Tafamidis, a Noninvasive Therapy for Delaying Transthyretin Familial Amyloid Polyneuropathy: Systematic Review and Meta-Analysis

BACKGROUND AND PURPOSE: Tafamidis functions to delay the loss of function in transthyretin familial amyloid polyneuropathy (TTR-FAP), which is a rare inherited amyloidosis with progressive sensorimotor and autonomic polyneuropathy. This systematic literature review and meta-analysis evaluated the efficacy and safety of tafamidis in TTR-FAP patients, with the aim of improving the evidence-based medical evidence of this treatment option for TTP-FAP. METHODS: A systematic search of the English-language literature in five databases was performed through to May 31, 2018 by two reviewers who independently extracted data and assessed the risk of bias. We extracted efficacy and safety outcomes and performed a meta-analysis. Statistical tests were performed to check for heterogeneity and publication bias. RESULTS: The meta-analysis identified six relevant studies. The tafamidis group showed smaller changes from baseline in the Neuropathy Impairment Score–Lower Limbs [mean difference (MD)=−3.01, 95% confidence interval (CI)=−3.26 to −2.75, p < 0.001] and the Norfolk Quality of Life-Diabetic Neuropathy total quality of life score (MD=−6.67, 95% CI=−9.70 to −3.64, p < 0.001), and a higher modified body mass index (MD=72.45, 95% CI=69.41 to 75.49, p < 0.001), with no significant difference in total adverse events [odds ratio (OR)=0.69, 95% CI=0.35 to 1.35, p=0.27]. The incidence of adverse events did not differ between tafamidis and placebo treatment except for fatigue (OR=0.13, 95% CI=0.02 to 0.72, p=0.02) and hypesthesia (OR=0.16, 95% CI=0.03 to 0.92, p=0.04). CONCLUSIONS: This systematic review and meta-analysis has demonstrated that tafamidis delays neurologic progression and preserves a better nutritional status and the quality of life. The rates of adverse events did not differ between the patients in the tafamidis and placebo groups. Tafamidis might be a safer noninvasive option for patients with TTR-FAP.

Research progress of anticoagulation combined with antiplatelet treatment strategy in acute coronary syndrome / 中国医师进修杂志

Dual antiplatelet therapy is the standard treatment for patients with acute coronary syndrome (ACS) and coronary heart disease interventional treatment. Clopidogrel, a traditional antiplatelet agent, has some disadvantages, such as slow onset time, individual differences and dissatisfy the antithrombosis requirement in ischemia of high-risk patients. In addition, for ACS patients with indications of anticoagulation, antiplatelet therapy cannot prevent venous thromboembolic events. However, dual antiplatelet combined with anticoagulant therapy may decrease the risk of ischemic events at the price of increasing bleeding. With the development of new antithrombotic agents, the antithrombotic strategy for ACS has made some progress, such as antiplatelet strategy for ACS, antithrombotic strategy for ACS with indication of anticoagulation and new antithrombotic drugs. With the development of clinical antithrombotic drug research, the patients with ACS will benefit from the optimized strategy of combined with antithrombotic therapy.