Statistical heterogeneity: Notion and estimation in meta-analysis

The efficacy and safety of tezepelumab in the treatment of uncontrolled asthma: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Tezepelumab is a human thymic stromal lymphopoietin (TSLP) antibody with effects in asthma. Therefore, our study aimed to evaluate the overall efficacy and safety of tezepelumab for the treatment of uncontrolled asthma.

METHODS

The databases Cochrane Library, PubMed, Embase, Web of Science, and Clinical Trials were searched from inception to April 1, 2022. Only randomized controlled trial (RCTs) that evaluated tezepelumab and a comparator for treating uncontrolled asthma were included. Additionally, articles were limited to English. The primary outcome was clinical efficacy, and the secondary outcome was adverse events. The risk of bias and quality were assessed by the Cochrane Collaboration bias assessment tool. The meta-analysis was performed using Review Manager Version 5.3.

RESULTS

Four RCTs with a total of 1600 patients were included in the study. Pooled analysis indicated that tezepelumab had significantly decreased annualized asthma exacerbations (odds ratio [OR] = 0.67, 95% confidence interval [CI] = [0.57, -0.80], P < .00001) and the asthma control questionnaire score of 6 (ACQ-6) among the patients (standard mean difference [SMD] = -0.29, 95% CI = [-0.39, -0.20], P < .00001) compared to placebo. Furthermore, tezepelumab treatment significantly improved forced expiratory volume in 1 second (FEV1, SMD = 0.28, 95% CI = [0.11, 0.45], P = .001). Regarding safety, the pooled analysis indicated that patients treated with tezepelumab showed no significant difference in adverse events that led to discontinuation of the treatment, but they experienced some other (non-serious) adverse events compared to the placebo group. However, there was a significant decrease in the incidence of serious adverse events and any adverse events in the tezepelumab group. Tezepelumab use was associated with adverse events, including nasopharyngitis, headache, and bronchitis, despite effectively treating asthma.

CONCLUSION

Tezepelumab effectively improved FEV1, reduced the disease symptom score, and decreased the risk of exacerbations in uncontrolled asthma patients. Tezepelumab was associated with some adverse events compared to placebo. This suggests that careful management of adverse events is required if tezepelumab is used to treat asthma patients.

Impact of Early Palliative Care to Improve Quality of Life of Advanced Cancer Patients: A Meta-Analysis of Randomised Controlled Trials

Palliative care is often started late in patients with life-threatening conditions, particularly in patients with advanced cancer. However, with the emergence of the early palliative care (EPC) paradigm, their quality of life (QoL) may be better. Although several previous meta-analyses support the effectiveness of EPC in increasing QoL, essential issues related to the optimisation of EPC interventions are still needed. A systematic review and meta-analysis of randomised controlled trials (RCTs) were conducted to determine the effectiveness of EPC on the QoL of patients with advanced cancer. PubMed, ProQuest, MEDLINE through EBSCOhost and Cochrane Library and clinicaltrials.gov (register website) were searched for RCTs published before May 2022. Data synthesis used the Review Manager 5.4 to generate pooled estimates of effect size. A total of 12 empirical trials met the eligibility criteria and were included in this study. The results showed that EPC intervention had a significant effect (standard mean difference = 0.16, 95% confidence interval: 0.04, 0.28, Z = 2.68, P < 0.05). However, the secondary outcomes showed including mood (mean difference = -0.90, 95% CI: -2.32, 0.51, P > 0.05) and symptom controls (MD = -1.49, 95% CI: -3.81, 0.81, P > 0.05) had no significant effect. EPC is effective in improving the QoL of patients with advanced cancer. However, other outcomes still need to be reviewed, because the review of QoL is not enough to generalise the benchmarks for the effectiveness and optimisation of EPC interventions. Another notable aspect is to consider the most effective and efficient duration for starting and ending EPC interventions.

Analgesic efficacy of erector spinae plane block in lumbar spine surgery: A systematic review and meta-analysis

STUDY OBJECTIVE

Erector spinae plane block (ESPB) has gained popularity for perioperative analgesia in various surgeries. However, its efficacy in lumbar surgery remains unclear. This review aimed to determine whether ESPB could improve analgesic efficacy in lumbar spine surgery.

DESIGN

A meta-analysis of randomized controlled trials.

SETTING

Perioperative setting.

