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Bartoszko JJ, Gutiérrez García M, Díaz Martínez JP, Yegorov S, Brignardello-Petersen R, Mertz D, Thabane L, Loeb M. Conduct and reporting of multivariate network meta-analyses: a scoping review. J Clin Epidemiol 2024; 166:111238. [PMID: 38081440 DOI: 10.1016/j.jclinepi.2023.111238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Combining multivariate and network meta-analysis methods simultaneously in a multivariate network meta-analysis (MVNMA) provides the methodological framework to analyze the largest amount of evidence relevant to decision-makers (i.e., from indirect evidence and correlated outcomes). The objectives of this scoping review were to summarize the characteristics of MVNMAs published in the health sciences literature and map the methodological guidance available for MVNMA. STUDY DESIGN AND SETTING We searched MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature from inception to 28 August 2023, along with citations of included studies, for quantitative evidence syntheses that applied MVNMA and articles addressing MVNMA methods. Pairs of reviewers independently screened potentially eligible studies. Collected data included bibliographic, methodological, and analytical characteristics of included studies. We reported results as total numbers, frequencies, and percentages for categorical variables and medians and interquartile ranges for continuous variables that were not normally distributed. RESULTS After screening 1,075 titles and abstracts, and 112 full texts, we included 38 unique studies, of which, 10 were quantitative evidence syntheses that applied MVNMA and 28 were articles addressing MVNMA methods. Among the 10 MVNMAs, the first was published in 2013, four used studies identified from already published systematic reviews, and eight addressed pharmacological interventions, which were the most common interventions. They evaluated interventions for metastatic melanoma, colorectal cancer, prostate cancer, oral hygiene, disruptive behavior disorders, rheumatoid arthritis, narcolepsy, type 2 diabetes, and overactive bladder syndrome. Five MVNMAs analyzed two outcomes simultaneously, and four MVNMAs analyzed three outcomes simultaneously. Among the articles addressing MVNMA methods, the first was published in 2007 and the majority provided methodological frameworks for conducting MVNMAs (26/28, 93%). One study proposed criteria to standardize reporting of MVNMAs and two proposed items relevant to the quality assessment of MVNMAs. Study authors used data from 18 different illnesses to provide illustrative examples within their methodological guidance. CONCLUSIONS The application of MVNMA in the health sciences literature is uncommon. Many methodological frameworks are published; however, standardization and specific criteria to guide reporting and quality assessment are lacking. This overview of the current landscape may help inform future conduct of MVNMAs and research on MVNMA methods.
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Affiliation(s)
- Jessica J Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada.
| | - Mayra Gutiérrez García
- Faculty of Science, National Autonomous University of Mexico, University City, Coyoacán, Mexico City 04510, Mexico
| | - Juan Pablo Díaz Martínez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Sergey Yegorov
- Institute for Infectious Disease Research, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Institute for Infectious Disease Research, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Departments of Anesthesia and Pediatrics, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Biostatistics Unit, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, Ontario L8N 4A6, Canada; Faculty of Health Sciences, University of Johannesburg, 5 Kingsway Ave, Rossmore, Johannesburg 2092, South Africa
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Institute for Infectious Disease Research, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
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2
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Zeraatkar D, Pitre T, Diaz-Martinez JP, Chu D, Rochwerg B, Lamontagne F, Kum E, Qasim A, Bartoszko JJ, Brignardello-Peterson R. Impact of Allocation Concealment and Blinding in Trials Addressing Treatments for COVID-19: A Methods Study. Am J Epidemiol 2023; 192:1678-1687. [PMID: 37254775 PMCID: PMC10558187 DOI: 10.1093/aje/kwad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 03/19/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023] Open
Abstract
We aimed to assess the impact of allocation concealment and blinding on the results of coronavirus disease 2019 (COVID-19) trials, using the World Health Organization COVID-19 database (to February 2022). We identified 488 randomized trials comparing drug therapeutics with placebo or standard care in patients with COVID-19. We performed random-effects meta-regressions comparing the results of trials with and without allocation concealment and blinding of health-care providers and patients. We found that, compared with trials with allocation concealment, trials without allocation concealment may estimate treatments to be more beneficial for mortality, mechanical ventilation, hospital admission, duration of hospitalization, and duration of mechanical ventilation, but results were imprecise. We did not find compelling evidence that, compared with trials with blinding, trials without blinding produce consistently different results for mortality, mechanical ventilation, and duration of hospitalization. We found that trials without blinding may estimate treatments to be more beneficial for hospitalizations and duration of mechanical ventilation. We did not find compelling evidence that COVID-19 trials in which health-care providers and patients are blinded produce different results from trials without blinding, but trials without allocation concealment estimate treatments to be more beneficial compared with trials with allocation concealment. Our study suggests that lack of blinding may not always bias results but that evidence users should remain skeptical of trials without allocation concealment.
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Affiliation(s)
- Dena Zeraatkar
- Correspondence to Dena Zeraatkar, Department of Anesthesia, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada (e-mail )
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3
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Rehman N, Wu M, Garcia C, Leenus A, El-Kechen H, Bhandari M, Zakaryan G, Zani B, Hajizadeh A, Wang A, Morassut RE, Bartoszko JJ, Makanjuola O, Jhuti D, Arora V, Kapoor A, Jones A, Djiadeu P, Mbuagbaw L. Measures of Retention in HIV Care: A Study Within a Review. AIDS Patient Care STDS 2023; 37:192-198. [PMID: 36951646 DOI: 10.1089/apc.2022.0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
People living with HIV (PLHIV) need lifelong medical care. However, retention in HIV care is not measured uniformly, making it challenging to compare or pool data. The objective of this study within a review (SWAR) is to describe the assortment of definitions used for retention in HIV care in randomized controlled trials (RCTs). We conducted a SWAR, drawing data from an overview of systematic reviews on interventions to improve the HIV care cascade. Ethics review was not required for this analysis of secondary data. We identified RCTs of interventions used to improve retention in care for PLHIV, including all age groups and extracted the definitions used and their characteristics. We identified 50 trials that measured retention published between 2007 and 2021 and provided 59 definitions for retention in care. The definitions consisted of nine different characteristics with follow-up time (n = 47), and clinical visits (n = 36) most used. The definitions of retention in HIV care are highly heterogeneous. In this study, we present the pros and cons of characteristics used to measure retention in HIV care.
