ABSTRACT
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease associated with high morbidity and mortality. Effective treatments for IPF are limited. Several recent studies have investigated novel therapeutic agents for IPF, but very few have addressed their comparative benefits and harms. METHODS: We performed a Bayesian network meta-analysis (NMA) to assess the effects of different treatments for IPF on mortality and serious adverse events (SAEs). We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) up to August 2015. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach served to assess the certainty in the evidence of direct and indirect estimates. We calculated the surface under the cumulative ranking curve (SUCRA) for each treatment. We included parallel group RCTs, including factorial designs, but excluded quasi-randomized and cross-over trials. Studies were only included if they involved adult (≥18 years of age) patients with IPF as defined by the 2011 criteria and examined one of the 10 interventions of interest (ambrisentan, bosentan, imatinib, macitentan, N-acetylcysteine, nintedanib, pirfenidone, sildenafil, prednisone/azathioprine/N-acetylcysteine triple therapy, and vitamin K antagonist). RESULTS: A total of 19 RCTs (5,694 patients) comparing 10 different interventions with placebo and an average follow-up period of 1 year fulfilled the inclusion criteria. SUCRA analysis suggests nintedanib, pirfenidone, and sildenafil are the three treatments with the highest probability of reducing mortality in IPF. Indirect comparison showed no significant difference in mortality between pirfenidone and nintedanib (NMA OR, 1.05; 95% CrI, 0.45-2.78, moderate certainty of evidence), pirenidone and sildenafil (NMA OR, 2.26; 95% CrI, 0.44-13.17, low certainty of evidence), or nintedanib and sildenafil (NMA OR 2.40; 95% CrI, 0.47-14.66, low certainty of evidence). Sildenafil, pirfenidone, and nintedanib were ranked second, fourth, and sixth out of 10 for SAEs. CONCLUSION: In the absence of direct comparisons between treatment interventions, this NMA suggests that treatment with nintedanib, pirfenidone, and sildenafil extends survival in patients with IPF. The SAEs of these agents are similar to the other interventions and include mostly dermatologic and gastrointestinal manifestations. Head-to-head comparisons need to confirm these findings.
Subject(s)
Acetylcysteine/therapeutic use , Free Radical Scavengers/therapeutic use , Idiopathic Pulmonary Fibrosis/drug therapy , Indoles/therapeutic use , Pyridones/therapeutic use , Adult , Anticoagulants/therapeutic use , Bayes Theorem , Female , Humans , Idiopathic Pulmonary Fibrosis/epidemiology , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Quality of Life , Treatment Outcome , Young AdultABSTRACT
La prevalencia del Helicobacter pylori es alta en nuestro medio, hay informes del 90 por ciento en algunas series de personas sanas. Existen controversia con respecto a la vía de transmisión. Hay algunas evidencias que sugieren que la bacteria ingresa por vía oral. Este trabajo trata de identificar las posibles variables ambientales y/o de la dieta que aumentan el riesgo o protegen de esta infección. Se estudiaron 146 pacientes, 65 con Helicobacter positivos y 81 sin la presencia de la bacteria documentadas por histología. A estas pacientes se les aplicó una encuesta de las condiciones ambientales y dietarias del individuo. En los resultados se encontró como factor protector el hervir el agua, mientras el consumo de pescado y alimentos callejeros se constituyeron como un riesgo para adquirir la infección. Este trabajo sugiere que el hervir el agua puede constituir una medida sanitaria para disminuir el riesgo de infección
