province of China. The authors declared no competing interests. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication. Credit Lead image: Dubovdaniilyu/Dreamstime Medscape Medical News © 2025 WebMD, LLC Cite this: Edited by Manasi Talwadekar. Rifaximin Lowers Hepatic Encephalopathy Risk in Cirrhosis - Medscape - May 29, 2025.