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Affiliation(s)
- Nadia Rehman
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Michael Wu
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Cristian Garcia
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Alvin Leenus
- Faculty of Law, University of Ottawa, Ottawa, Canada
| | - Hussein El-Kechen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Manika Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Gohar Zakaryan
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Babalwa Zani
- Public Health Research Unit, AB Consulting, Cape Town, South Africa
| | - Anisa Hajizadeh
- Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - Annie Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Rita E Morassut
- Department of Obstetrics and Gynaecology Western University, London, Canada
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Oluwatoni Makanjuola
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Diya Jhuti
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Vaibhav Arora
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Andrew Kapoor
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Aaron Jones
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Pascal Djiadeu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Department of Anesthesia, McMaster University, Hamilton, Canada
- Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
- Department of Pediatrics, McMaster University, Hamilton, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Canada
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Abstract
OBJECTIVES To quantify the prognostic effects of demographic and modifiable factors in streptococcal toxic shock syndrome (STSS). DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE and CINAHL from inception to 19 September 2022, along with citations of included studies. ELIGIBILITY CRITERIA Pairs of reviewers independently screened potentially eligible studies of patients with Group A Streptococcus-induced STSS that quantified the association between at least one prognostic factor and outcome of interest. DATA EXTRACTION AND SYNTHESIS We performed random-effects meta-analysis after duplicate data extraction and risk of bias assessments. We rated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. RESULTS One randomised trial and 40 observational studies were eligible (n=1918 patients). We found a statistically significant association between clindamycin treatment and mortality (n=144; OR 0.14, 95% CI 0.06 to 0.37), but the certainty of evidence was low. Within clindamycin-treated STSS patients, we found a statistically significant association between intravenous Ig treatment and mortality (n=188; OR 0.34, 95% CI 0.15 to 0.75), but the certainty of evidence was also low. The odds of mortality may increase in patients ≥65 years when compared with patients 18-64 years (n=396; OR 2.37, 95% CI 1.47 to 3.84), but the certainty of evidence was low. We are uncertain whether non-steroidal anti-inflammatory drugs increase the odds of mortality (n=50; OR 4.14, 95% CI 1.13 to 15.14; very low certainty). Results failed to show a significant association between any other prognostic factor and outcome combination (very low to low certainty evidence) and no studies quantified the association between a prognostic factor and morbidity post-infection in STSS survivors. CONCLUSIONS Treatment with clindamycin and within clindamycin-treated patients, IVIG, was each significantly associated with mortality, but the certainty of evidence was low. Future research should focus on morbidity post-infection in STSS survivors. PROSPERO REGISTRATION NUMBER CRD42020166961.
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Affiliation(s)
- Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Zeyad Elias
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paulina Rudziak
- Department of Biology, Western University, London, Ontario, Canada
| | - Carson K L Lo
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Departments of Anesthesia and Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
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5
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Bartoszko JJ, Mitchell R, Katz K, Mulvey M, Mataseje L. Characterization of Extensively Drug-Resistant (XDR) Carbapenemase-Producing Enterobacterales (CPE) in Canada from 2019 to 2020. Microbiol Spectr 2022; 10:e0097522. [PMID: 35950772 PMCID: PMC9430190 DOI: 10.1128/spectrum.00975-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022] Open
Abstract
Data regarding the epidemiology of extensively drug-resistant (XDR) carbapenemase-producing Enterobacterales (CPE) in Canada are scarce. Among CPE patients identified by the Canadian Nosocomial Infection Surveillance Program, the following were each significantly associated with XDR status: international travel history; CPE acquisition from a health care exposure abroad; presence of the New Delhi metallo-β-lactamase (NDM) carbapenemase gene; E. coli sequence type (ST) 167, ST405, and ST648; E. cloaceae ST177; C. freundii ST22; and resistance to all antimicrobials except colistin, tigecycline, and ceftazidime-avibactam. IMPORTANCE Extensively drug-resistant (XDR) carbapenemase-producing Enterobacterales (CPE) are a global public health concern. XDR CPE are among the most drug-resistant and difficult-to-treat bacteria, and infected patients are likely to experience adverse outcomes. Because XDR status further reduces effective therapeutic options, it is critical for clinicians to consider resistance and therapeutic options not only in the context of a patient with CPE but also in the context of potential XDR status. Our study reports on patient characteristics associated with the acquisition of an XDR CPE. Our study also reports on the species and carbapenemases associated with XDR status among Enterobacterales identified in Canada. Among a panel of 22 antibiotics, including novel combination drugs, we showed which retained the highest activity against XDR CPE, which may help guide the selection of antibiotic treatments.
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Affiliation(s)
- Jessica J. Bartoszko
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Robyn Mitchell
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Kevin Katz
- Department of Infection Prevention and Control, North York General Hospital, Toronto, Ontario, Canada
| | - Michael Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Laura Mataseje
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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6
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Jimenez-Mora MA, Varela AR, Meneses-Echavez JF, Bidonde J, Angarita-Fonseca A, Siemieniuk RAC, Zeraatkar D, Bartoszko JJ, Brignardello-Petersen R, Honarmand K, Rochwerg B, Guyatt G, Yepes-Nuñez JJ. Patient-important outcomes reported in randomized controlled trials of pharmacologic treatments for COVID-19: a protocol of a META-epidemiological study. Syst Rev 2021; 10:289. [PMID: 34724980 PMCID: PMC8559914 DOI: 10.1186/s13643-021-01838-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 10/13/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The coronavirus disease 19 (covid-19) pandemic has underscored the need to expedite clinical research, which may lead investigators to shift away from measuring patient-important outcomes (PIO), limiting research applicability. We aim to investigate if randomized controlled trials (RCTs) of covid-19 pharmacological therapies include PIOs. METHODS We will perform a meta-epidemiological study of RCTs that included people at risk for, or with suspected, probable, or confirmed covid-19, examining any pharmacological treatment or blood product aimed at prophylaxis or treatment. We will obtain data from all RCTs identified in a living network metanalysis (NMA). The main data sources are the living WHO covid-19 database up to 1 March 2021 and six additional Chinese databases up to 20 February 2021. Two reviewers independently will review each citation, full-text article, and abstract data. To categorize the outcomes according to their importance to patients, we will adapt a previously defined hierarchy: a) mortality, b) quality of life/ functional status/symptoms, c) morbidity, and d) surrogate outcomes. Outcomes within the category a) and b) will be considered critically important to patients, and outcomes within the category c) will be regarded as important. We will use descriptive statistics to assess the proportion of studies that report each category of outcomes. We will perform univariable and multivariable analysis to explore associations between trial characteristics and the likelihood of reporting PIOs. DISCUSSION The findings from this meta-epidemiological study will help health care professionals and researchers understand if the current covid-19 trials are effectively assessing and reporting the outcomes that are important to patients. If a deficiency in capturing PIOs is identified, this information may help inform the development of future RCTs in covid-19. SYSTEMATIC REVIEW REGISTRATIONS Open Science Framework registration: osf.io/6xgjz .
