3 research outputs found
Repetitive Transcranial Magnetic Stimulation (r-TMS) and Selective Serotonin Reuptake Inhibitor-Resistance in Obsessive-Compulsive Disorder: A Meta-Analysis and Clinical Implications
- Author
- Publication venue
- 'Elsevier BV'
- Publication date
- 01/01/2022
- Field of study
© 2022 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)Introduction: Despite promising results from several randomized controlled trials (RCTs) and meta-analyses, the efficacy of r-TMS as a treatment for OCD remains controversial, at least in part owing to inconsistency in the trial methodologies and heterogeneity in the trial outcomes. This meta-analysis attempts to explain some of this heterogeneity by comparing the efficacy of r-TMS in patients with or without resistance to treatment with selective serotonin reuptake inhibitors (SSRI), defined using standardised criteria. Methods: We conducted a pre-registered (PROSPERO ID: 241381) systematic review and meta-analysis. English language articles reporting blinded RCTs were retrieved from searches using MEDLINE, PsycINFO, and Cochrane Library databases. Studies were subjected to subgroup analysis based on four stages of treatment resistance, defined using an adaptation of published criteria (1=not treatment resistant, 2=one SSRI trial failed, 3=two SSRI trials failed, 4=two SSRI trials failed plus one or more CBT trial failed). Meta-regression analyses investigated patient and methodological factors (age, duration of OCD, illness severity, stage of treatment-resistance, or researcher allegiance) as possible moderators of effect size. Results: Twenty-five independent comparisons (23 studies) were included. Overall, r-TMS showed a medium-sized reduction of Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores (Hedge’s g: -0.47; 95%CI: - 0.67 to -0.27) with moderate heterogeneity (I2=39.8%). Assessment of publication bias using Trim and Fill analysis suggested a reduced effect size that remained significant (g: -0.29; 95%CI: -0.51 to -0.07). Subgroup analysis found that those studies including patients non-resistant to SSRI (stage 1) (g: -0.65; 95%CI: -1.05 to -0.25, k=7) or with low SSRI-resistance (stage 2) (g:-0.47; 95%CI: -0.86 to -0.09, k=6) produced statistically significant results with low heterogeneity, while studies including more highly resistant patients at stage 3 (g: -0.39; 95%CI: -0.90 to 0.11, k=4) and stage 4 (g: -0.36; 95%CI: -0.75 to 0.03, k=8) did not. Intriguingly, the only significant moderator of the effect size found by meta-regression was the severity of baseline depressive symptoms. All trials showed evidence of researcher allegiance in favour of the intervention and therefore caution is required in interpreting the reported effect sizes. Conclusion This meta-analysis shows that r-TMS is an effective treatment for OCD, but largely for those not resistant to SSRI or failing to respond to only one SSRI trial. As a consequence, r-TMS may be best implemented earlier in the care pathway. These findings would have major implications for clinical service development, but further well-powered RCTs, which eliminate bias from researcher allegiance, are needed before definitive conclusions can be drawn.Peer reviewe
Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes
- Author
- Abayomi Osunkoya
- Abderrahim Oulhaj
- Abraham Salacata
- Adam DeVore
- Adi Butnaru
- Aditya Mandawat
- Adolphus Anekwe
- Adriaan Kooy
- Adrian Cruciani
- Adrian Schnall
- Adriana Costa e Forti
- Adriana Philippiova
- Adriana Villarino
- Adriano Truffa
- Agatha Wilhase
- Agnes-Anette Himpel Boenninghoff
- Ajay Labroo
- Alain Taylon
- Alan Bell
- Alan Forker
- Alan Kravitz
- Alan Marcus
- Alan Tannenbaum
- Alan Wine
- Albert Lecube
- Albert LeCube Torello
- Alejandro Orozco Linares
- Alessandro Cavarape
- Alessandro Salvioni
- Alexander Dreval
- Alexander Higgins
- Alexander Khokhlov
- Alexander Sherenkov
- Alexander Tong-Boon Tan
- Alexander V Dreval
- Alexey Repin
- Alfonso Soto
- Alice Pik Shan Kong
- Alison Dawson
- Allegra Stone
- Allen Greenspoon
- Amanda Adler
- Amir Bashkin
- Amorin Remus Popa
- Amrit Takhar
- Amritanshu Pandey
- Ana Zazula
- Anand Rohatgi
- Anat Jaffe
- Andras Nagy
- Andras Papp
- Andras Taller
- Andrea Ferch
- Andrea Mölle
- Andrea On Yan Luk
- Andrea Tisch
- Andreas Hamann
- Andreas Mugge
- Andreas Pfutzner
- Andrej Dzupina
- Andrej Levinger
- Andrew Hamer
- Andrew Johnson
- Andrew McWilliams
- Andrew Woodall
- Andrey Obrezan
- Andrian Yakov
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- Anne Chang
- Anne Kilvert
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- Anthony Bartkowiak Jr
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- Aranka Kovacs
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- Axel Akerblom
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- B van Bemmel
- Bankim Bhatt
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- Barry Reicher
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- Bimal Shah
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- Carolina Gonzaga
- Caryn Baldauf
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- Cezar Staniloae
- Chaitanya Ravi
- Chan J. C.
- Chang-Wook Nam
- Changsheng Ma
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- Vadym Berenfus
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- Vicdan Köse
- Vicki Kalen
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- Vincent Tok-Fai Yeung
- Vincent Woo
- Vira Tseluyko
- Vitaliy Maslyanko
- Volodymyr Botsyurko
- Vyacheslav Marasaev
- Vyara Videva
- Wanda Lakey
- Wayne Huey Herng Sheu
- Wayne Sheu
- Wee Kooi Cheah
- Wei Gu
- Wen-Ter Lai
- Wilgard Pohl
- Willem Wouter van Kempen
- William Bestermann Jr
- William Jeffries
- William Kirby
- William Nseir
- Winston Gandy
- Wojciech Homenda
- Wolfram Kamke
- Won-Young Lee
- Xiaohui Guo
- Yanbing Li
- Yee Weng Wong
- Yee-Weng Wong
- Yevgen Suprun
- Yi-Jen Hung
- Yiming Mu
- Yingqing Feng
- Ynez Kelfkens
- Yolanda Meadows
- Yong Wang
- Yoon-Nyun Kim
- Youping Dong
- Yulia Samoylova
- Yuming Du
- Yupin Benjasuratwong
- Yves Robitaille
- Zahari Nikitov
- Ziad Gellad
- Zinaida Teliatnikova
- Zinman B.
- Zoltan Czegany
- Zsolt Gaal
- Zsolt Pauker
- Zsolt Ples
- Zsolt Zilahi
- Zsuzsanna Kerenyi
- Zubin Eapen
- Zubin Punthakee
- Zuyi Yuan
- Publication venue
- 'Massachusetts Medical Society'
- Publication date
- 01/01/2017
- Field of study
BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo
Cardiovascular Efficacy and Safety of Bococizumab in High-Risk Patients
- Author
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- Zoet-Nugteren S. K.
- Zrazhevskiy K.
- Zubek V.
- Publication venue
- 'Massachusetts Medical Society'
- Publication date
- 01/01/2017
- Field of study
BACKGROUN