1.
The effects of erythropoiesis stimulating therapy for anemia in chronic heart failure: a meta-analysis of randomized clinical trials
Kang J, Park J, Lee JM, Park JJ, Choi DJ
International Journal of Cardiology. 2016;218:12-22.
Abstract
BACKGROUND Although anemia is common in chronic heart failure (CHF), the use of erythropoiesis stimulating agents (ESAs) in CHF patients remains controversial. In this meta-analysis, we sought to clarify the efficacy and safety of ESAs in anemic patients with CHF. METHODS We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, the U.S. National Institutes of Health registry of clinical trials. We included 13 randomized clinical trials (RCTs) in the meta-analysis. The co-primary outcome was all-cause mortality and rehospitalization. The safety analysis outcome was thromboembolic events. RESULTS Preliminary analysis showed that ESA-treatment did not have any effect for all-cause mortality and rehospitalization. However, we revealed a significant small-study bias, and used the trim-and-fill method to reduce this bias. The summary effect of ESA-treatment was insignificant for all-cause mortality (risk ratio [RR] 0.91, 95% confidence interval [CI] 0.59-1.42, p=0.69) and for rehospitalization (RR 0.91, 95% CI 0.67-1.23, p=0.53). Regarding symptoms, ESA-treatment improved dyspnea (NYHA grade improvement: 1.63, 95% CI 0.65-2.62, p<0.001) and quality-of-life measured by subjective questionnaires. However, in safety analysis, ESAs increased the over-all risk for thromboembolic events (RR 1.28, 95% CI 1.03-1.58, p=0.026), however, no specific increase was observed in severe thromboembolic events. Subgroup analysis showed no difference in ESA-treatment according to the type of ESAs (darbepoetin vs. erythropoietin) and between studies of different follow-up durations (<6months or ≥6months). CONCLUSION Among CHF patients with anemia, ESA-treatment has a neutral effect on all-cause mortality and rehospitalization and improves symptoms, but has harmful effects on thromboembolic events.
2.
Oral tranexamic acid enhances the efficacy of low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet laser treatment for melasma in Koreans: a randomized, prospective trial
Shin JU, Park J, Oh SH, Lee JH
Dermatologic Surgery. 2013;39((3, Pt 1):):435-42.
Abstract
BACKGROUND Tranexamic acid (TA) has recently gained in popularity in the treatment of pigmentary disorders. OBJECTIVE To evaluate the clinical efficacy and safety of oral TA combined with low-fluence 1064-nm quality-switched neodymium-doped yttrium aluminum garnet (QSNY) laser for the treatment of melasma. MATERIALS AND METHODS Forty-eight patients with melasma were enrolled in the study and subsequently divided into two groups: a combination group and a laser treatment group. All patients were treated with two sessions of low-fluence QSNY laser, and patients in the combination group took 8 weeks of oral TA. Two blinded dermatologists evaluated patients using the Modified Melasma Area and Severity Index (mMASI) and a clinical improvement scale. RESULTS Mean mMASI score 4weeks after the second treatment decreased significantly in both groups from base line. Based on overall clinical improvement, a greater number of patients scored as grade 3 and more in the combination group; no patients were scored as grade 4 in the laser-alone group. CONCLUSIONS Oral TA may prove a safe and efficient treatment option for melasma in combination with low-fluence QSNY laser therapy. 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.