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Affiliation(s)
| | | | | | - Julia Bidonde
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- School of Rehabilitation Science, Univ of Saskatchewan, Saskatoon, SK Canada
| | - Adriana Angarita-Fonseca
- Université de Montréal, Montréal, Quebec, Canada
- Universidad de Santander, Bucaramanga, Santander Colombia
| | - Reed A. C. Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Jessica J. Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | | | - Kimia Honarmand
- Division of Critical Care, Department of Medicine, Western University, London, ON Canada
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
- Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Juan José Yepes-Nuñez
- School of Medicine, Universidad de los Andes, Bogotá, 111711 Colombia
- Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
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7
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Siemieniuk RA, Bartoszko JJ, Díaz Martinez JP, Kum E, Qasim A, Zeraatkar D, Izcovich A, Mangala S, Ge L, Han MA, Agoritsas T, Arnold D, Ávila C, Chu DK, Couban R, Cusano E, Darzi AJ, Devji T, Foroutan F, Ghadimi M, Khamis A, Lamontagne F, Loeb M, Miroshnychenko A, Motaghi S, Murthy S, Mustafa RA, Rada G, Rochwerg B, Switzer C, Vandvik PO, Vernooij RW, Wang Y, Yao L, Guyatt GH, Brignardello-Petersen R. Antibody and cellular therapies for treatment of covid-19: a living systematic review and network meta-analysis. BMJ 2021; 374:n2231. [PMID: 34556486 PMCID: PMC8459162 DOI: 10.1136/bmj.n2231] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of antiviral antibody therapies and blood products for the treatment of novel coronavirus disease 2019 (covid-19). DESIGN Living systematic review and network meta-analysis, with pairwise meta-analysis for outcomes with insufficient data. DATA SOURCES WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, and six Chinese databases (up to 21 July 2021). STUDY SELECTION Trials randomising people with suspected, probable, or confirmed covid-19 to antiviral antibody therapies, blood products, or standard care or placebo. Paired reviewers determined eligibility of trials independently and in duplicate. METHODS After duplicate data abstraction, we performed random effects bayesian meta-analysis, including network meta-analysis for outcomes with sufficient data. We assessed risk of bias using a modification of the Cochrane risk of bias 2.0 tool. The certainty of the evidence was assessed using the grading of recommendations assessment, development, and evaluation (GRADE) approach. We meta-analysed interventions with ≥100 patients randomised or ≥20 events per treatment arm. RESULTS As of 21 July 2021, we identified 47 trials evaluating convalescent plasma (21 trials), intravenous immunoglobulin (IVIg) (5 trials), umbilical cord mesenchymal stem cells (5 trials), bamlanivimab (4 trials), casirivimab-imdevimab (4 trials), bamlanivimab-etesevimab (2 trials), control plasma (2 trials), peripheral blood non-haematopoietic enriched stem cells (2 trials), sotrovimab (1 trial), anti-SARS-CoV-2 IVIg (1 trial), therapeutic plasma exchange (1 trial), XAV-19 polyclonal antibody (1 trial), CT-P59 monoclonal antibody (1 trial) and INM005 polyclonal antibody (1 trial) for the treatment of covid-19. Patients with non-severe disease randomised to antiviral monoclonal antibodies had lower risk of hospitalisation than those who received placebo: casirivimab-imdevimab (odds ratio (OR) 0.29 (95% CI 0.17 to 0.47); risk difference (RD) -4.2%; moderate certainty), bamlanivimab (OR 0.24 (0.06 to 0.86); RD -4.1%; low certainty), bamlanivimab-etesevimab (OR 0.31 (0.11 to 0.81); RD -3.8%; low certainty), and sotrovimab (OR 0.17 (0.04 to 0.57); RD -4.8%; low certainty). They did not have an important impact on any other outcome. There was no notable difference between monoclonal antibodies. No other intervention had any meaningful effect on any outcome in patients with non-severe covid-19. No intervention, including antiviral antibodies, had an important impact on any outcome in patients with severe or critical covid-19, except casirivimab-imdevimab, which may reduce mortality in patients who are seronegative. CONCLUSION In patients with non-severe covid-19, casirivimab-imdevimab probably reduces hospitalisation; bamlanivimab-etesevimab, bamlanivimab, and sotrovimab may reduce hospitalisation. Convalescent plasma, IVIg, and other antibody and cellular interventions may not confer any meaningful benefit. SYSTEMATIC REVIEW REGISTRATION This review was not registered. The protocol established a priori is included as a data supplement. FUNDING This study was supported by the Canadian Institutes of Health Research (grant CIHR- IRSC:0579001321). READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Interim updates and additional study data will be posted on our website (www.covid19lnma.com).
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Affiliation(s)
- Reed Ac Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Joint first authors
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Juan Pablo Díaz Martinez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Elena Kum
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Anila Qasim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Ariel Izcovich
- Servicio de Clinica Médica del Hospital Alemán, Buenos Aires, Argentina
| | - Sophia Mangala
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Long Ge
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Donald Arnold
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Ellen Cusano
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea J Darzi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Tahira Devji
- Medical school, University of Toronto, Toronto, ON, Canada
| | - Farid Foroutan
- Ted Rogers Center for Heart Research, University Health Network, Toronto, ON, Canada
| | - Maryam Ghadimi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Assem Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Francois Lamontagne
- Department of Medicine and Centre de recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Sharhzad Motaghi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | | | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Charlotte Switzer
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Per O Vandvik
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Robin Wm Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ying Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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8
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Bartoszko JJ, Siemieniuk RAC, Kum E, Qasim A, Zeraatkar D, Martinez JPD, Azab M, Ibrahim S, Izcovich A, Soto GB, Roldan Y, Agarwal A, Agoritsas T, Chu DK, Couban R, Devji T, Foroutan F, Ghadimi M, Honarmand K, Khamis A, Lamontagne F, Loeb M, McLeod SL, Motaghi S, Murthy S, Mustafa RA, Rochwerg B, Switzer C, Thabane L, Vandvik PO, Vernooij RWM, Wang Y, Yao L, Guyatt GH, Brignardello-Petersen R. Prophylaxis against covid-19: living systematic review and network meta-analysis. BMJ 2021; 373:n949. [PMID: 33903131 PMCID: PMC8073806 DOI: 10.1136/bmj.n949] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UPDATES This is the second version (first update) of the living systematic review, replacing the previous version (available as a data supplement). When citing this paper please consider adding the version number and date of access for clarity. OBJECTIVE To determine and compare the effects of drug prophylaxis on severe acute respiratory syndrome coronavirus virus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (covid-19). DESIGN Living systematic review and network meta-analysis (NMA). DATA SOURCES World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature to 4 March 2022. STUDY SELECTION Randomised trials in which people at risk of covid-19 were allocated to prophylaxis or no prophylaxis (standard care or placebo). Pairs of reviewers independently screened potentially eligible articles. METHODS After duplicate data abstraction, we conducted random-effects bayesian network meta-analysis. We assessed risk of bias of the included studies using a modification of the Cochrane risk of bias 2.0 tool and assessed the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach. RESULTS The second iteration of this living NMA includes 32 randomised trials which enrolled 25 147 participants and addressed 21 different prophylactic drugs; adding 21 trials (66%), 18 162 participants (75%) and 16 (76%) prophylactic drugs. Of the 16 prophylactic drugs analysed, none provided convincing evidence of a reduction in the risk of laboratory confirmed SARS-CoV-2 infection. For admission to hospital and mortality outcomes, no prophylactic drug proved different than standard care or placebo. Hydroxychloroquine and vitamin C combined with zinc probably increase the risk of adverse effects leading to drug discontinuation—risk difference for hydroxychloroquine (RD) 6 more per 1000 (95% credible interval (CrI) 2 more to 10 more); for vitamin C combined with zinc, RD 69 more per 1000 (47 more to 90 more), moderate certainty evidence. CONCLUSIONS Much of the evidence remains very low certainty and we therefore anticipate future studies evaluating drugs for prophylaxis may change the results for SARS-CoV-2 infection, admission to hospital and mortality outcomes. Both hydroxychloroquine and vitamin C combined with zinc probably increase adverse effects. SYSTEMATIC REVIEW REGISTRATION This review was not registered. The protocol established a priori is included as a supplement. FUNDING This study was supported by the Canadian Institutes of Health Research (grant CIHR-IRSC:0579001321).
