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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Neurotrauma
2016 ; 33
(5
): 468-81
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Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries:
A Systematic Review and Meta-Analysis
#MMPMID26529320
Evaniew N
; Belley-Côté EP
; Fallah N
; Noonan VK
; Rivers CS
; Dvorak MF
J Neurotrauma
2016[Mar]; 33
(5
): 468-81
PMID26529320
show ga
Previous meta-analyses of methylprednisolone (MPS) for patients with acute
traumatic spinal cord injuries (TSCIs) have not addressed confidence in the
quality of evidence used for pooled effect estimates, and new primary studies
have been recently published. We aimed to determine whether MPS improves motor
recovery and is associated with increased risks for adverse events. We searched
MEDLINE, EMBASE, and The Cochrane Library, and two reviewers independently
screened articles, extracted data, and evaluated risk of bias. We pooled outcomes
from randomized, controlled trials (RCTs) and controlled observational studies
separately and used the Grades of Recommendation, Assessment, Development, and
Evaluation approach to evaluate confidence. We included four RCTs and 17
observational studies. MPS was not associated with an increase in long-term motor
score recovery (two RCTs: 335 participants; mean difference [MD], -1.11; 95%
confidence interval [CI], -4.75 to 2.53; p = 0.55, low confidence; two
observational studies: 528 participants; MD, 1.37; 95% CI, -3.08 to 5.83; p =
0.55, very low confidence) or improvement by at least one motor grade (three
observational studies: 383 participants; risk ratio [RR], 0.84; 95% CI,
0.53-1.33; p = 0.46, very low confidence). Evidence from two RCTs demonstrated
superior short-term motor score improvement if MPS was administered within 8 h of
injury (two RCTs: 250 participants; MD, 4.46; 95% CI, 0.97-7.94; p = 0.01, low
confidence), but risk of bias and imprecision limit confidence in these findings.
Observational studies demonstrated a significantly increased risk for
gastrointestinal bleeding (nine studies: 2857 participants; RR, 2.18; 95% CI,
1.13-4.19; p = 0.02, very low confidence), but RCTs did not. Pooled evidence does
not demonstrate a significant long-term benefit for MPS in patients with acute
TSCIs and suggests it may be associated with increased gastrointestinal bleeding.
These findings support current guidelines against routine use, but strong
recommendations are not warranted because confidence in the effect estimates is
limited.
|Acute Disease
[MESH]
|Anti-Inflammatory Agents/adverse effects/*therapeutic use
[MESH]
|Hemorrhage/chemically induced
[MESH]
|Humans
[MESH]
|Methylprednisolone/adverse effects/*therapeutic use
[MESH]
|Randomized Controlled Trials as Topic/methods
[MESH]