1.
Meta-analysis of effectiveness of steroid-sparing attack prevention in MOG-IgG-associated disorder
Thakolwiboon S, Zhao-Fleming H, Karukote A, Mao-Draayer Y, Flanagan EP, Avila M
Multiple sclerosis and related disorders. 2021;56:103310
Abstract
OBJECTIVE To estimate the efficacy of the commonly used long-term immunotherapies in myelin oligodendrocyte glycoprotein IgG associated disorder (MOGAD) METHOD A comprehensive search of the databases including PubMed/MEDLINE, EMBASE, and Cochrane database was performed for all studies that assessed the efficacy of azathioprine (AZA), mycophenolate mofetil (MMF), rituximab (RTX), and maintenance intravenous immunoglobulin (mIVIG) in MOGAD. The random-effect model is used to estimate the standard mean difference (SMD) of annualized relapse rate (ARR) and expanded disability status scale (EDSS), mean ARR, probabilities of relapse and worsening EDSS during treatment. RESULTS The initial search identified 714 articles, and 21 satisfied eligibility criteria. All immunotherapies significantly reduced ARR in both pediatric and adult populations. Relapse probabilities and pooled mean ARR (SE: standard error) during therapies were as follow: AZA 53.1% [95%CI 37.4% to 68.2%; ARR 0.291 (0.134)], MMF 38.5% [95%CI 19.4% to 62.0%; ARR 0.836 (0.176)], RTX 48.9% [95%CI 37.8% to 60.2%; ARR 0.629(0.162)], and mIVIG 25.3% [95%CI 14.0% to 41.3%; ARR 0.081 (0.058)]. Only RTX significantly improved EDSS, SMD -0.499 (95%CI -0.996 to -0.003). The proportion of worsening EDSS with immunotherapies were 20.7% (95%CI 8.8% to 41.6%), 8.1% (95%CI 1.1% to 41.2%), and 10.8% (95%CI 3.8% to 26.8%) for AZA, MMF, and RTX, respectively. CONCLUSION These commonly used immunotherapies significantly reduced ARR in MOGAD. Only RTX had a significant benefit in EDSS improvement. However, a substantial portion of patients continued to relapse with treatment. Randomized controlled studies are needed to verify these findings and perform head-to-head comparisons among these treatment options.
2.
Efficacy of a fibrin sealant (Tissucol Duo(R)) for the prevention of lymphocele after laparoscopic pelvic lymphadenectomy: a randomised controlled trial
Jaunarena I, Ruiz R, Gorostidi M, Cobas P, Avila M, Valle DD, Cespedes J, Lekuona A
Journal of Minimally Invasive Gynecology. 2018
Abstract
STUDY OBJECTIVE To assess the efficacy of Tissucol Duo(R) (Baxter AG) fibrin sealant in decreasing the incidence of lymphocele (LC) after pelvic laparoscopic lymph node dissection using harmonic shears. DESIGN CLASSIFICATION Randomized controlled trial (Canadian Task Force Classification level I) SETTING Tertiary referral and educational center. PATIENTS A double blind randomized controlled study was conducted (February 2012-June 2016) including 74 patients randomizing the use of sealant per hemipelvis. INTERVENTION Following bilateral pelvic lymphadenectomy, a fibrin sealant was used in one hemipelvis but not the other, being applied in 41 (55.4%) left and 33 (44.6%) right hemipelvises. The primary outcome was the incidence of LC after surgery in symptomatic and asymptomatic patients. Imaging (ultrasound, computed tomography and magnetic resonance) was performed to detect LC at 3, 6 and 12 months after surgery.