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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

INTRODUCTION: Over the past few decades, advances in traumatic brain injury (TBI) pathology research have dynamically enriched our knowledge. Therefore, we aimed to systematically elucidate the safety and efficacy of erythropoietin (EPO) dosing regimens in patients with TBI. METHODS: Data search inc...

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Autores principales: Zheng, Qingyong, Duan, Dan, Xu, Jianguo, Wang, Xing, Ge, Yonggui, Xiong, Lu, Yang, Jingjing, Wulayin, Saimire, Luo, Xiaofeng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9793776/
https://www.ncbi.nlm.nih.gov/pubmed/36582613
http://dx.doi.org/10.3389/fneur.2022.998320
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author Zheng, Qingyong
Duan, Dan
Xu, Jianguo
Wang, Xing
Ge, Yonggui
Xiong, Lu
Yang, Jingjing
Wulayin, Saimire
Luo, Xiaofeng
author_facet Zheng, Qingyong
Duan, Dan
Xu, Jianguo
Wang, Xing
Ge, Yonggui
Xiong, Lu
Yang, Jingjing
Wulayin, Saimire
Luo, Xiaofeng
author_sort Zheng, Qingyong
collection PubMed
description INTRODUCTION: Over the past few decades, advances in traumatic brain injury (TBI) pathology research have dynamically enriched our knowledge. Therefore, we aimed to systematically elucidate the safety and efficacy of erythropoietin (EPO) dosing regimens in patients with TBI. METHODS: Data search included PubMed, the Cochrane Library, Embase, Web of Science, and ClinicalTrials.gov for related research published before July 2022. The network meta-analysis was conducted using ADDIS 1.16.8, and the CINeMA tool was used to assess the quality level of evidence. RESULTS: A total of six RCTs involving 981 patients were included in the network meta-analysis. EPO did not significantly reduce mortality in patients with TBI, but its risk of death decreased with increasing dosage (odds ratio (OR) of 12,000u vs. placebo = 0.98, 95% CI: 0.03–40.34; OR of group 30,000u vs. placebo = 0.56, 95% CI: 0.06–5.88; OR of 40,000u vs. placebo = 0.35, 95% CI: 0.01–9.43; OR of 70,000u vs. placebo = 0.29, 95% CI: 0.01–9.26; OR of group 80,000u vs. placebo = 0.22, 95% CI: 0.00–7.45). A total of three studies involving 739 patients showed that EPO did not increase the incidence of deep vein thrombosis in patients with TBI. However, the risk tended to rise as the dosage increased. Another two studies demonstrated that EPO did not increase the incidence of pulmonary embolism. The quality of evidence for all outcomes was low to moderate. CONCLUSION: Although the efficacy of EPO was not statistically demonstrated, we found a trend toward an association between EPO dosage and reduced mortality and increased embolic events in patients with TBI. More high-quality original studies should be conducted to obtain strong evidence on the optimal dosage of EPO. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=272500. The study protocol was registered with PROSPERO (CRD42021272500).
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spelling pubmed-97937762022-12-28 Comparative safety of multiple doses of erythropoietin for the treatment of traumatic brain injury: A systematic review and network meta-analysis Zheng, Qingyong Duan, Dan Xu, Jianguo Wang, Xing Ge, Yonggui Xiong, Lu Yang, Jingjing Wulayin, Saimire Luo, Xiaofeng Front Neurol Neurology INTRODUCTION: Over the past few decades, advances in traumatic brain injury (TBI) pathology research have dynamically enriched our knowledge. Therefore, we aimed to systematically elucidate the safety and efficacy of erythropoietin (EPO) dosing regimens in patients with TBI. METHODS: Data search included PubMed, the Cochrane Library, Embase, Web of Science, and ClinicalTrials.gov for related research published before July 2022. The network meta-analysis was conducted using ADDIS 1.16.8, and the CINeMA tool was used to assess the quality level of evidence. RESULTS: A total of six RCTs involving 981 patients were included in the network meta-analysis. EPO did not significantly reduce mortality in patients with TBI, but its risk of death decreased with increasing dosage (odds ratio (OR) of 12,000u vs. placebo = 0.98, 95% CI: 0.03–40.34; OR of group 30,000u vs. placebo = 0.56, 95% CI: 0.06–5.88; OR of 40,000u vs. placebo = 0.35, 95% CI: 0.01–9.43; OR of 70,000u vs. placebo = 0.29, 95% CI: 0.01–9.26; OR of group 80,000u vs. placebo = 0.22, 95% CI: 0.00–7.45). A total of three studies involving 739 patients showed that EPO did not increase the incidence of deep vein thrombosis in patients with TBI. However, the risk tended to rise as the dosage increased. Another two studies demonstrated that EPO did not increase the incidence of pulmonary embolism. The quality of evidence for all outcomes was low to moderate. CONCLUSION: Although the efficacy of EPO was not statistically demonstrated, we found a trend toward an association between EPO dosage and reduced mortality and increased embolic events in patients with TBI. More high-quality original studies should be conducted to obtain strong evidence on the optimal dosage of EPO. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=272500. The study protocol was registered with PROSPERO (CRD42021272500). Frontiers Media S.A. 2022-12-13 /pmc/articles/PMC9793776/ /pubmed/36582613 http://dx.doi.org/10.3389/fneur.2022.998320 Text en Copyright © 2022 Zheng, Duan, Xu, Wang, Ge, Xiong, Yang, Wulayin and Luo. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Zheng, Qingyong
Duan, Dan
Xu, Jianguo
Wang, Xing
Ge, Yonggui
Xiong, Lu
Yang, Jingjing
Wulayin, Saimire
Luo, Xiaofeng
Comparative safety of multiple doses of erythropoietin for the treatment of traumatic brain injury: A systematic review and network meta-analysis
title Comparative safety of multiple doses of erythropoietin for the treatment of traumatic brain injury: A systematic review and network meta-analysis
title_full Comparative safety of multiple doses of erythropoietin for the treatment of traumatic brain injury: A systematic review and network meta-analysis
title_fullStr Comparative safety of multiple doses of erythropoietin for the treatment of traumatic brain injury: A systematic review and network meta-analysis
title_full_unstemmed Comparative safety of multiple doses of erythropoietin for the treatment of traumatic brain injury: A systematic review and network meta-analysis
title_short Comparative safety of multiple doses of erythropoietin for the treatment of traumatic brain injury: A systematic review and network meta-analysis
title_sort comparative safety of multiple doses of erythropoietin for the treatment of traumatic brain injury: a systematic review and network meta-analysis
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9793776/
https://www.ncbi.nlm.nih.gov/pubmed/36582613
http://dx.doi.org/10.3389/fneur.2022.998320
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