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Affiliation(s)
- Jessica J Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Reed AC Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Elena Kum
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Anila Qasim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Juan Pablo Diaz Martinez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Maria Azab
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Sara Ibrahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Ariel Izcovich
- Servicio de Clinica Médica del Hospital Alemán, Buenos Aires, Argentina
| | - Gonzalo Bravo Soto
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Yetiani Roldan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Tahira Devji
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Maryam Ghadimi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Kimia Honarmand
- Department of Medicine, Western University, London, ON, Canada
| | - Assem Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Francois Lamontagne
- Department of Medicine and Centre de recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sharhzad Motaghi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Charlotte Switzer
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Per O Vandvik
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Robin WM Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ying Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
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9
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Volling C, Ahangari N, Bartoszko JJ, Coleman BL, Garcia-Jeldes F, Jamal AJ, Johnstone J, Kandel C, Kohler P, Maltezou HC, Maze Dit Mieusement L, McKenzie N, Mertz D, Monod A, Saeed S, Shea B, Stuart RL, Thomas S, Uleryk E, McGeer A. Are Sink Drainage Systems a Reservoir for Hospital-Acquired Gammaproteobacteria Colonization and Infection? A Systematic Review. Open Forum Infect Dis 2020; 8:ofaa590. [PMID: 33553469 PMCID: PMC7856333 DOI: 10.1093/ofid/ofaa590] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/04/2020] [Indexed: 01/23/2023] Open
Abstract
Increasing rates of antimicrobial-resistant organisms have focused attention on sink drainage systems as reservoirs for hospital-acquired Gammaproteobacteria colonization and infection. We aimed to assess the quality of evidence for transmission from this reservoir. We searched 8 databases and identified 52 studies implicating sink drainage systems in acute care hospitals as a reservoir for Gammaproteobacterial colonization/infection. We used a causality tool to summarize the quality of evidence. Included studies provided evidence of co-occurrence of contaminated sink drainage systems and colonization/infection, temporal sequencing compatible with sink drainage reservoirs, some steps in potential causal pathways, and relatedness between bacteria from sink drainage systems and patients. Some studies provided convincing evidence of reduced risk of organism acquisition following interventions. No single study provided convincing evidence across all causality domains, and the attributable fraction of infections related to sink drainage systems remains unknown. These results may help to guide conduct and reporting in future studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Adam Monod
- Sinai Health System, Toronto, Ontario, Canada
| | | | | | | | - Sera Thomas
- Sinai Health System, Toronto, Ontario, Canada
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10
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Agarwal A, Hunt B, Stegemann M, Rochwerg B, Lamontagne F, Siemieniuk RA, Agoritsas T, Askie L, Lytvyn L, Leo YS, Macdonald H, Zeng L, Alhadyan A, Muna AM, Amin W, da Silva ARA, Aryal D, Barragan FAJ, Bausch FJ, Burhan E, Calfee CS, Cecconi M, Chacko B, Chanda D, Dat VQ, De Sutter A, Du B, Freedman S, Geduld H, Gee P, Haider M, Gotte M, Harley N, Hashimi M, Hui D, Ismail M, Jehan F, Kabra SK, Kanda S, Kim YJ, Kissoon N, Krishna S, Kuppalli K, Kwizera A, Lado Castro-Rial M, Lisboa T, Lodha R, Mahaka I, Manai H, Mendelson M, Migliori GB, Mino G, Nsutebu E, Peter J, Preller J, Pshenichnaya N, Qadir N, Ranganathan SS, Relan P, Rylance J, Sabzwari S, Sarin R, Shankar-Hari M, Sharland M, Shen Y, Souza JP, Swanstrom R, Tshokey T, Ugarte S, Uyeki T, Evangelina VC, Venkatapuram S, Vuyiseka D, Wijewickrama A, Tran L, Zeraatkar D, Bartoszko JJ, Ge L, Brignardello-Petersen R, Owen A, Guyatt G, Diaz J, Kawano-Dourado L, Jacobs M, Vandvik PO. A living WHO guideline on drugs for covid-19. BMJ 2020; 370:m3379. [PMID: 32887691 DOI: 10.1136/bmj.m3379] [Citation(s) in RCA: 475] [Impact Index Per Article: 118.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Updates This is the fourteenth version (thirteenth update) of the living guideline, replacing earlier versions (available as data supplements). New recommendations will be published as updates to this guideline. Clinical question What is the role of drugs in the treatment of patients with covid-19? Context The evidence base for therapeutics for covid-19 is evolving with numerous randomised controlled trials (RCTs) recently completed and underway. Emerging SARS-CoV-2 variants and subvariants are changing the role of therapeutics. What is new? The guideline development group (GDG) defined 1.5% as a new threshold for an important reduction in risk of hospitalisation in patients with non-severe covid-19. Combined with updated baseline risk estimates, this resulted in stratification into patients at low, moderate, and high risk for hospitalisation. New recommendations were added for moderate risk of hospitalisation for nirmatrelvir/ritonavir, and for moderate and low risk of hospitalisation for molnupiravir and remdesivir. New pharmacokinetic evidence was included for nirmatrelvir/ritonavir and molnupiravir, supporting existing recommendations for patients at high risk of hospitalisation. The recommendation for ivermectin in patients with non-severe illness was updated in light of additional trial evidence which reduced the high degree of uncertainty informing previous guidance. A new recommendation was made against the antiviral agent VV116 for patients with non-severe and with severe or critical illness outside of randomised clinical trials based on one RCT comparing the drug with nirmatrelvir/ritonavir. The structure of the guideline publication has also been changed; recommendations are now ordered by severity of covid-19. About this guideline This living guideline from the World Health Organization (WHO) incorporates new evidence to dynamically update recommendations for covid-19 therapeutics. The GDG typically evaluates a therapy when the WHO judges sufficient evidence is available to make a recommendation. While the GDG takes an individual patient perspective in making recommendations, it also considers resource implications, acceptability, feasibility, equity, and human rights. This guideline was developed according to standards and methods for trustworthy guidelines, making use of an innovative process to achieve efficiency in dynamic updating of recommendations. The methods are aligned with the WHO Handbook for Guideline Development and according to a pre-approved protocol (planning proposal) by the Guideline Review Committee (GRC). A box at the end of the article outlines key methodological aspects of the guideline process. MAGIC Evidence Ecosystem Foundation provides methodological support, including the coordination of living systematic reviews with network meta-analyses to inform the recommendations. The full version of the guideline is available online in MAGICapp and in PDF on the WHO website, with a summary version here in The BMJ. These formats should facilitate adaptation, which is strongly encouraged by WHO to contextualise recommendations in a healthcare system to maximise impact. Future recommendations Recommendations on anticoagulation are planned for the next update to this guideline. Updated data regarding systemic corticosteroids, azithromycin, favipiravir and umefenovir for non-severe illness, and convalescent plasma and statin therapy for severe or critical illness, are planned for review in upcoming guideline iterations.
