Paschos, Paschalis

AbstractObjectivesWe performed a systematic review and meta‐regression analysis of randomized control trials to investigate the association between response to initial treatment and survival outcomes in patients with newly diagnosed multiple myeloma (MM).MethodsResponse outcomes included complete response (CR) and the combined outcome of CR or very good partial response (VGPR), while survival outcomes were overall survival (OS) and progression‐free survival (PFS). We used random‐effect meta‐regression models and conducted sensitivity analyses based on definition of CR and study quality.ResultsSeventy‐two trials were included in the systematic review, 63 of which contributed data in meta‐regression analyses. There was no association between OS and CR in patients without autologous stem cell transplant (ASCT) (regression coefficient: .02, 95% confidence interval [CI] −0.06, 0.10), in patients undergoing ASCT (−.11, 95% CI −0.44, 0.22) and in trials comparing ASCT with non‐ASCT patients (.04, 95% CI −0.29, 0.38). Similarly, OS did not correlate with the combined metric of CR or VGPR, and no association was evident between response outcomes and PFS. Sensitivity analyses yielded similar results.ConclusionsThis meta‐regression analysis suggests that there is no association between conventional response outcomes and survival in patients with newly diagnosed MM.

Aim To assess the efficacy and safety of recently approved once‐weekly glucagon‐like peptide 1 receptor agonists ( GLP ‐1 RAs ) in patients with type 2 diabetes. Methods We conducted a systematic review and meta‐analysis of randomized controlled trials comparing any GLP ‐1 RA licensed for once‐weekly dosing (albiglutide, dulaglutide or exenatide extended release) with placebo or other antidiabetic agents. We searched M edline, E mbase, the C ochrane L ibrary and grey literature for articles published up to D ecember 2014 and extracted data in duplicate. Results In our systematic review we included 33 trials with a total of 16 003 participants. Compared with placebo the change in glycated haemoglobin ( HbA1c ) concentration was −0.66% [six studies; 95% confidence interval ( CI ) −1.14 to −0.19; I 2 = 88%] with albiglutide, and −1.18% (seven studies; 95% CI −1.34 to −1.02; I 2 = 65%) with dulaglutide. Based on data from placebo‐controlled trials, we did not detect statistically significant weight‐sparing benefits for albiglutide or dulaglutide. Compared with other antidiabetic agents, once‐weekly GLP ‐1 RAs outperformed sitagliptin, daily exenatide and insulin glargine in terms of HbA1c ‐lowering (mean differences −0.40%; 95% CI −0.66 to −0.14; I 2 = 85%, −0.44%; 95% CI −0.58 to −0.29; I 2 = 40% and −0.28; 95% CI −0.45 to −0.10; I 2 = 81%, respectively). The main adverse effects of treatment included gastrointestinal and injection site reactions. Conclusions Given their dosing scheme and overall efficacy and safety profile, once‐weekly GLP ‐1 RAs are a convenient therapeutic option for use as add‐on to metformin.