Remission rate

缓解率
  • 文章类型: Meta-Analysis
    快速进展的间质性肺病(RP-ILD)明显损害皮肌炎/多发性肌炎(DM/PM)患者的预后,然而,在这一领域缺乏数字患病率和治疗比较。因此,这项研究的目的是确定DM/PM患者中RP-ILD的患病率并比较预后,包括缓解率和生存数据,治疗之间。研究包括DM/PM患者RP-ILD报告的研究以及DM/PM-RP-ILD明确缓解和/或生存数据的研究。数据源已发布,Embase,和Cochrane图书馆没有语言限制。两位作者(WHL和WWQ)独立提取了数据。使用Mantel-Haenszel技术(随机效应)计算合并效应的估计值。患病率荟萃分析包括18篇论文,6058名DM/PM患者,并对31篇论文进行了治疗效果分析,包括缓解率,6个月生存率,1年生存率,5年生存率。数据库搜索产生1816篇文章。在DM/PM人群中,RP-ILD的合并患病率为8.9%(95%CI,5.8%~12.1%).RP-ILD患者的缓解率为58.4%(95%CI,47.3%至69.4%),采用缓解率最高的生物治疗,其次是三联疗法(定义为添加第三种静脉注射药物,包括环磷酰胺和免疫球蛋白)。生物制品治疗在6个月时总生存率最高(95%CI,49.8%至73.9%),其次是cDMARDs,血浆置换,和三联疗法。1年生存率为77.4%(95%CI,66.7%~88.1%),三联疗法和cDMARDs的生存率最好。5年生存率为40.0%(95%CI,10.0%~69.9%)。RP-ILD在DM/PM中的患病率约为8.9%,长期预后不良。使用生物制剂似乎提供了最好的治疗结果,为RP-ILD管理提供一种新的循证疗法。使用强免疫抑制治疗可能导致危及生命的副作用,因此,临床医生必须密切监测病情。
    Rapidly progressive interstitial lung disease (RP-ILD) clearly harms the prognoses of dermatomyositis/polymyositis (DM/PM) patients, however there is a dearth of numerical prevalence and therapy comparison in this field. Therefore, the purpose of this study was to determine the prevalence of RP-ILD in DM/PM patients and compare prognoses, including remission rate and survival data, between treatments. Studies with reports of RP-ILD in DM/PM patients and studies with definite remission and/or survival data of DM/PM-RP-ILD were included in the study. Data sources were Pubmed, Embase, and Cochrane Library without language restrictions. Two authors (WHL and WWQ) extracted independently the data. Estimates of the pooled effects were calculated using the Mantel-Haenszel technique (random effects). The prevalence meta-analysis included 18 papers with 6058 DM/PM patients, and 31 papers were analyzed for treatment effects, including remission rate, 6-month survival rate, 1-year survival rate, and 5-year survival rate. Database search yielded 1816 articles. In the DM/PM population, the combined prevalence of RP-ILD was 8.9% (95% CI, 5.8% to 12.1%). Patients with RP-ILD have a remission rate of 58.4% (95% CI, 47.3% to 69.4%), with biologic treatment with the highest remission rate, followed by triple therapy (defined as adding a third intravenous medication, including cyclophosphamide and immunoglobulin). Biologics therapy had the highest overall survival rate at six months (95% CI, 49.8% to 73.9%), followed by cDMARDs, plasma exchange, and triple therapy. The 1-year survival rate was 77.4% (95% CI, 66.7% to 88.1%), and triple therapy and cDMARDs had the best survival rates. The 5-year survival rate was 40.0% (95% CI, 10.0% to 69.9%). The prevalence of RP-ILD in DM/PM was approximately 8.9%, with a poor long-term prognosis. The use of biological agents appears to provide the best therapeutic outcomes, providing RP-ILD management with a novel evidence-based therapy. The use of strong immunosuppressive treatments may result in life-threatening side effects, thus clinicians must closely monitor the condition.