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Affiliation(s)
- Arnav Agarwal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Beverly Hunt
- St Thomas’ Hospital, London, UK
- ivermectin and IL-6 receptor blocker panel member
| | - Miriam Stegemann
- Charité - Universitätsmedizin Berlin, Germany
- ivermectin and IL-6 receptor blocker panel member
| | - Bram Rochwerg
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - François Lamontagne
- Université de Sherbrooke, Centre de recherche due CHU de Sherbrooke, Quebec, Canada
- Not panel member; resource for methodology, systematic review, and content support
- Corticosteroid panel member
| | - Reed Ac Siemieniuk
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Not panel member; resource for methodology, systematic review, and content support
- Corticosteroid panel member
| | - Lisa Askie
- World Health Organization, Geneva, Switzerland
| | - Lyubov Lytvyn
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Yee-Sin Leo
- National Center for Infectious Diseases, Singapore
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Helen Macdonald
- The BMJ, London, UK
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy
- Not panel member; resource for methodology, systematic review, and content support
| | - Linan Zeng
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | | | | | - Wagdy Amin
- Ministry of Health and Population, Cairo, Egypt
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | | | - Frederique Jacquerioz Bausch
- Geneva University Hospital, Switzerland
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Erlina Burhan
- Infection Division, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine Universitas Indonesia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Carolyn S Calfee
- University of California, San Francisco, USA
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano (MI), Italy
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
| | | | - Duncan Chanda
- Adult Infectious Disease Centre, University Teaching Hospital, Lusaka, Zambia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - An De Sutter
- University of Gent, Belgium
- ivermectin and IL-6 receptor blocker panel member
| | - Bin Du
- Peking Union Medical College Hospital, Beijing, China
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Stephen Freedman
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Canada
| | - Heike Geduld
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Patrick Gee
- USA
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Nerina Harley
- Royal Melbourne Hospital and Epworth Healthcare, Melbourne, Australia
- ivermectin and IL-6 receptor blocker panel member
| | - Madiha Hashimi
- Ziauddin University, Karachi, Pakistan
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - David Hui
- Stanley Ho Centre for Emerging Infectious Diseases, Chinese University of Hong Kong, China
| | | | | | - Sushil K Kabra
- All India Institute of Medical Sciences, New Delhi, India
- Department of Anaesthesia and Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Seema Kanda
- McMaster University (alumnus)
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Yae-Jean Kim
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Niranjan Kissoon
- Department of Paediatrics and Emergency Medicine, University of British Columbia, Vancouver, Canada
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Arthur Kwizera
- Department of Anaesthesia and Critical Care, College of Health Sciences, Makerere University, Kampala, Uganda
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Rakesh Lodha
- All India Institute of Medical Sciences, New Delhi, India
| | - Imelda Mahaka
- Zimbabwe
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Hela Manai
- Emergency Medical Services, Faculty of Medicine, Tunis, Tunisia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Marc Mendelson
- Groote Schuur Hospital, University of Cape Town, South Africa
| | | | - Greta Mino
- Alcivar Hospital in Guayaquil, Ecuador
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Emmanuel Nsutebu
- Sheikh Shakhbout Medical City, Abu Dhabi
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Natalia Pshenichnaya
- Central Research Institute of Epidemiology of Rospotrebnadzor, Moscow, Russia
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Nida Qadir
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Shalini Sri Ranganathan
- University of Colombo, Sri Lanka
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Saniya Sabzwari
- Aga Khan University, Karachi, Pakistan
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Rohit Sarin
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Manu Shankar-Hari
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- ivermectin and IL-6 receptor blocker panel member
| | - Michael Sharland
- St. George’s University Hospital, UK
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Yinzhong Shen
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Joao P Souza
- University of Sao Paulo, Brazil
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | | | | | - Sebastian Ugarte
- Faculty of Medicine Andres Bello University, Indisa Clinic, Santiago, Chile)
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Timothy Uyeki
- Influenza Division, U.S. Centers for Disease Control and Prevention, United States
| | | | - Sridhar Venkatapuram
- King’s College, London, UK
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Dubula Vuyiseka
- University of Stellenbosch, South Africa
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Ananda Wijewickrama
- Ministry of Health, Sri Lanka
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Lien Tran
- Infectious Diseases Data Observatory (IDDO), Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Long Ge
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- The BMJ, London, UK
- Not panel member; resource for methodology, systematic review, and content support
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Andrew Owen
- Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, England
- Not panel member; resource for methodology, systematic review, and content support
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Not panel member; resource for methodology, systematic review, and content support
| | - Janet Diaz
- World Health Organization, Geneva, Switzerland
- Not panel member; resource for methodology, systematic review, and content support
- co-senior author
| | - Leticia Kawano-Dourado
- Pulmonary Division, Heart Institute (InCor)- HCFMUSP, Medical School, University of Sao Paulo, São Paulo, Brazil and Research Institute, Hospital do Coração (HCor), São Paulo, Brazil
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- Corticosteroid panel member
- ivermectin and IL-6 receptor blocker panel member
| | - Michael Jacobs
- Royal Free London NHS Foundation Trust
- Remdesivir, hydroxychloroquine, and lopinavir-ritonavir panel member
- ivermectin and IL-6 receptor blocker panel member
- co-senior author
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Health Economics and Health Management, Institute for Health and Society, University of Oslo, Oslo, Norway
- Not panel member; resource for methodology, systematic review, and content support
- co-senior author
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11
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Siemieniuk RA, Bartoszko JJ, Zeraatkar D, Kum E, Qasim A, Martinez JPD, Izcovich A, Lamontagne F, Han MA, Agarwal A, Agoritsas T, Azab M, Bravo G, Chu DK, Couban R, Devji T, Escamilla Z, Foroutan F, Gao Y, Ge L, Ghadimi M, Heels-Ansdell D, Honarmand K, Hou L, Ibrahim Q, Khamis A, Lam B, Mansilla C, Loeb M, Miroshnychenko A, Marcucci M, McLeod SL, Motaghi S, Murthy S, Mustafa RA, Pardo-Hernandez H, Rada G, Rizwan Y, Saadat P, Switzer C, Thabane L, Tomlinson G, Vandvik PO, Vernooij RW, Viteri-García A, Wang Y, Yao L, Zhao Y, Guyatt GH, Brignardello-Petersen R. Drug treatments for covid-19: living systematic review and network meta-analysis. BMJ 2020; 370:m2980. [PMID: 32732190 PMCID: PMC7390912 DOI: 10.1136/bmj.m2980] [Citation(s) in RCA: 484] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare the effects of treatments for coronavirus disease 2019 (covid-19). DESIGN Living systematic review and network meta-analysis. DATA SOURCES WHO covid-19 database, a comprehensive multilingual source of global covid-19 literature, up to 3 December 2021 and six additional Chinese databases up to 20 February 2021. Studies identified as of 1 December 2021 were included in the analysis. STUDY SELECTION Randomised clinical trials in which people with suspected, probable, or confirmed covid-19 were randomised to drug treatment or to standard care or placebo. Pairs of reviewers independently screened potentially eligible articles. METHODS After duplicate data abstraction, a bayesian network meta-analysis was conducted. Risk of bias of the included studies was assessed using a modification of the Cochrane risk of bias 2.0 tool, and the certainty of the evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. For each outcome, interventions were classified in groups from the most to the least beneficial or harmful following GRADE guidance. RESULTS 463 trials enrolling 166 581 patients were included; 267 (57.7%) trials and 89 814 (53.9%) patients are new from the previous iteration; 265 (57.2%) trials evaluating treatments with at least 100 patients or 20 events met the threshold for inclusion in the analyses. Compared with standard care, three drugs reduced mortality in patients with mostly severe disease with at least moderate certainty: systemic corticosteroids (risk difference 23 fewer per 1000 patients, 95% credible interval 40 fewer to 7 fewer, moderate certainty), interleukin-6 receptor antagonists when given with corticosteroids (23 fewer per 1000, 36 fewer to 7 fewer, moderate certainty), and Janus kinase inhibitors (44 fewer per 1000, 64 fewer to 20 fewer, high certainty). Compared with standard care, two drugs probably reduce hospital admission in patients with non-severe disease: nirmatrelvir/ritonavir (36 fewer per 1000, 41 fewer to 26 fewer, moderate certainty) and molnupiravir (19 fewer per 1000, 29 fewer to 5 fewer, moderate certainty). Remdesivir may reduce hospital admission (29 fewer per 1000, 40 fewer to 6 fewer, low certainty). Only molnupiravir had at least moderate quality evidence of a reduction in time to symptom resolution (3.3 days fewer, 4.8 fewer to 1.6 fewer, moderate certainty); several others showed a possible benefit. Several drugs may increase the risk of adverse effects leading to drug discontinuation; hydroxychloroquine probably increases the risk of mechanical ventilation (moderate certainty). CONCLUSION Corticosteroids, interleukin-6 receptor antagonists, and Janus kinase inhibitors probably reduce mortality and confer other important benefits in patients with severe covid-19. Molnupiravir and nirmatrelvir/ritonavir probably reduce admission to hospital in patients with non-severe covid-19. SYSTEMATIC REVIEW REGISTRATION This review was not registered. The protocol is publicly available in the supplementary material. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This is the fifth version of the original article published on 30 July 2020 (BMJ 2020;370:m2980), and previous versions can be found as data supplements. When citing this paper please consider adding the version number and date of access for clarity.
