Evidence map›Paper›PMID 35030189›Full record

SynthesisPloS one

Effects of replacement therapies with clotting factors in patients with hemophilia: A systematic review and meta-analysis.

Carolina J Delgado-Flores, David García-Gomero, Stefany Salvador-Salvador, José Montes-Alvis, Celina Herrera-Cunti, Alvaro Taype-Rondan

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PloS one. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
1.8field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 12 citations in OpenAlex.

  1. Review
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  4. Article
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 2 countries.

Carolina J Delgado-FloresInstituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud, Lima, Peru.
David García-GomeroFacultad de Medicina "San Fernando", Universidad Nacional Mayor de San Marcos, Lima, Peru.
Stefany Salvador-SalvadorInstituto de Evaluación de Tecnologías en Salud e Investigación - IETSI, EsSalud, Lima, Peru.
José Montes-AlvisEviSalud Evidencias en Salud, Lima, Peru.
Celina Herrera-CuntiHospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.
Alvaro Taype-RondanUnidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.ORCID https://orcid.org/0000-0001-8758-0463
EsSALUD · PEHospital Base Guillermo Almenara Irigoyen · PENational University of San Marcos · PEUniversidad San Ignacio de Loyola · PE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDifferent prophylactic and episodic clotting factor treatments are used in the management of hemophilia. A summarize of the evidence is needed inform decision-making.

objectiveTo compare the effects of factor replacement therapies in patients with hemophilia.

methodsWe performed a systematic search in PubMed, Central Cochrane Library, and Scopus. We included randomized controlled trials (RCTs) published up to December 2020, which compared different factor replacement therapies in patients with hemophilia. Random-effects meta-analyses were performed whenever possible. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42021225857).

resultsNine RCTs were included in this review, of which six compared episodic with prophylactic treatment, all of them performed in patients with hemophilia A. Pooled results showed that, compared to the episodic treatment group, the annualized bleeding rate was lower in the low-dose prophylactic group (ratio of means [RM]: 0.27, 95% CI: 0.17 to 0.43), intermediate-dose prophylactic group (RM: 0.15, 95% CI: 0.07 to 0.36), and high-dose prophylactic group (RM: 0.07, 95% CI: 0.04 to 0.13). With significant difference between these subgroups (p = 0.003, I2 = 82.9%). In addition, compared to the episodic treatment group, the annualized joint bleeding rate was lower in the low-dose prophylactic group (RM: 0.17, 95% CI: 0.06 to 0.43), intermediate-dose prophylactic group (RM of 0.14, 95% CI: 0.07 to 0.27), and high-dose prophylactic group (RM of 0.08, 95% CI: 0.04 to 0.16). Without significant subgroup differences. The certainty of the evidence was very low for all outcomes according to GRADE methodology. The other studies compared different types of clotting factor concentrates (CFCs), assessed pharmacokinetic prophylaxis, or compared different frequencies of medication administration.

conclusionsOur results suggest that prophylactic treatment (at either low, intermediate, or high doses) is superior to episodic treatment for bleeding prevention. In patients with hemophilia A, the bleeding rate seems to have a dose-response effect. However, no study compared different doses of prophylactic treatment, and all results had a very low certainty of the evidence. Thus, future studies are needed to confirm these results and inform decision making.

Indexed as

Blood Coagulation FactorsFactor IXFactor VIIIFemaleHemarthrosisHemophilia AHemophilia BHemorrhageHumansMalePre-Exposure ProphylaxisRandomized Controlled Trials as TopicBlood Coagulation FactorsFactor IXFactor VIII

Identifiers

PMID35030189
PMCPMC8759703
OpenAlexW4206450213

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.