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  • 文章类型: Journal Article
    背景:慢性自发性(以前称为特发性)荨麻疹(CSU)是一种慢性皮肤病,具有自然缓解的潜力。这篇有针对性的文献综述的目的是确定CSU临床病程的证据,包括缓解率,并估计不同时间点的累积缓解率。
    方法:电子数据库(MEDLINE,MEDLINE-In流程,Embase,WebofScience,搜索了BIOSIS预览和Cochrane图书馆)和相关会议记录,以确定涉及年龄≥12岁的CSU患者的研究,这些研究提供了缓解率和疾病持续时间的数据。包括患者随访≥1年或评论文章的观察性研究。从五项选定的研究中提取的数据用于运行Kaplan-Meier(KM)分析和最佳拟合分布,以计算每4周的缓解率和加权平均值。
    结果:本综述包括10篇出版物。在第1年内达到缓解的患者比例为21%至47%,而第5年报告的缓解率估计为34%和45%。根据计算的4周缓解率,累计缓解估计值在第1年为9%~38%,在第5年为29%~71%,在第20年为52%~93%.在第1年、第5年和第20年缓解的患者比例的累积加权平均估计值为17%,45%和73%,分别。
    结论:已发表的证据表明,CSU是一种具有不同疾病严重程度和持续时间的自限性疾病,显然取决于多种因素。然而,数据来源在疾病严重程度和缓解的定义方面有所不同,以及影响因素的结论。需要进一步的研究和统一的定义。
    BACKGROUND: Chronic spontaneous (previously known as idiopathic) urticaria (CSU) is a chronic skin disease with the potential for natural remission. The objectives of this targeted literature review were to identify evidence on the clinical course of CSU, including remission rates, and to estimate cumulative remission rates for different time points.
    METHODS: Electronic databases (MEDLINE, MEDLINE-In Process, Embase, Web of Science, BIOSIS Previews and the Cochrane Library) and relevant conference proceedings were searched to identify studies involving patients with CSU aged ≥ 12 years that provide data on remission rates and disease duration. Observational studies with patient follow-ups of ≥ 1 year or review articles were included. Data extracted from five selected studies were used to run Kaplan-Meier (KM) analyses and best-fit distributions to calculate remission rates per 4-week period and weighted averages.
    RESULTS: Ten publications were included in this review. The proportion of patients achieving remission within year 1 ranged from 21 to 47%, while reported remission rate estimates at year 5 were 34% and 45%. Based on calculated 4-weekly remission rates, cumulative remission estimates ranged from 9 to 38% at year 1, from 29 to 71% at year 5 and from 52 to 93% at year 20. Cumulative weighted average estimates for the proportion of patients remitting at years 1, 5 and 20 were 17%, 45% and 73%, respectively.
    CONCLUSIONS: Published evidence suggests that CSU is a self-limiting condition with variable disease severity and duration, apparently dependent on multiple factors. However, data sources differed in terms of definitions of disease severity and remission, as well as in conclusions on influencing factors. Further studies and uniform definitions are required.
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  • 文章类型: Journal Article
    We explored whether stem cell therapy was effective for animal models and patients with Crohn\'s disease (CD).
    We searched five online databases. The relative outcomes were analyzed with the aid of GetData Graph Digitizer 2.26 and Stata 16.0 software. The SYRCLE risk of bias tool and the MINORS tool were used to assess study quality.
    We evaluated 46 studies including 28 animal works (n = 567) and 18 human trials (n = 360). In the animal studies, the disease activity index dramatically decreased in the mesenchymal stem cell (MSC) treatment groups compared to the control group. Rats and mice receiving MSCs exhibited longer colons [mice: standardized mean difference (SMD) 2.84, P = 0.000; rats: SMD 1.44, P = 0.029], lower histopathological scores (mice: SMD - 4.58, p = 0.000; rats: SMD - 1.41, P = 0.000) and lower myeloperoxidase levels (SMD - 6.22, P = 0.000). In clinical trials, stem cell transplantation reduced the CD activity index (SMD - 2.10, P = 0.000), the CD endoscopic index of severity (SMD - 3.40, P = 0.000) and simplified endoscopy score for CD (SMD - 1.71, P = 0.000) and improved the inflammatory bowel disease questionnaire score (SMD 1.33, P = 0.305) compared to control values. CD patients maintained high remission rates for 3-24 months after transplantation.
    Stem cell transplantation is a valuable supplementary therapy for CD.