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Affiliation(s)
- Reed Ac Siemieniuk
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Dena Zeraatkar
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Joint first authors
| | - Elena Kum
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Anila Qasim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Juan Pablo Díaz Martinez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Ariel Izcovich
- Servicio de Clinica Médica del Hospital Alemán, Buenos Aires, Argentina
| | - Francois Lamontagne
- Department of Medicine and Centre de recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Arnav Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Maria Azab
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Gonzalo Bravo
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Derek K Chu
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Rachel Couban
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Tahira Devji
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Zaira Escamilla
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Farid Foroutan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Ted Rogers Center for Heart Research, Toronto General Hospital, ON, Canada
| | - Ya Gao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Long Ge
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
- Joint first authors
| | - Maryam Ghadimi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Diane Heels-Ansdell
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Kimia Honarmand
- Department of Medicine, Western University, London, ON, Canada
| | - Liangying Hou
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Quazi Ibrahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Assem Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK
| | - Bonnie Lam
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Christian Mansilla
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anna Miroshnychenko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sharhzad Motaghi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Srinivas Murthy
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Reem A Mustafa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Hector Pardo-Hernandez
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gabriel Rada
- Epistemonikos Foundation, Santiago, Chile
- UC Evidence Center, Cochrane Chile Associated Center, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yamna Rizwan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Pakeezah Saadat
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Charlotte Switzer
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | | | - Robin Wm Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Andrés Viteri-García
- Epistemonikos Foundation, Santiago, Chile
- Centro de Investigación de Salud Pública y Epidemiología Clínica (CISPEC), Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | - Ying Wang
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Yunli Zhao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada
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Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses 2020; 14:365-373. [PMID: 32246890 PMCID: PMC7298295 DOI: 10.1111/irv.12745] [Citation(s) in RCA: 297] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Respiratory protective devices are critical in protecting against infection in healthcare workers at high risk of novel 2019 coronavirus disease (COVID-19); however, recommendations are conflicting and epidemiological data on their relative effectiveness against COVID-19 are limited. PURPOSE To compare medical masks to N95 respirators in preventing laboratory-confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers. DATA SOURCES MEDLINE, Embase, and CENTRAL from January 1, 2014, to March 9, 2020. Update of published search conducted from January 1, 1990, to December 9, 2014. STUDY SELECTION Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers. DATA EXTRACTION Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence. DATA SYNTHESIS Four RCTs were meta-analyzed adjusting for clustering. Compared with N95 respirators; the use of medical masks did not increase laboratory-confirmed viral (including coronaviruses) respiratory infection (OR 1.06; 95% CI 0.90-1.25; I2 = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98-2.28; I2 = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49). LIMITATIONS Indirectness and imprecision of available evidence. CONCLUSIONS Low certainty evidence suggests that medical masks and N95 respirators offer similar protection against viral respiratory infection including coronavirus in healthcare workers during non-aerosol-generating care. Preservation of N95 respirators for high-risk, aerosol-generating procedures in this pandemic should be considered when in short supply.
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Affiliation(s)
- Jessica J. Bartoszko
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonONCanada
| | | | - Waleed Alhazzani
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonONCanada
- Department of MedicineDivision of Critical CareMcMaster UniversityHamiltonONCanada
| | - Mark Loeb
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonONCanada
- Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonONCanada
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13
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Bartoszko JJ, Farooqi MAM, Alhazzani W, Loeb M. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses 2020. [PMID: 32246890 DOI: 10.1111/irv.v14.410.1111/irv.12745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Respiratory protective devices are critical in protecting against infection in healthcare workers at high risk of novel 2019 coronavirus disease (COVID-19); however, recommendations are conflicting and epidemiological data on their relative effectiveness against COVID-19 are limited. PURPOSE To compare medical masks to N95 respirators in preventing laboratory-confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers. DATA SOURCES MEDLINE, Embase, and CENTRAL from January 1, 2014, to March 9, 2020. Update of published search conducted from January 1, 1990, to December 9, 2014. STUDY SELECTION Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers. DATA EXTRACTION Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence. DATA SYNTHESIS Four RCTs were meta-analyzed adjusting for clustering. Compared with N95 respirators; the use of medical masks did not increase laboratory-confirmed viral (including coronaviruses) respiratory infection (OR 1.06; 95% CI 0.90-1.25; I2 = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98-2.28; I2 = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49). LIMITATIONS Indirectness and imprecision of available evidence. CONCLUSIONS Low certainty evidence suggests that medical masks and N95 respirators offer similar protection against viral respiratory infection including coronavirus in healthcare workers during non-aerosol-generating care. Preservation of N95 respirators for high-risk, aerosol-generating procedures in this pandemic should be considered when in short supply.
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Affiliation(s)
- Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Waleed Alhazzani
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
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14
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Han MA, Storman D, Al-Rammahy H, Tang S, Hao Q, Leung G, Kandi M, Moradi R, Bartoszko JJ, Arnold C, Rehman N, Guyatt G. Impact of maternal reproductive factors on cancer risks of offspring: A systematic review and meta-analysis of cohort studies. PLoS One 2020; 15:e0230721. [PMID: 32226046 PMCID: PMC7105118 DOI: 10.1371/journal.pone.0230721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/06/2020] [Indexed: 02/05/2023] Open
Abstract
Background A number of studies have reported on associations between reproductive factors, such as delivery methods, number of birth and breastfeeding, and incidence of cancer in children, but systematic reviews addressing this issue to date have important limitations, and no reviews have addressed the impact of reproductive factors on cancer over the full life course of offspring. Methods We performed a comprehensive search in MEDLINE, and Embase up to January 2020 and Web of Science up to 2018 July, including cohort studies reporting the association between maternal reproductive factors of age at birth, birth order, number of births, delivery methods, and breastfeeding duration and cancer in children. Teams of two reviewers independently extracted data and assessed risk of bias. We conducted random effects meta-analyses to estimate summary relative estimates, calculated absolute differences between those with and without risk factors, and used the GRADE approach to evaluate the certainty of evidence. Results For most exposures and most cancers, we found no suggestion of a causal relation. We found low to very low certainty evidence of the following very small possible impact: higher maternal age at birth with adult multiple myeloma and lifetime uterine cervix cancer incidence; lower maternal age at birth with childhood overall cancer mortality (RR = 1.15, 95% CI = 1.01–1.30; AR/10,000 = 1, 95% CI = 0 to 2), adult leukemia and lifetime uterine cervix cancer incidence; higher birth order with adult melanoma, cervix uteri, corpus uteri, thyroid cancer incidence, lifetime lung, corpus uteri, prostate, testis, sarcoma, thyroid cancer incidence; larger number of birth with childhood brain (RR = 1.27, 95% CI = 1.06–1.52; AR/10,000 = 1, 95% CI = 0 to 2), leukemia (RR = 2.11, 95% CI = 1.62–2.75; AR/10,000 = 9, 95% CI = 5 to 14), lymphoma (RR = 4.66, 95% CI = 1.40–15.57; AR/10,000 = 11, 95% CI = 1 to 44) incidence, adult stomach, corpus uteri cancer incidence and lung cancer mortality, lifetime stomach, lung, uterine cervix, uterine corpus, multiple myeloma, testis cancer incidence; Caesarean delivery with childhood kidney cancer incidence (RR = 1.25, 95% CI = 1.01–1.55; AR/10,000 = 0, 95% CI = 0 to 1); and breastfeeding with adult colorectal cancer incidence. Conclusion Very small impacts existed between a number of reproductive factors and cancer incidence and mortality in children and the certainty of evidence was low to very low primarily due to observational design.