PATIENTS

Patients undergoing lumbar spine surgery under general anesthesia.

INTERVENTIONS

We searched the databases including PubMed, Cochrane Library, EMBASE, Web of Science etc. for published eligible controlled trials comparing ESPB with control (no block/sham block) in lumbar spine surgery.

MEASUREMENTS

The primary outcome was opioid consumption in the first 24 h after surgery.

MAIN RESULTS

Twelve studies comprising 665 participants were included. Compared to the control, ESPB reduced the opioid (morphine milligram equivalents) consumption significantly 24 h after surgery [mean difference (MD) = -14.55; 95% confidence interval (CI), -21.03 to -8.07; P < 0.0001] and lowered the pain scores at various time points (at rest or during movement) for 48 h after surgery. ESPB increased the patient satisfaction score (0-10) (MD = 2.38; 95% CI, 2.10 to 2.66; P < 0.0001), decreased the postoperative nausea and vomiting [risk ratio (RR) = 0.36; 95% CI, 0.20 to 0.67; P = 0.001], and minimized the length of hospital stay (MD = -1.24 days; 95% CI, -2.31 to -0.18; P = 0.02). Furthermore, subgroup analysis revealed additional reduction in opioid consumption by the block approach at the vertebral level of incision/operation than that at the fixed thoracic/lumbar level. However, considerable heterogeneity and low-grade quality of evidence were observed.

CONCLUSIONS

ESPB provided effective postoperative analgesia resulting in better patient satisfaction and recovery with decreased postoperative nausea and vomiting in patients undergoing lumbar surgery compared to the control. However, the low-grade quality of evidence compromised the findings, therefore further high-quality of evidence is required. PROSPERO registration number: CRD42021233362.

Evaluating the Lower Anterior Facial Height in Patients Treated with Extraction Versus Non-extraction Fixed Mechanotherapy: “A Systematic Review and Meta-analysis”

Objective:

The objective of this study was to evaluate the effects of the four first premolars extraction compared with a non-extraction treated control group on the lower anterior facial height.

Methods:

Electronic search was conducted on PubMed, Cochrane, Scopus, Lilacs, Scielo, clinical trials, and opengrey.eu databases; only article published in English were included. The eligibility criteria were extraction of four first premolars compared with a non-extraction control group treated with fixed mechanotherapy. Anterior Nasal Spine to Menton (ANS-Me) (mm) was taken as the primary outcome; Frankfurt mandibular plane angle (FMA) and Nasion to Menton (N-Me) were selected as secondary outcomes. Non-randomized Studies-of Intervention (ROBINS-I) tool was used for the quality assessment and risk of bias. Heterogeneity was analyzed using statistical tests, including chi-squared-based Q-statistic, tau-square, and I-squared statistics. Review Manager was used for quantitative assessment and meta-analysis.

Results:

Five retrospective studies were included for quantitative assessment and three were included in the meta-analysis due to certain missing data. Extraction of four first premolars did not affect both primary and secondary outcomes with P = .65, P = .93, and P = .91, respectively, for ANS-Me, FMA, and N-Me.

Conclusion:

This review and meta-analysis concluded that there was no statistically significant effect of extraction of four first premolars on lower anterior facial height.

Effect of Different Additives on the Mechanical Properties of Gelatin Methacryloyl Hydrogel: A Meta-analysis

Gelatin methacryloyl (GelMA) hydrogel has adjustable physicochemical properties and a three-dimensional network structure for cell growth and hence a hot issue in the field of tissue engineering. However, its poor mechanical properties limit the application in the scaffold, especially as a bone scaffold. To date, many research studies have been carried out by adding some additives into GelMA to construct GelMA-based composites to improve the mechanical properties. However, there is a controversy as to whether the additives can improve the mechanical properties of GelMA. Herein, meta-analysis was used to evaluate the influence of the additives on the mechanical properties of GelMA-based composites, which can provide reference for the further enhancement of mechanical properties of GelMA. In this study, meta-analysis was adopted to investigate the influence of additives on the mechanical properties of GelMA composites; composites with different concentrations of GelMA, that is, ≥10% (w/v), 5-10% (w/v), and ≤5% (w/v) were found in 23 literatures and heterogeneity could be found among these references. Accordingly, it is found that additives can improve the mechanical properties in each concentration.