Recently Published Projects

Published on June 23, 2021
Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: An update of the 2007 Comparative Effectiveness Review [Entered Retrospectively]
221 Studies • 2 Key Questions • 221 Extraction Forms
Project created on June 23, 2021
Last updated on June 23, 2021
Objectives: Background: Depressive disorders such as major depressive disorder (MDD), dysthymia, and subsyndromal depression may be serious disabling illnesses. MDD affects more than 16 percent of adults at some point during their lifetimes. Second-generation antidepressants dominate the medical management of depressive disorders. These drugs include selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and other drugs with related mechanisms of action that selectively target neurotransmitters. Objectives: The objective of this report was to compare the benefits and harms of bupropion, citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine for the treatment of depressive disorders, including variations of effects in patients with accompanying symptoms and patient subgroups. Data Sources: We updated a comparative effectiveness review published in 2007 by the Agency for Healthcare Research and Quality searching PubMed, Embase, The Cochrane Library, and International Pharmaceutical Abstracts up to January 2011. Review Methods: Two people independently reviewed the literature, abstracted data, and rated the risk of bias. If data were sufficient, we conducted meta-analyses of head-to-head trials of the relative benefit of response to treatment. In addition, we conducted mixed treatment comparisons to derive indirect estimates of the comparative efficacy among all second-generation antidepressants. Results: From a total of 3,722 citations, we identified 248 studies of good or fair quality. Overall, no substantial differences in efficacy could be detected among second-generation antidepressants for the treatment of acute-phase MDD. Statistically significant differences in response rates between some drugs are small and likely not clinically relevant. No differences in efficacy were apparent in patients with accompanying symptoms or in subgroups based on age, sex, ethnicity, or comorbidities, although evidence within these subpopulations was limited. Differences exist in the incidence of specific adverse events and the onset of action. Venlafaxine leads to higher rates of nausea and vomiting, sertraline to higher rates of diarrhea, and mirtazapine to higher rates of weight gain than comparator drugs. Bupropion causes lower rates of sexual dysfunction than other antidepressants. The evidence is insufficient to draw conclusions about the comparative efficacy and effectiveness for the treatment of dysthymia and subsyndromal depression. Conclusions: Our findings indicate that the existing evidence does not warrant the choice of one second-generation antidepressant over another based on greater efficacy and effectiveness. Differences with respect to onset of action and adverse events may be taken into consideration for the choice of a medication.
Published on June 23, 2021
Imaging for the Pretreatment Staging of Small Cell Lung Cancer
7 Studies • 3 Key Questions • 7 Extraction Forms
Project created on June 23, 2021
Last updated on June 23, 2021
Objectives: Systematic Review for AHRQ EPC Program
Published on June 23, 2021
Imaging Techniques for the Diagnosis and Staging of Hepatocellular Carcinoma [Retrospectively Entered]
281 Studies • 9 Key Questions • 281 Extraction Forms
Project created on June 23, 2021
Last updated on June 23, 2021
Objectives: Hepatocellular carcinoma (HCC) is the most common primary malignant neoplasm of the liver, and accurate diagnosis and staging of HCC are important for guiding treatment and other clinical decisions. A number of imaging modalities are available for detection of HCC in surveillance and non-surveillance settings, evaluation of focal liver lesions to identify HCC, and staging of HCC. The purpose of this review is to compare the effectiveness of imaging techniques for HCC on test performance, clinical decisionmaking, clinical outcomes, and harms.
Published on June 23, 2021
Interventions to Reduce Antibiotic Prescribing for Uncomplicated Acute Respiratory Tract Infections [Entered Retrospectively]
133 Studies • 6 Key Questions • 133 Extraction Forms
Project created on June 23, 2021
Last updated on June 23, 2021
Objectives: Objectives. To assess the comparative effectiveness of interventions for reducing antibiotic use for acute respiratory tract infections (RTIs) in adults and children. Data Sources. Electronic databases (MEDLINE® from 1990 and the Cochrane Library databases from 2005 to February 2015), reference lists of included systematic reviews, and scientific information packets from of point-of-care test manufacturers and experts. Review Methods. Using predefined criteria, we selected studies of any intervention designed to reduce antibiotic prescribing for acute RTIs. Interventions were organized into educational, communication, clinical, system level, and multifaceted categories. The key outcome was change in prescribing; secondary outcomes were undesirable consequences such as medical complications and satisfaction. The quality of included studies was rated and the strength of the evidence was assessed. Clinical and methodological heterogeneity limited quantitative analysis. Our synthesis focused on interventions that had evidence of net benefit: at least moderate strength of evidence for decreasing overall prescribing of antibiotics for acute RTI and at least low strength evidence for other outcomes. Results. Based on 132 studies, including 88 randomized controlled trials, several interventions had net benefit. Compared with usual care, reductions in overall prescribing were 21 percent for clinic-based educational programs for parents, 7 percent for public education campaigns combined with clinician education, 9 to 26 percent for communication training, 5 to 9 percent for electronic decision support, 2 to 34 percent for C-reactive protein (CRP), 12 to 72 percent for procalcitonin in adults, and >25 percent for clinician communication training plus CRP testing. Delayed prescribing reduced use by 34 to 76 percent compared with immediate prescribing. Additionally, public education campaigns combined with clinician education and electronic decision support possibly improved appropriate prescribing. Interventions varied in their effects on other outcomes. Few studies assessed impact on the most serious undesirable outcomes, but in those that did, there were no increases in medical complications for public education campaigns combined with clinician education or electronic decision support and, for hospitalizations, no increases for CRP or procalcitonin and only a slight increase for communication+CRP. Negative impacts on less serious outcomes were few and small: more return visits with CRP testing, slightly longer symptom duration with communication training plus CRP testing, and decreased patient satisfaction and slightly longer symptom duration with delayed prescribing. Direct comparisons of interventions were few; only clinician communication training plus CRP testing showed net benefit over CRP testing alone. Interventions with no or negative impact on antibiotic prescribing were procalcitonin in children, clinic-based education for parents of children ≤24 months with acute otitis media, and point-of-care testing for influenza in children. Conclusions. Interventions from all categories had evidence of net benefit and no serious adverse consequences. Magnitude of benefit varied widely and current evidence is inadequate to determine key modifying factors. Future studies need to better evaluate potential effect modifiers, and directly compare the effective interventions individually and combined, on net benefit, sustainability, and resource use.
Published on June 23, 2021
Imaging Techniques for Treatment Evaluation for Metastatic Breast Cancer [Retrospectively Entered]
17 Studies • 11 Key Questions • 17 Extraction Forms
Project created on June 23, 2021
Last updated on June 23, 2021
Objectives: The purpose of this technical brief is to understand current utilization of metastatic breast imaging modalities for treatment evaluation in the United States, both in order to summarize the current state of the science and to inform future research on this topic.