ABSTRACT
Ustekinumab and vedolizumab are key treatment options for Crohn's disease patients who fail anti-tumor necrosis factor (TNF) therapy. This updated meta-analysis aims to compare the efficacy and safety of these two drugs. We performed a systematic review in PubMed, Embase, and Cochrane databases searching for randomized and nonrandomized studies comparing vedolizumab versus ustekinumab in patients with Crohn's disease with previous anti-TNF failure or intolerance. The primary outcome was steroid-free clinical remission (SFR) at the pos-induction (12-16 weeks) and maintenance period (48-52 weeks). The odds ratio (OR) was used for binary outcomes with their respective 95% confidence interval (CI). Heterogeneity was assessed using the Cochran Q test and I2 statistics. This meta-analysis included 11 studies and 2724 patients. There was a significant difference favoring ustekinumab in SFR at pos-induction (OR, 1.44; 95% CI, 1.11-1.88; P = 0.006; I2 = 27%) and maintenance periods (OR, 1.86; 95% CI, 1.23-2.82; P = 0.003; I2 = 80%), in clinical remission at pos-induction period (OR, 2.04; 95% CI, 1.58-2.63; P < 0.001; I2 = 3%), and in treatment discontinuation due to adverse events (OR, 0.31; 95% CI, 0.16-0.60; P < 0.001; I2 = 0%). In patients with Crohn's disease with prior anti-TNF failure, ustekinumab showed higher SFR during both the pos-induction and maintenance period and a lower rate of treatment discontinuation due to adverse events.
ABSTRACT
BACKGROUND & AIMS: Endoscopic sphincterotomy (ES) is not mandatory before biliary stenting. The impact of ES before biliary stent placement remains uncertain. Previous studies have reported that ES can increase adverse event rates by up to 4.5 times compared to no ES. We aimed to assess the occurrence of post-ERCP adverse events following biliary stent placement with and without ES. METHODS: PubMed, Embase, and Cochrane were systematically searched for randomized controlled trials. The primary outcome was post-ERCP pancreatitis (PEP). Subgroup analyses were performed with patients undergoing biliary drainage due to obstruction, using metal stents, and using plastic stents. Secondary outcomes included were post-procedure bleeding, perforation, stent/catheter occlusion, stent/catheter migration, and cholangitis. Heterogeneity was examined using I2 statistics, and a random-effects model was employed. Review manager 5.4 was used for statistical analyses. RESULTS: Seven RCTs with 1,022 patients were included. There was no significant difference between ES and non-ES groups (OR 0.46; 95% 0.19 to 1.09; p = 0.08; I2 = 59%) regarding PEP; however, a significant difference in bleeding rates was found between groups, favoring non-ES (OR 7.55; 95% CI 2.46 to 23.21; p = 0.0004; I2 = 0%). The analysis of the occurrence of cholangitis (OR 1.25; 95% CI 0.58 to 2.69; p = 0.56; I2 = 67%); perforation (OR 1.95; 95% CI 0.07 to 55.73; p = 0.70; I2 = 58%); stent/catheter migration (OR 1.95; 95% CI 0.07 to 55.73; p = 0.23; I2 = 6%); and stent/catheter occlusion (OR 0.90; 95% CI 0.37 to 2.19; p = 0.81; I2 = 0%) did not favor either group. CONCLUSION: Performing ES before biliary drainage does not impact the PEP rate but is associated with an increased postprocedure bleeding rate.
ABSTRACT
BACKGROUND: Catheter ablation has become a widely accepted treatment for atrial fibrillation, but early recurrences remain a challenge, often attributed to inflammatory responses triggered during the procedure. This systematic review and meta-analysis aimed to evaluate the effectiveness of colchicine in preventing short-term AF recurrence post-ablation. METHOD: PubMed, Embase, and Cochrane Library were searched for studies comparing use of colchicine and placebo in patients after AF ablation. Outcomes included AF recurrence, GI side effects, and hospitalization. R program (version 4.3.2) was used for statistical analysis. Heterogeneity was assessed with I2 statistics. RESULTS: Five studies, including 1592 patients, were analyzed. Pooled results revealed no statistically significant decrease in AF recurrence (OR 0.74; 95% CI 0.48-1.12; p = 0.153) and pericarditis rates (OR 0.67; 95% CI 0.26-1.72; p = 0.403) with colchicine use. No significant difference in hospitalization rates was observed between colchicine and placebo groups (OR 1.00; 95% CI 0.63-1.59; p = 0.996). In addition, gastrointestinal side effects were notably higher in the colchicine group (OR 4.84; 95% CI 2.58-9.05; p < 0.001). CONCLUSION: Prophylactic use of colchicine after atrial ablation was not associated with a reduction in AF recurrence and pericarditis rates. In addition, there was no difference in the rate of all-cause hospitalization between the groups, and colchicine use was associated with gastrointestinal adverse events.
ABSTRACT
BACKGROUND: Caffeine is commonly used as therapy for apnea of prematurity and has shown potential in preventing other conditions in preterm neonates. However, the optimal timing for caffeine therapy remains uncertain. OBJECTIVE: This study aimed to compare the outcomes of early versus late administration of caffeine in preterm neonates. METHODS: PubMed, Embase, and Cochrane Library were searched for studies comparing 0-2 days to ≥3 days caffeine introduction in preterm neonates. Outcomes included were mortality, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA), late-onset sepsis, length of hospital stay, and the composite of BPD or death. RevMan 5.4.1 was used for statistical analysis. RESULTS: A total of 122,579 patients from 11 studies were included, 2 were randomized controlled trials (RCTs), and 63.9% of the neonates received early caffeine administration. The rates of BPD (OR: 0.70; 95% CI: [0.60-0.81]; p < 0.0001), IVH (OR: 0.86; 95% CI: [0.82-0.90]; p < 0.0001), ROP (OR: 0.80; 95% CI: [0.74-0.86]; p < 0.0001), late-onset sepsis (OR: 0.84; 95% CI: [0.79-0.89]; p < 0.00001), and PDA (OR: 0.60; 95% CI: [0.47-0.78]; p < 0.0001) were significantly reduced in the early caffeine group. The composite outcome of BPD or death was also lower in the early caffeine group (OR: 0.76; 95% CI: [0.66-0.88]; p < 0.0003). Mortality rate was higher in the early caffeine group (OR: 1.20; 95% CI: 1.12-1.29; p < 0.001). CONCLUSION: As compared with late caffeine administration, early caffeine is associated with a reduction in BPD, IVH, ROP, late-onset sepsis, and PDA in preterm neonates, albeit increased mortality. Additional RCTs are warranted to confirm these findings and evaluate whether the effect on mortality may be related to survival bias in observational studies favoring the late treatment group.