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Affiliation(s)
- Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
- * E-mail:
| | - Dawid Storman
- Department of Hygiene and Dietetics, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Husam Al-Rammahy
- Life Sciences—Department of Biomedical and Molecular Sciences, Queen's University at Kingston, Kingston, Canada
| | - Shaowen Tang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiukui Hao
- The center of Gerontology and Geriatrics, National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Gareth Leung
- Department of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Maryam Kandi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Romina Moradi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jessica J. Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Callum Arnold
- Division of Infectious Diseases, the Hospital for Sick Children, Toronto, Canada
| | - Nadia Rehman
- Department of Continuing Education, McMaster University, Hamilton, Canada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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15
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Zeraatkar D, Han MA, Guyatt GH, Vernooij RWM, El Dib R, Cheung K, Milio K, Zworth M, Bartoszko JJ, Valli C, Rabassa M, Lee Y, Zajac J, Prokop-Dorner A, Lo C, Bala MM, Alonso-Coello P, Hanna SE, Johnston BC. Red and Processed Meat Consumption and Risk for All-Cause Mortality and Cardiometabolic Outcomes: A Systematic Review and Meta-analysis of Cohort Studies. Ann Intern Med 2019; 171:703-710. [PMID: 31569213 DOI: 10.7326/m19-0655] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Dietary guidelines generally recommend limiting intake of red and processed meat. However, the quality of evidence implicating red and processed meat in adverse health outcomes remains unclear. PURPOSE To evaluate the association between red and processed meat consumption and all-cause mortality, cardiometabolic outcomes, quality of life, and satisfaction with diet among adults. DATA SOURCES EMBASE (Elsevier), Cochrane Central Register of Controlled Trials (Wiley), Web of Science (Clarivate Analytics), CINAHL (EBSCO), and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019, without language restrictions, as well as bibliographies of relevant articles. STUDY SELECTION Cohort studies with at least 1000 participants that reported an association between unprocessed red or processed meat intake and outcomes of interest. DATA EXTRACTION Teams of 2 reviewers independently extracted data and assessed risk of bias. One investigator assessed certainty of evidence, and the senior investigator confirmed the assessments. DATA SYNTHESIS Of 61 articles reporting on 55 cohorts with more than 4 million participants, none addressed quality of life or satisfaction with diet. Low-certainty evidence was found that a reduction in unprocessed red meat intake of 3 servings per week is associated with a very small reduction in risk for cardiovascular mortality, stroke, myocardial infarction (MI), and type 2 diabetes. Likewise, low-certainty evidence was found that a reduction in processed meat intake of 3 servings per week is associated with a very small decrease in risk for all-cause mortality, cardiovascular mortality, stroke, MI, and type 2 diabetes. LIMITATION Inadequate adjustment for known confounders, residual confounding due to observational design, and recall bias associated with dietary measurement. CONCLUSION The magnitude of association between red and processed meat consumption and all-cause mortality and adverse cardiometabolic outcomes is very small, and the evidence is of low certainty. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42017074074).
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Affiliation(s)
- Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Robin W M Vernooij
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands, and Dalhousie University, Halifax, Nova Scotia, Canada (R.W.V.)
| | - Regina El Dib
- Science and Technology Institute, Universidade Estadual Paulista, São Paulo, Brazil, and Dalhousie University, Halifax, Nova Scotia, Canada (R.E.)
| | - Kevin Cheung
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Kirolos Milio
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Max Zworth
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Jessica J Bartoszko
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Claudia Valli
- Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R.)
| | - Montserrat Rabassa
- Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain (C.V., M.R.)
| | - Yung Lee
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Joanna Zajac
- Jagiellonian University Medical College, Krakow, Poland (J.Z., A.P., M.M.B.)
| | - Anna Prokop-Dorner
- Jagiellonian University Medical College, Krakow, Poland (J.Z., A.P., M.M.B.)
| | - Calvin Lo
- University of British Columbia, Vancouver, British Columbia, Canada (C.L.)
| | - Malgorzata M Bala
- Jagiellonian University Medical College, Krakow, Poland (J.Z., A.P., M.M.B.)
| | - Pablo Alonso-Coello
- Biomedical Research Institute San Pau (IIB Sant Pau) and CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain (P.A.)
| | - Steven E Hanna
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., K.C., K.M., M.Z., J.J.B., Y.L., S.E.H.)
| | - Bradley C Johnston
- Dalhousie University, Halifax, Nova Scotia, Canada, and McMaster University, Hamilton, Ontario, Canada (B.C.J.)
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16
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Han MA, Zeraatkar D, Guyatt GH, Vernooij RWM, El Dib R, Zhang Y, Algarni A, Leung G, Storman D, Valli C, Rabassa M, Rehman N, Parvizian MK, Zworth M, Bartoszko JJ, Lopes LC, Sit D, Bala MM, Alonso-Coello P, Johnston BC. Reduction of Red and Processed Meat Intake and Cancer Mortality and Incidence: A Systematic Review and Meta-analysis of Cohort Studies. Ann Intern Med 2019; 171:711-720. [PMID: 31569214 DOI: 10.7326/m19-0699] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
UNLABELLED This article has been corrected. The original version (PDF) is appended to this article as a Supplement. BACKGROUND Cancer incidence has continuously increased over the past few centuries and represents a major health burden worldwide. PURPOSE To evaluate the possible causal relationship between intake of red and processed meat and cancer mortality and incidence. DATA SOURCES Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, and ProQuest from inception until July 2018 and MEDLINE from inception until April 2019 without language restrictions. STUDY SELECTION Cohort studies that included more than 1000 adults and reported the association between consumption of unprocessed red and processed meat and cancer mortality and incidence. DATA EXTRACTION Teams of 2 reviewers independently extracted data and assessed risk of bias; 1 reviewer evaluated the certainty of evidence, which was confirmed or revised by the senior reviewer. DATA SYNTHESIS Of 118 articles (56 cohorts) with more than 6 million participants, 73 articles were eligible for the dose-response meta-analyses, 30 addressed cancer mortality, and 80 reported cancer incidence. Low-certainty evidence suggested that an intake reduction of 3 servings of unprocessed meat per week was associated with a very small reduction in overall cancer mortality over a lifetime. Evidence of low to very low certainty suggested that each intake reduction of 3 servings of processed meat per week was associated with very small decreases in overall cancer mortality over a lifetime; prostate cancer mortality; and incidence of esophageal, colorectal, and breast cancer. LIMITATION Limited causal inferences due to residual confounding in observational studies, risk of bias due to limitations in diet assessment and adjustment for confounders, recall bias in dietary assessment, and insufficient data for planned subgroup analyses. CONCLUSION The possible absolute effects of red and processed meat consumption on cancer mortality and incidence are very small, and the certainty of evidence is low to very low. PRIMARY FUNDING SOURCE None. (PROSPERO: CRD42017074074).
