Meta-analysis of Efficacy and Safety of Single or Dual Antiplatelet Therapy for Short-term Complications after Transcatheter Aortic Valve Implantation / 中国药房

OBJECTIVE： To systematically evaluate effectiveness and safety of single antiplatelet therapy （SAPT） versus dual antiplatelet therapy （DAPT） on short-term complications after transcatheter aortic valve implantation （TAVI）， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from PubMed， Cochrane clinical controlled trials registry， Web of Science， CNKI， Wanfang database， CBM and Chinese Clinical Trial Registry， RCTs and observational studies about effectiveness （all-cause mortality， incidence of stroke and incidence of myocardial infarction 30 days after operation） and safety （the incidence of bleeding events at 30 days after operation） of SAPT versus DAPT on short-term complications of TAVI were collected during the date of database establishment to Jan. 2019. After data extraction of included studies and quality evaluation with Cochrane system evaluator manual 5.1.0 （for RCT） and the Newcastle-Ottawa Scale （NOS） （for observational studies）， Meta-analysis was conducted by using Rev Man 5.3 statistical software. RESULTS： Totally 3 RCTs and 7 cohort studies were included， involving 3 188 patients. Results of Meta-analysis showed that the incidence of all-cause mortality 30 days after operation [OR＝0.48， 95％ CI （0.32， 0.73）， P＜0.001] and the incidence of bleeding events 30 days after operation [OR＝0.43， 95％CI （0.30， 0.59）， P＜0.001] in SAPT group were significantly lower than DAPT group， with statistical significance. There was no statistical significance in the incidence of stroke 30 days after operation [OR＝0.63， 95％CI （0.38， 1.06） ， P＝0.08] or the incidence of myocardial infarction 30 days after operation [OR＝1.09， 95％CI （0.46， 2.59）， P＝0.85] between 2 groups. CONCLUSIONS： Compared with DAPT， SAPT can decrease the incidence of all-cause mortality 30 days after TAVI and the incidence of bleeding events 30 days after TAVI.

Advances in clinical application of afatinib in advanced non-small cell lung cancer based on the LUX-Lung trials / 肿瘤

Afatinib which is orally administered is an irreversible inhibitor of theepidermal growth factor receptor (EGFR) family tyrosine kinase. TheLUX-Lung 7 trial has shown that in the first-line treatment of patientswith advanced EGFR -mutant lung adenocarcinoma, afatinib couldsignificantly improve the progression-free survival (PFS) and the timeto treatment failure (TTF) as compared with gefitinib, but failed toachieve clinical benefit for the overall survival (OS). As compared withpemetrexed plus cisplatin regimen (LUX-Lung 3 trial) and gemcitabineplus cisplatin regimen (LUX-Lung 6 trial), afatinib could significantlyprolong the PFS, but not the OS. However, it is worth noting that bothLUX-Lung 3 trial and LUX-Lung 6 trial have shown that in the subgroup of patients with 19 exon deletion mutation of EGFR , the OS was significantly prolonged whenreceiving afatinib treatment versus chemotherapy. In addition, in the second-line treatment ofadvanced squamous-cell lung carcinoma, afatinib has shown to significantly prolong the PFSand OS as compared with erlotinib, regardless of EGFR mutation status (LUX-Lung 8 trial). Sideeffects of afatinib treatment in patients with NSCLC could be prevented by lowering the dose.In conclusion, afatinib can be used in the first-line treatment for patients with EGFR -mutantadvanced NSCLC, and also can be used in the second-line treatment of squamous-cell lungcarcinoma with progression after platinum-based chemotherapy.