38 research outputs found
Chloroquine or hydroxychloroquine for prevention and treatment of COVID-19
Background
The coronavirus disease 2019 (COVIDâ19) pandemic has resulted in substantial mortality. Some specialists proposed chloroquine (CQ) and hydroxychloroquine (HCQ) for treating or preventing the disease. The efficacy and safety of these drugs have been assessed in randomized controlled trials.
Objectives
To evaluate the effects of chloroquine (CQ) or hydroxychloroquine (HCQ) for
1) treating people with COVIDâ19 on death and time to clearance of the virus;
2) preventing infection in people at risk of SARSâCoVâ2 exposure;
3) preventing infection in people exposed to SARSâCoVâ2.
Search methods
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Current Controlled Trials (www.controlledâtrials.com), and the COVIDâ19âspecific resources www.covidânma.com and covidâ19.cochrane.org, for studies of any publication status and in any language. We performed all searches up to 15 September 2020. We contacted researchers to identify unpublished and ongoing studies.
Selection criteria
We included randomized controlled trials (RCTs) testing chloroquine or hydroxychloroquine in people with COVIDâ19, people at risk of COVIDâ19 exposure, and people exposed to COVIDâ19.
Adverse events (any, serious, and QTâinterval prolongation on electrocardiogram) were also extracted.
Data collection and analysis
Two review authors independently assessed eligibility of search results, extracted data from the included studies, and assessed risk of bias using the Cochrane âRisk of biasâ tool. We contacted study authors for clarification and additional data for some studies. We used risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CIs). We performed metaâanalysis using a randomâeffects model for outcomes where pooling of effect estimates was appropriate
Public health deworming programmes for soilâtransmitted helminths in children living in endemic areas
Background The World Health Organization (WHO) recommends treating all school children at regular intervals with deworming drugs in areas where helminth infection is common. Global advocacy organizations claim routine deworming has substantive health and societal effects beyond the removal of worms. In this update of the 2015 edition we included six new trials, additional data from included trials, and addressed comments and criticisms. Objectives To summarize the effects of public health programmes to regularly treat all children with deworming drugs on child growth, haemoglobin, cognition, school attendance, school performance, physical fitness, and mortality. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; LILACS; the metaRegister of Controlled Trials (mRCT); reference lists; and registers of ongoing and completed trials up to 19 September 2018. Selection criteria We included randomized controlled trials (RCTs) and quasiâRCTs that compared deworming drugs for soilâtransmitted helminths (STHs) with placebo or no treatment in children aged 16 years or less, reporting on weight, height, haemoglobin, and formal tests of cognition. We also sought data on other measures of growth, school attendance, school performance, physical fitness, and mortality. Data collection and analysis At least two review authors independently assessed the trials for inclusion, risk of bias, and extracted data. We analysed continuous data using the mean difference (MD) with 95% confidence intervals (CIs). Where data were missing, we contacted trial authors. We stratified the analysis based on the background burden of STH infection. We used outcomes at time of longest followâup. We assessed the certainty of the evidence using the GRADE approach. Main results We identified 51 trials, including 10 clusterâRCTs, that met the inclusion criteria. One trial evaluating mortality included over one million children, and the remaining 50 trials included a total of 84,336 participants. Twentyâfour trials were in populations categorized as high burden, including nine trials in children selected because they were helminthâstool positive; 18 with intermediate burden; and nine as low burden. First or single dose of deworming drugs Fourteen trials reported on weight after a single dose of deworming drugs (4970 participants, 14 RCTs). The effects were variable. There was little or no effect in studies