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Affiliation(s)
- Mi Ah Han
- Chosun University, Gwangju, Republic of Korea (M.A.H.)
| | - Dena Zeraatkar
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Gordon H Guyatt
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Robin W M Vernooij
- Dalhousie University, Halifax, Nova Scotia, Canada, and Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands (R.W.V.)
| | - Regina El Dib
- Science and Technology Institute, Universidade Estadual Paulista, São José dos Campos, São Paulo, Brazil, and Dalhousie University, Halifax, Nova Scotia, Canada (R.E.)
| | - Ying Zhang
- Beijing University of Chinese Medicine, Beijing, China (Y.Z.)
| | | | - Gareth Leung
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Dawid Storman
- Jagiellonian University Medical College, Kraków, Poland (D.S.)
| | - Claudia Valli
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute Sant Pau, and CIBER de Epidemiología y Salud Pública, Barcelona, Spain (C.V., M.R.)
| | - Montserrat Rabassa
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute Sant Pau, and CIBER de Epidemiología y Salud Pública, Barcelona, Spain (C.V., M.R.)
| | - Nadia Rehman
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Michael K Parvizian
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Max Zworth
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | - Jessica J Bartoszko
- McMaster University, Hamilton, Ontario, Canada (D.Z., G.H.G., G.L., N.R., M.K.P., M.Z., J.J.B.)
| | | | - Daegan Sit
- University of British Columbia, Vancouver, British Columbia, Canada (D.S.)
| | | | - Pablo Alonso-Coello
- McMaster University, Hamilton, Ontario, Canada, and Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute Sant Pau, and CIBER de Epidemiología y Salud Pública, Barcelona, Spain (P.A.)
| | - Bradley C Johnston
- Dalhousie University, Halifax, Nova Scotia, and McMaster University, Hamilton, Ontario, Canada (B.C.J.)
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Zeraatkar D, Cheung K, Milio K, Zworth M, Gupta A, Bhasin A, Bartoszko JJ, Kiflen M, Morassut RE, Noor ST, Lawson DO, Johnston BC, Bangdiwala SI, de Souza RJ. Methods for the Selection of Covariates in Nutritional Epidemiology Studies: A Meta-Epidemiological Review. Curr Dev Nutr 2019; 3:nzz104. [PMID: 31598577 PMCID: PMC6778415 DOI: 10.1093/cdn/nzz104] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/05/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Observational studies provide important information about the effects of exposures that cannot be easily studied in clinical trials, such as nutritional exposures, but are subject to confounding. Investigators adjust for confounders by entering them as covariates in analytic models. OBJECTIVE The aim of this study was to evaluate the reporting and credibility of methods for selection of covariates in nutritional epidemiology studies. METHODS We sampled 150 nutritional epidemiology studies published in 2007/2008 and 2017/2018 from the top 5 high-impact nutrition and medical journals and extracted information on methods for selection of covariates. RESULTS Most studies did not report selecting covariates a priori (94.0%) or criteria for selection of covariates (63.3%). There was general inconsistency in choice of covariates, even among studies investigating similar questions. One-third of studies did not acknowledge potential for residual confounding in their discussion. CONCLUSION Studies often do not report methods for selection of covariates, follow available guidance for selection of covariates, nor discuss potential for residual confounding.
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Affiliation(s)
- Dena Zeraatkar
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Cheung
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kirolos Milio
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Max Zworth
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Arnav Gupta
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Arrti Bhasin
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jessica J Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michel Kiflen
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Rita E Morassut
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Salmi T Noor
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Daeria O Lawson
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Bradley C Johnston
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shrikant I Bangdiwala
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Russell J de Souza
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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18
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Bartoszko JJ, Mertz D, Thabane L, Loeb M. Antibiotic therapy for skin and soft tissue infections: a protocol for a systematic review and network meta-analysis. Syst Rev 2018; 7:138. [PMID: 30205844 PMCID: PMC6134765 DOI: 10.1186/s13643-018-0804-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 08/29/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Skin and soft tissue infections (SSTIs) in hospital and community settings impose a substantial socio-economic burden. Therapeutic uncertainty due to the availability of a wide range of antibiotics and the need for empirical treatment decisions complicate SSTI clinical management. Completion of numerous pairwise meta-analyses to account for this variability in antibiotics is impractical, and many head-to-head comparisons of potential interest are likely not available. In comparing multiple antibiotics simultaneously, this network meta-analysis aims to identify the antibiotic(s) with the greatest value in the treatment of SSTIs, in terms of patient-important outcomes such as efficacy and safety. METHODS We will conduct a systematic review to identify randomized controlled trials of persons with suspected or confirmed SSTI assigned to orally or parenterally administered antibiotic therapy that report results on at least one outcome of interest. We will search MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL), along with trial registries. Our primary outcome of interest is clinical success at the test-of-cure visit. Secondary outcomes may include (1) early clinical success (2-3 days after the therapy starts), (2) mortality, (3) adverse events, (4) treatment duration, and (5) length of hospital stay. Independent reviewers will complete screening of titles, abstracts, and full texts, data extraction, risk of bias assessment (using the Cochrane Risk of Bias tool), and evaluation of the certainty of evidence (using the GRADE approach) in duplicate. We will complete pairwise and network meta-analyses within the Bayesian framework when possible using a random effects model. We will stratify SSTIs by severity into uncomplicated and complicated SSTIs when possible. Subgroup analyses by age, infection type, comorbidity, and suspected or confirmed methicillin-resistant Staphylococcus aureus (MRSA)-associated infection are planned. DISCUSSION This study has several strengths compared to previous reviews: inclusion of a wider range of infection types, antibiotics, and outcomes; a comprehensive search strategy; a priori subgroup analyses; application of GRADE; and improved interpretability of findings through visual presentation of results. We hope our findings will inform future research, health care professionals, and policy makers resulting in improved evidence-based clinical management of SSTIs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018085607.
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Affiliation(s)
- Jessica J. Bartoszko
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5 Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5 Canada
- Department of Medicine, McMaster University, Hamilton, Ontario L8S 4K1 Canada
- Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario L8S 4L8 Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8N 3Z5 Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5 Canada
- Departments of Anesthesia and Pediatrics, McMaster University, Hamilton, Ontario L8S 4L8 Canada
- Biostatistics Unit, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario L8N 4A6 Canada
| | - Mark Loeb
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario L8N 3Z5 Canada
- Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario L8S 4L8 Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario L8N 3Z5 Canada
- Michael DeGroote Centre for Learning and Discovery (MDCL) - 3208, 1280 Main St W, Hamilton, Ontario L8S 4K1 Canada
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