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  • 文章类型: Journal Article
    Background: Generalized anxiety disorder (GAD) is one of the most common psychiatric disorders associated with substantial dysfunction and socioeconomic burden. Pharmacotherapy is the first choice for GAD. Remission [Hamilton Anxiety Scale (HAM-A) score ≤7] is regarded as a crucial treatment goal for patients with GAD. There is no up-to-date evidence to compare remission rate and tolerability of all available drugs by using network meta-analysis. Therefore, the goal of our study is to update evidence and determine the best advantageous drugs for GAD in remission rate and tolerability profiles. Method: We performed a systematic review and network meta-analysis of double-blind randomized controlled trials (RCTs). We searched PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, wanfang data, China Biology Medicine and ClinicalTrials.gov from their inception to March 2020 to identify eligible double-blind, RCTs reporting the outcome of remission in adult patients who received any pharmacological treatment for GAD. Two reviewers independently assessed quality of included studies utilizing the Cochrane Collaboration\'s risk of bias tool as described in Cochrane Collaboration Handbook and extracted data from all manuscripts. Our outcomes were remission rate (proportion of participants with a final score of seven or less on HAM-A) and tolerability (treatments discontinuations due to adverse events). We calculated summary odds ratios (ORs) and 95% confidence intervals (CIs) of each outcome via pairwise and network meta-analysis with random effects. Results: Overall, 30 studies were included, comprising 32 double-blind RCTs, involving 13,338 participants diagnosed as GAD by DSM-IV criteria. Twenty-eight trials were rated as moderate risk of bias, four trials as low. For remission rate, agomelatine (OR 2.70, 95% CI 1.74-4.19), duloxetine (OR 1.88, 95% CI 1.47-2.40), escitalopram (OR 2.03, 95% CI 1.48-2.78), paroxetine (OR 1.74, 95% CI 1.25-2.42), quetiapine (OR 1.88, 95% CI 1.39-2.55), and venlafaxine (OR 2.28, 95% CI 1.69-3.07) were superior to placebo. For tolerability, sertraline, agomelatine, vortioxetine, and pregabalin were found to be comparable to placebo. However, the others were worse than placebo in terms of tolerability, with ORs ranging between 1.86 (95% CI 1.25-2.75) for tiagabine and 5.98 (95% CI 2.41-14.87) for lorazepam. In head-to-head comparisons, agomelatine, duloxetine, escitalopram, quetiapine, and venlafaxine were more efficacious than tiagabine in terms of remission rate, ORs from 1.66 (95% CI 1.04-2.65) for duloxetine to 2.38 (95% CI 1.32-4.31) for agomelatine. We also found that agomelatine (OR 2.08, 95% CI 1.15-3.75) and venlafaxine (OR 1.76, 95% CI 1.08-2.86) were superior to vortioxetine. Lorazepam and quetiapine were poorly tolerated when compared with other drugs. Conclusions: Of these interventions, only agomelatine manifested better remission with relatively good tolerability but these results were limited by small sample sizes. Duloxetine, escitalopram, venlafaxine, paroxetine, and quetiapine showed better remission but were poorly tolerated.
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  • 文章类型: Journal Article
    This systematic review and meta-analysis aim to evaluate the remission rate of patients with rheumatoid arthritis (RA) in real-world studies and to summarize potential predictors of remission in RA. Studies reporting remission rate in patients with RA were searched from MEDLINE, EMBASE, and Scopus databases. Two reviewers independently assessed all studies according to eligibility criteria and extracted data. Generally, observational studies reporting remission rate in adult (≥ 18 years) patients with RA were included. Quality assessments were performed using the Newcastle-Ottawa Scale. Pooled analyses of remission rate were conducted using a random-effects model and data were analyzed in subgroups to identify potential source of heterogeneity. Sensitivity analyses were performed by serially excluding each study. Potential predictors of remission were summarized. Thirty-one studies with ~ 82,450 RA patients in total were included. Using the DAS28 remission criteria, the pooled 3-, 6-, 12-, and 24-month remission rates were 17.2%, 16.3%, 21.5%, and 23.5%, respectively. Subgroup analyses showed that 11.7% and 13.8% of TNFi inadequate responders reached remission after 6- and 12-month use of non-TNFi biologics. Predictors of remission included male, higher education level, and lower baseline disease activity, while initial use of corticosteroids was negative predictors of remission. Sustained remission was rare regardless of different criteria used. Remission was a reachable target in real-world studies, while attention should also be paid to achieve sustained remission.
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