PMID- 36465804
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221206
IS  - 2296-6870 (Electronic)
IS  - 2296-6870 (Linking)
VI  - 7
IP  - 3
DP  - 2022 Sep-Dec
TI  - Comparison of Various Pharmacologic Agents in the Management of Hemodynamically 
      Significant Patent Ductus Arteriosus in Preterm: A Network Meta-Analysis and 
      Risk-Benefit Analysis.
PG  - 125-145
LID - 10.1159/000526318 [doi]
AB  - INTRODUCTION: Various pharmacological treatments are available for preterm 
      infants with patent ductus arteriosus (PDA), but their risks and benefits are 
      controversial. This study aimed to identify the best treatment for PDA using 
      network meta-analysis (NMA) and risk-benefit assessment (RBA). METHODS: Relevant 
      randomized controlled trials (RCTs) were identified from MEDLINE, Scopus, and the 
      Cochrane Library. RCTs were eligible if they were studied for preterm or low 
      birth weight infants with presymptomatic PDA and hemodynamically significant PDA 
      (hsPDA). The outcomes were PDA closure for a benefit and the composite risk 
      outcome of adverse effects (AEs) for risk. An NMA was used to estimate the 
      treatment effects of benefit and risk. The RBA helped to incorporate the risk and 
      benefits of multiple treatments. Then, an incremental risk-benefit ratio was 
      calculated by dividing the incremental risk by benefit using data from NMA, and 
      they were jointly simulated using Monte Carlo methods. Finally, net clinical 
      benefit (NCB) probability curves were constructed at varying acceptability 
      thresholds. RESULTS: Seventy RCTs with hsPDA were eligible considering 13 
      different interventions, but data on presymptomatic PDA were not enough for 
      pooling. The clustered ranking plot from NMA indicated that 3 interventions 
      (i.e., high-dose oral ibuprofen, standard-dose oral acetaminophen, and 
      standard-dose oral ibuprofen) yielded high PDA closure and low AE. These three 
      treatments and additional commonly used indomethacin were considered in the RBA. 
      Given an acceptable threshold of 25% or having one AE out of four PDA closures, 
      high-dose oral ibuprofen had a 36% chance of having the highest NCB, followed by 
      standard-dose oral acetaminophen (27%), and oral ibuprofen (23.7%). Subgroup 
      analysis indicated that the chances of having the highest NCB of GA >/=28 weeks 
      were similar to that of all available studies. The best for GA <28 weeks, no data 
      for high-dose oral ibuprofen, was standard-dose oral acetaminophen, followed by 
      standard-dose oral ibuprofen. CONCLUSIONS: Trade-off RBA indicated that high-dose 
      oral ibuprofen might be the best treatment for preterm, GA >/=28 weeks, with hsPDA 
      followed by the standard-dose oral acetaminophen and ibuprofen. Preferably, 
      optimal high doses, postnatal age to start treatment, and long-term outcomes are 
      needed to study in the future.
CI  - Copyright (c) 2022 by The Author(s). Published by S. Karger AG, Basel.
FAU - Eursiriwan, Sudarat
AU  - Eursiriwan S
AD  - Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
AD  - Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Vajira Hospital, 
      Navamindradhiraj University, Bangkok, Thailand.
FAU - Okascharoen, Chusak
AU  - Okascharoen C
AD  - Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
AD  - Neonatal Unit, Department of Pediatrics, Faculty of Medicine, Ramathibodi 
      Hospital, Mahidol University, Bangkok, Thailand.
FAU - Vallibhakara, Sakda Arj-Ong
AU  - Vallibhakara SA
AD  - Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
FAU - Pattanaprateep, Oraluck
AU  - Pattanaprateep O
AD  - Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
FAU - Numthavaj, Pawin
AU  - Numthavaj P
AD  - Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
FAU - Attia, John
AU  - Attia J
AD  - Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, 
      Newcastle, New South Wales, Australia.
FAU - Thakkinstian, Ammarin
AU  - Thakkinstian A
AD  - Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, 
      Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20221024
PL  - Switzerland
TA  - Biomed Hub
JT  - Biomedicine hub
JID - 101692630
PMC - PMC9710462
OTO - NOTNLM
OT  - Acetaminophen
OT  - Hemodynamically significant patent ductus arteriosus
OT  - Ibuprofen
OT  - Indomethacin
OT  - Patent ductus arteriosus
OT  - Preterm
OT  - Risk-benefit analysis
COIS- The authors have no conflicts of interest to declare.
EDAT- 2022/12/06 06:00
MHDA- 2022/12/06 06:01
PMCR- 2022/10/24
CRDT- 2022/12/05 03:49
PHST- 2021/03/27 00:00 [received]
PHST- 2022/07/27 00:00 [accepted]
PHST- 2022/12/05 03:49 [entrez]
PHST- 2022/12/06 06:00 [pubmed]
PHST- 2022/12/06 06:01 [medline]
PHST- 2022/10/24 00:00 [pmc-release]
AID - bmh-0007-0125 [pii]
AID - 10.1159/000526318 [doi]
PST - epublish
SO  - Biomed Hub. 2022 Oct 24;7(3):125-145. doi: 10.1159/000526318. eCollection 2022 
      Sep-Dec.