Research from JAMA Ophthalmology — Efficacy and Safety of Trabeculectomy vs Nonpenetrating Surgical Procedures — A Systematic Review and Meta-analysis

Context: GH excess causes an increase in bone turnover, but the consequences in terms of skeletal fragility have long been uncertain due to the heterogeneity of studies dealing with this topic. Objective: We conducted a meta-analysis of studies examining the effects of acromegaly on bone turnover, bone mineral density (BMD), and fractures. Furthermore, we evaluated the effects of sex, gonadal status, and activity of disease on skeletal end-points in acromegaly. Data Sources: We conducted MEDLINE and EMBASE systematic searches up to December 31, 2013. Study Eligibility Criteria: Studies conducted in patients with acromegaly and reporting at least one determinant of skeletal fragility. Data Extraction and Analysis: Study design, patient characteristics, interventions, and outcomes were independently extracted by two authors. We calculated the standardized mean difference (SMD) of bone turnover and BMD differences, whereas fractures were presented as relative frequencies in acromegaly and odds ratios between patients and controls. Results: Forty-one studies fulfilled eligibility criteria and were therefore selected for data extraction and analysis. A total of 1935 patients were included (eight to 206 per study). Acromegaly patients had higher bone formation (SMD, 1.49; 95% confidence interval [CI], 0.97–2.01; P < .0001) and bone resorption (SMD, 1.57; 95% CI, 1.03–2.10; P < .0001) as compared to control subjects, without significant differences in lumbar spine BMD. BMD at the femoral neck tended to be higher in acromegaly patients vs control subjects (SMD, 0.67; 95% CI, 0.07–1.27; P = .03). Patients with acromegaly had high frequency of vertebral fractures (odds ratio, 8.26; 95% CI, 2.91–23.39; P < .0001), in close relationship with male gender, hypogonadism, and active acromegaly. Limitations: Limitations included heterogeneous study protocols with possible variability in the assessment of skeletal end-points. Conclusions: Skeletal fragility is an emerging complication of acromegaly.

Purpose: To estimate the intraocular pressure (IOP)-lowering effect of prostaglandin analogs (PGAs) administered in combination with β-blockers. Methods: We searched the Medline and Embase databases for randomized trials comparing topical therapies with PGAs and timolol administered as monotherapy (Mt), or in fixed (FC) or unfixed combinations (UC) to patients with glaucoma or ocular hypertension. The efficacy endpoint was the mean difference (MeD) in the reduction in IOP from baseline; the tolerability endpoint was the incidence of hyperemia. Results: The 18 eligible trials involved 23 comparisons of FC versus Mt, and 5 of FC versus UC. The FCs were less efficacious than UCs (MeD: 0.69, 95% CI: 0.29 to 1.08). In comparison with timolol Mt, the latanoprost/timolol FC led to a greater IOP reduction (MeD: −2.74, 95% CI: −3.24 to −2.23) than the bimatoprost/timolol FC (MeD: −1.49, 95% CI: −1.86 to −1.12) or the travoprost/timolol FC (MeD: −1.93, 95%CI: −2.98 to −0.88). The FCs led to a lower hyperemia risk than UCs [relative risk (RR): 0.70, 95% CI: 0.43 to 1.14] and PGA Mt (RR: 0.61, 95% CI: 0.53 to 0.70). Conclusions: FCs are more efficacious than their individual components, but less efficacious than their respective UCs. FCs lead to a lower hyperemia risk than UCs and their respective PGA Mts.

The platinum‐free interval is the most important predictive factor of a response to subsequent lines of chemotherapy and the most important prognostic factor for progression‐free and overall survival in patients with recurrent epithelial ovarian cancer. A nonplatinum regimen is generally considered the most appropriate approach when the disease recurs very early after the end of chemotherapy, whereas platinum‐based chemotherapy is usually adopted when the platinum‐free interval exceeds 12 months. However, the therapeutic management of patients with intermediate sensitivity (ie, when the relapse occurs between 6 and 12 months) remains debatable. Preclinical and clinical data suggest that the extension of platinum‐free interval (using a nonplatinum‐based regimen) might restore platinum sensitivity, thus allowing survival improvement. The objective of this review was to critically analyze preclinical and clinical evidences supporting this hypothesis. Cancer 2017;123:3450‐9. © 2017 American Cancer Society.