conducted in low and intermediate worm burden groups. In the highâburden group, there was little or no effect in most studies, except for a large effect detected from one study area in Kenya reported in two trials carried out over 30 years ago. These trials result in qualitative heterogeneity and uncertainty in the metaâanalysis across all studies (I2 statistic = 90%), with GRADE assessment assessed as very lowâcertainty, which means we do not know if a first dose or single dose of deworming impacts on weight. For height, most studies showed little or no effect after a single dose, with one of the two trials in Kenya from 30 years ago showing a large average difference (2621 participants, 10 trials, lowâcertainty evidence). Single dose probably had no effect on average haemoglobin (MD 0.10 g/dL, 95% CI 0.03 lower to 0.22 higher; 1252 participants, five trials, moderateâcertainty evidence), or on average cognition (1596 participants, five trials, lowâcertainty evidence). The data are insufficient to know if there is an effect on school attendance and performance (304 participants, one trial, lowâcertainty evidence), or on physical fitness (280 participants, three trials, very lowâcertainty evidence). No trials reported on mortality. Multiple doses of deworming drugs The effect of regularly treating children with deworming drugs given every three to six months on weight was reported in 18 trials, with followâup times of between six months and three years; there was little or no effect on average weight in all but two trials, irrespective of worm prevalenceâintensity. The two trials with large average weight gain included one in the high burden area in Kenya carried out over 30 years ago, and one study from India in a low prevalence area where subsequent studies in the same area did not show an effect. This heterogeneity causes uncertainty in any metaâanalysis (I2 = 78%). Postâhoc analysis excluding trials published prior to 2000 gave an estimate of average difference in weight gain of 0.02 kg (95%CI from 0.04 kg loss to 0.08 gain, I2 = 0%). Thus we conclude that we do not know if repeated doses of deworming drugs impact on average weight, with a fewer older studies showing large gains, and studies since 2000 showing little or no average gain. Regular treatment probably had little or no effect on the following parameters: average height (MD 0.02 cm higher, 95% CI 0.09 lower to 0.13 cm higher; 13,700 participants, 13 trials, moderateâcertainty evidence); average haemoglobin (MD 0.01 g/dL lower; 95% CI 0.05 g/dL lower to 0.07 g/dL higher; 5498 participants, nine trials, moderateâcertainty evidence); formal tests of cognition (35,394 participants, 8 trials, moderateâcertainty evidence); school performance (34,967 participants, four trials, moderateâcertainty evidence). The evidence assessing an effect on school attendance is inconsistent, and at risk of bias (mean attendance 2% higher, 95% CI 5% lower to 8% higher; 20,650 participants, three trials, very lowâcertainty evidence). No trials reported on physical fitness. No effect was shown on mortality (1,005,135 participants, three trials, lowâcertainty evidence). Authors' conclusions Public health programmes to regularly treat all children with deworming drugs do not appear to improve height, haemoglobin, cognition, school performance, or mortality. We do not know if there is an effect on school attendance, since the evidence is inconsistent and at risk of bias, and there is insufficient data on physical fitness. Studies conducted in two settings over 20 years ago showed large effects on weight gain, but this is not a finding in more recent, larger studies. We would caution against selecting only the evidence from these older studies as a rationale for contemporary mass treatment programmes as this ignores the recent studies that have not shown benefit
Glucose-6-phosphate dehydrogenase deficiency near-patient tests for tafenoquine or primaquine use with Plasmodium vivax malaria
Objectives
This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows:
To assess the diagnostic accuracy of nearâpatient tests for G6PD deficiency in people undergoing treatment or prophylaxis with primaquine or tafenoquine for malaria; or in people at risk of or susceptible to malaria.
Secondary objectives
To investigate sources of heterogeneity, namely the following.
