Meta-Analysis with Trial Sequential Analysis on the Efficacy and Safety of Erythropoietin in Traumatic Brain Injury: A New Paradigm

Katiyar, Varidh; Chaturvedi, Aprajita; Sharma, Ravi; Gurjar, Hitesh; Goda, Revanth; Singla, Raghav; Ganeshkumar, Akshay

doi:10.1016/j.wneu.2020.05.142

Cited by 8 publications

(10 citation statements)

References 23 publications

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“…With regard to the occurrence of deep vein thrombosis, the results of our research showed that EPO use did not increase the risk of its occurrence, which was similar to the results of previous traditional meta-analyses [19][20][21][22]. EPO may become a risk factor for the increased incidence of DVT for TBI patients with further study or increase of EPO dose.…”

Section: Discussionsupporting

confidence: 88%

“…The results of our network meta-analysis displayed that erythropoietin did not show a statistically signi cant in reducing in mortality among TBI patients, which differs from previous studies [19][20][21][22]. The probable reason is that we excluded relevant RCT studies that did not accurately report drug doses and did not distinguish when mortality occurred, as well as the algorithm mechanism differences between traditional pairwise meta-analysis and network metaanalysis produced by Addis software.…”

Section: Discussioncontrasting

confidence: 70%

“…But it's worth noting that erythropoietin plays an important role in reducing mortality in patients with TBI. In the subgroup analysis, there was a statistically signi cant in reducing 6 months mortality [19,21,22]. Liu's research [22] found that erythropoietin has some effect on shortening the length of hospital stay of patients.…”

Section: Discussionmentioning

confidence: 99%

“…The end of the other related indicators also was reported in the original study, such as the neural function recovery, the hospitalization time and cardiovascular events, and so on. However, due to its small amount, it could not constitute our dose study network and there was no certain statistical signi cance in traditional Meta-analysis [19][20][21][22], and we didn't analyze it. The number of RCTs included in this study was small, and we are looking forward to more original studies to better con rm the optimal dose of erythropoietin and its therapeutic relationship with patients with TBI.…”

Section: Discussionmentioning

confidence: 99%

“…A network meta-analysis (NMA) enables a coherent ranking of multiple interventions, which can thus assist decision-makers who must choose among variable treatment options [18]. In the existing meta-analysis and related original studies [19][20][21][22], the dosage of erythropoietin in the treatment of TBI varies widely. Dose optimization studies were not clear, and no dose-response studies of erythropoietin in TBI treatment had been well established.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Safety of Multiple Doses of Erythropoietin for the Treatment of Traumatic Brain Injury: A Systematic Review and Network Meta-Analysis

Zheng

Duan

et al. 2021

Preprint

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Background: Although many studies have shown that erythropoietin plays an important role in the prognosis of traumatic brain injury (TBI) patients, the effective dose of erythropoietin has not been clearly defined. Our aim was to systematically elucidate the safety and efficacy of erythropoietin administration regimens in TBI patients.Methods: Data search included PubMed, the Cochrane Library, EMBASE and ClinicalTrials.gov for articles published before December, 2020, updated to June 2021. Network meta-analysis was performed when sufficient comparable evidence was available, and CINeMA tool was used to evaluated the quality of our evidence.Results: A total of 6 RCTs involving 981 patients were included in the network meta-analysis. All studies assessed the effect of erythropoietin on mortality. Erythropoietin reduced the mortality rate in patients with TBI, and the risk of death decreased with increasing dose, but the difference was not statistically significant (odd ratio of 12,000u vs Placebo=0.98, 95%CI, 0.03-40.34; odd ratio of group 30,000u vs Placebo=0.56, 95%CI, 0.06-5.88; odd ratio of 40,000u vs Placebo=0.35, 95%CI, 0.01-9.43; odd ratio of 70,000u vs Placebo=0.29, 95%CI, 0.01-9.26; odd ratio of group 80,000u vs Placebo=0.22, 95%CI, 0.00-7.45). Three studies involving 739 patients showed that erythropoietin did not increase the incidence of deep vein thrombosis in patients with TBI. However, the risk tended to rise as the dose increases. Two studies demonstrated that erythropoietin did not increase the incidence of pulmonary embolism. The evidential quality of all the results of the evidence ranged from low to medium.Conclusion: Although the efficacy of erythropoietin was not statistically demonstrated, we found a trend in the association of erythropoietin dose with reduced mortality and increased embolic events in TBI patients. We are looking forward to more high-quality original studies focusing on the dose and timing of erythropoietin for the treatment of TBI, in order to obtain stronger evidence on the optimal erythropoietin dose.Study Registration: PROSPERO (CRD42021272500).

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Section: Discussionsupporting

confidence: 88%