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Open Access Original Article Issue
Ⅳ ketamine infusion therapy for chronic pain: A systematic review and meta‐analysis
Medicine Advances 2023, 1 (4): 394-407
Published: 19 December 2023
Downloads:3
Background

Chronic pain exerts a significant physical, emotional, and socioeconomic toll on millions of patients worldwide. Traditional pharmacological interventions are often inadequate in providing lasting and effective pain relief for patients suffering from severe chronic pain. However, in recent years, intravenous ketamine infusion therapy has emerged as a promising and alternative treatment modality. The effectiveness of intravenous ketamine infusion therapy in treating chronic pain has been investigated in various pain conditions, such as neuropathic pain, fibromyalgia, complex regional pain syndrome (CRPS), and phantom limb pain. However, varied patient demographics, different endpoints for measuring analgesia, and inconsistent numbers of patients in studies have led to conflicting results. The objective of the present inquiry is to undertake a contemporary updated meta‐analysis of the application of Ⅳ ketamine infusion therapy in the context of persistent pain.

Methods

A search was conducted, adhering to the PRISMA guidelines, to compare the efficacy of Ⅳ Ketamine infusion versus control (placebo, midazolam, gabapentin, hydromorphone, and pregabalin) among individuals with chronic pain. During the analysis, Medline, Cochrane, and Embase were thoroughly searched. Two independent investigators identified randomized double‐blind and non‐randomized trials comparing Ⅳ Ketamine infusions with controls. Review Manager 5.4.1 was used to scrutinize the data, with the main focus on pain scores. Secondary outcomes such as quality of sleep, as well as side effects such as nausea, hallucinations, and sedation, were also analyzed. Sixteen studies were included involving 1080 patients.

Results

The pain score was significantly reduced by Ⅳ Ketamine (Mean difference −1.05; 95% CI −1.72, −0.39; p = 0.002), while the quality of sleep (Mean difference 0.00; 95% CI −0.12, 0.12; p = 1.00) was not significantly different between studies. Nausea (risk ratio 1.42; 95% CI 0.84, 2.39; p = 0.19), hallucinations (risk ratio 1.08; 95% CI 0.67, 1.76; p = 0.75), and sedation (risk ratio 1.05; 95% CI 0.24, 4.54; p = 0.95) outcomes were not significantly different among the studies.

Conclusions

Our meta‐analysis indicates that Ⅳ Ketamine infusion is efficacious and safe in patients with chronic pain.

Open Access Meta-analysis Issue
Intrahepatic cholestasis of pregnancy is associated with increased risk of hepatobiliary disease and adverse fetal outcomes: A systematic review and meta-analysis
iLIVER 2023, 2 (4): 219-226
Published: 13 November 2023
Downloads:2
Background and aims

The aim of this study was to review the literature and perform a meta-analysis to clarify the association between intrahepatic cholestasis of pregnancy and risks of long-term maternal hepatobiliary disease as well as adverse fetal outcomes including preterm birth, meconium-stained amniotic fluid, and stillbirth.

Methods

This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive literature search was performed using Cochrane, Embase, and PubMed databases to identify observational or cohort studies comparing pregnant women with intrahepatic cholestasis of pregnancy (ICP) to pregnant women without ICP. Data from the included studies were analyzed using the Review Manager 5.4.1 software.

Results

The meta-analysis showed a significant association between ICP and the risk of hepatobiliary diseases (pooled risk ratio [RR]: 2.81, 95% confidence interval [CI]: 2.66–2.97, p < 0.00001), hepatitis C (HC): a significant association between ICP and risk of HC (pooled RR: 4.02, 95% CI: 3.12–5.19, p < 0.00001), meconium-stained amniotic fluid (MSAF): ICP was significantly associated with an increased risk of MSAF (pooled RR: 1.91, 95% CI: 1.65–2.21, p < 0.00001), and preterm birth: the meta-analysis demonstrated a significant association between ICP and preterm birth (pooled RR: 2.11, 95% CI: 2.01–2.21, p < 0.00001).

Conclusion

ICP demonstrated statistically significant associations with increased risks of hepatobiliary disease, HC, MSAF, and preterm birth.

Open Access Original Article Issue
Meta‐analysis of the use of Ofatumumab in the treatment of relapsing‐remitting multiple sclerosis
Medicine Advances 2023, 1 (3): 278-287
Published: 14 September 2023
Downloads:26
Background

Ofatumumab is the first monoclonal antibody developed specifically for treating relapsed multiple sclerosis (RMS). This disease (Multiple Sclerosis) includes relapsing–remitting multiple sclerosis (RRMS), a chronic autoimmune illness that affects the central nervous system (CNS), including the brain and spinal cord. The purpose of this study is to determine whether Ofatumumab is efficacious and safe in the treatment of relapsing–remitting multiple sclerosis.

Methods

An analysis of studies comparing Ofatumumab with placebo in people with relapsing‐remitting multiple sclerosis was done in accordance with PRISMA guidelines. We looked up information in MEDLINE, SciSearch, BIOSIS Previews, Derwent Drug File, Embase, and International Pharmaceutical Abstracts. In patients with relapsing–remitting multiple sclerosis, randomized double‐blind and non‐randomized trials contrasting Ofatumumab with placebo were found by two independent investigators. Utilizing Review Manager 5.4.1, data were examined. The main results were total gadolinium‐enhancing (Gd+) T1 lesions, annualized relapse rate, and new or expanding total T2 lesions. Secondary outcomes concentrated on general adverse events and adverse events related to infections.

Results

Three studies were included involving 334 patients, and the meta‐analysis indicated that Ofatumumab showed good efficacy and safety in patients with relapsing forms of multiple sclerosis. The annual rate of relapse was significantly reduced by Ofatumumab (OR 0.51; 95% CI 0.27, 0.98; P = 0.04). Ofatumumab reduced the number of gadolinium‐enhancing (Gd+) T1 lesions per scan (Mean difference −0.59; 95% CI −0.63, −0.55; P < 0.05). Ofatumumab treatment decreased new or enlarging total T2 lesions significantly (Mean difference −1.03; 95% CI −1.29, −0.76; P < 0.05). Infection‐related adverse effects were seen more frequently with Ofatumumab shown by the odd ratio 0.48; 95% CI 0.22, 1.04; P = 0.06. Infection is, thus, a major limitation to its use.

Conclusion

The meta‐analysis indicated that Ofatumumab is efficacious and safe for patients with relapsing forms of multiple sclerosis.

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