Age: adults versus children
Sex: male versus female
Reported prevalence of G6PD (high versus low)
Malaria endemicity (endemic versus nonâendemic)
Geographic location (continent of residence; that is, Africa, Asia, or other continent)
Reference standard used (adjusted male median, median G6PD, laboratory standard)
Type of blood used (venous versus capillary)
To compare the accuracy of each type of test
High-intensity interval training for reducing cardiometabolic syndrome in healthy but sedentary populations
Eribulin for treating locally advanced or metastatic breast cancer after one prior chemotherapy regimen
A systematic review of lenvatinib and sorafenib for treating progressive, locally advanced or metastatic, differentiated thyroid cancer after treatment with radioactive iodine
Low carbohydrate versus balanced carbohydrate diets for reducing weight and cardiovascular risk
Brentuximab vedotin for treating relapsed or refractory CD30-positive cutaneous T-cell lymphoma (17/56/12)
Diagnostic accuracy and clinical impact of MRI-based technologies for patients with non-alcoholic fatty liver disease : systematic review and economic evaluation
BACKGROUND: Magnetic resonance imaging-based technologies are non-invasive diagnostic tests that can be used to assess non-alcoholic fatty liver disease. OBJECTIVES: The study objectives were to assess the diagnostic test accuracy, clinical impact and cost-effectiveness of two magnetic resonance imaging-based technologies (LiverMultiScan and magnetic resonance elastography) for patients with non-alcoholic fatty liver disease for whom advanced fibrosis or cirrhosis had not been diagnosed and who had indeterminate results from fibrosis testing, or for whom transient elastography or acoustic radiation force impulse was unsuitable, or who had discordant results from fibrosis testing. DATA SOURCES: The data sources searched were MEDLINE, MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Database of Controlled Trials, Database of Abstracts of Reviews of Effects and the Health Technology Assessment. METHODS: A systematic review was conducted using established methods. Diagnostic test accuracy estimates were calculated using bivariate models and a summary receiver operating characteristic curve was calculated using a hierarchical model. A simple decision-tree model was developed to generate cost-effectiveness results. RESULTS: The diagnostic test accuracy review (13 studies) and the clinical impact review (11 studies) only included one study that provided evidence for patients who had indeterminate or discordant results from fibrosis testing. No studies of patients for whom transient elastography or acoustic radiation force impulse were unsuitable were identified. Depending on fibrosis level, relevant published LiverMultiScan diagnostic test accuracy results ranged from 50% to 88% (sensitivity) and from 42% to 75% (specificity). No magnetic resonance elastography diagnostic test accuracy data were available for the specific population of interest. Results from the clinical impact review suggested that acceptability of LiverMultiScan was generally positive. To explore how the decision to proceed to biopsy is influenced by magnetic resonance imaging-based technologies, the External Assessment Group presented cost-effectiveness analyses for LiverMultiScan plus biopsy versus biopsy only. Base-case incremental cost-effectiveness ratio per quality-adjusted life year gained results for seven of the eight diagnostic test strategies considered showed that LiverMultiScan plus biopsy was dominated by biopsy only; for the remaining strategy (Brunt grade â„2), the incremental cost-effectiveness ratio per quality-adjusted life year gained was ÂŁ1,266,511. Results from threshold and scenario analyses demonstrated that External Assessment Group base-case results were robust to plausible variations in the magnitude of key parameters. LIMITATIONS: Diagnostic test accuracy, clinical impact and cost-effectiveness data for magnetic resonance imaging-based technologies for the population that is the focus of this assessment were limited. CONCLUSIONS: Magnetic resonance imaging-based technologies may be useful to identify patients who may benefit from additional testing in the form of liver biopsy and those for whom this additional testing may not be necessary. However, there is a paucity of diagnostic test accuracy and clinical impact data for patients who have indeterminate results from fibrosis testing, for whom transient elastography or acoustic radiation force impulse are unsuitable or who had discordant results from fibrosis testing. Given the External Assessment Group cost-effectiveness analyses assumptions, the use of LiverMultiScan and magnetic resonance elastography for assessing non-alcoholic fatty liver disease for patients with inconclusive results from previous fibrosis testing is unlikely to be a cost-effective use of National Health Service resources compared with liver biopsy only. STUDY REGISTRATION: This study is registered as PROSPERO CRD42021286891. FUNDING: Funding for this study was provided by the Evidence Synthesis Programme of the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 10. See the NIHR Journals Library website for further project information