Heterogeneity of treatment response to beta-blockers in the treatment of portal hypertension: a systematic review
Background: It has been suggested that a relevant proportion of patients do not respond to nonselective beta-blockers (NSBB)s, which raises questions regarding the need for individualized therapy. The existence of potential heterogeneity in the treatment response can be assessed using the variabilit...
| Autores: | , , , , , , , , |
|---|---|
| Tipo de recurso: | artículo |
| Fecha de publicación: | 2024 |
| País: | España |
| Institución: | Universitat Politècnica de Catalunya (UPC) |
| Repositorio: | UPCommons. Portal del coneixement obert de la UPC |
| Idioma: | inglés |
| OAI Identifier: | oai:upcommons.upc.edu:2117/400928 |
| Acceso en línea: | https://hdl.handle.net/2117/400928 https://dx.doi.org/10.1097/HC9.0000000000000321 |
| Access Level: | acceso abierto |
| Palabra clave: | Medical statistics Estadística mèdica Classificació AMS::62 Statistics::62H Multivariate analysis Àrees temàtiques de la UPC::Matemàtiques i estadística::Estadística aplicada::Estadística biosanitària |
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Heterogeneity of treatment response to beta-blockers in the treatment of portal hypertension: a systematic reviewAlsaeid, MohammadSung, ShuenBai, WayneTam, MatthewWong, Yu JunCortés Martínez, Jordi|||0000-0002-3764-0795Cobo Valeri, Erik|||0000-0002-3534-5602González Alastrué, José Antonio|||0000-0002-3113-4779González Abraldes, JuanMedical statisticsEstadística mèdicaClassificació AMS::62 Statistics::62H Multivariate analysisÀrees temàtiques de la UPC::Matemàtiques i estadística::Estadística aplicada::Estadística biosanitàriaBackground: It has been suggested that a relevant proportion of patients do not respond to nonselective beta-blockers (NSBB)s, which raises questions regarding the need for individualized therapy. The existence of potential heterogeneity in the treatment response can be assessed using the variability ratio (VR) of the outcome measurement (in this case, HVPG) between the treated and placebo groups. We conducted a systematic review and meta-analysis of randomized controlled trials to assess the potential heterogeneity in the portal pressure response to NSBBs. Methods: After a systematic search, we quantified the heterogeneity of treatment response with the VR between the treatment and control groups, with VR > 1 indicating potential heterogeneity. We used a similar approach to compare carvedilol with propranolol and statins with placebo. Results: We identified 18 studies that included 965 patients. A comparison between beta-blockers and placebo showed a pooled VR of 0.99 (95% CI:0.87–1.14), which suggests a homogeneous HVPG response to NSBB at the individual patient level (ie, no evidence to support that some patients responded to beta-blockers and others did not). For the comparison between carvedilol and propranolol, pooled VR was 0.97 (95% CI 0.82–1.14), suggesting that carvedilol achieves a greater average response (rather than an increase in the proportion of responders). There was no evidence of a heterogeneous response to statins. Conclusion: Our analysis did not support the existence of a heterogeneous patient-by-patient response to NSBBs in cirrhosis. These findings challenge the concept of personalized therapy based on portal pressure response and indicate that routine portal pressure measurement may not be necessary to guide NSBB therapy.The authors JC and EC acknowledge the support of the Ministerio de Ciencia e Innovación (Spain) [PID2019- 104830RB-I00/ DOI (AEI): 10.13039/501100011033] and the Generalitat de Catalunya (Spain) (2021SGR01421).Peer Reviewed20242024-02-0120242024-02-05journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/2117/400928https://dx.doi.org/10.1097/HC9.0000000000000321reponame:UPCommons. Portal del coneixement obert de la UPCinstname:Universitat Politècnica de Catalunya (UPC)InglésengAgencia Estatal de Investigación http://doi.org/10.13039/501100011033 Plan Estatal de Investigación Científica y Técnica y de Innovación 2017-2020 PID2019-104830RB-I00 METODOLOGIAS ESTADISTICAS PARA DATOS CLINICOS Y OMICOS Y SUS APLICACIONES EN CIENCIAS DE LA SALUDopen accesshttp://purl.org/coar/access_right/c_abf2Attribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:upcommons.upc.edu:2117/4009282026-05-27T15:37:01Z |
| dc.title.none.fl_str_mv |
Heterogeneity of treatment response to beta-blockers in the treatment of portal hypertension: a systematic review |
| title |
Heterogeneity of treatment response to beta-blockers in the treatment of portal hypertension: a systematic review |
| spellingShingle |
Heterogeneity of treatment response to beta-blockers in the treatment of portal hypertension: a systematic review Alsaeid, Mohammad Medical statistics Estadística mèdica Classificació AMS::62 Statistics::62H Multivariate analysis Àrees temàtiques de la UPC::Matemàtiques i estadística::Estadística aplicada::Estadística biosanitària |
| title_short |
Heterogeneity of treatment response to beta-blockers in the treatment of portal hypertension: a systematic review |
| title_full |
Heterogeneity of treatment response to beta-blockers in the treatment of portal hypertension: a systematic review |
| title_fullStr |
Heterogeneity of treatment response to beta-blockers in the treatment of portal hypertension: a systematic review |
| title_full_unstemmed |
Heterogeneity of treatment response to beta-blockers in the treatment of portal hypertension: a systematic review |
| title_sort |
Heterogeneity of treatment response to beta-blockers in the treatment of portal hypertension: a systematic review |
| dc.creator.none.fl_str_mv |
Alsaeid, Mohammad Sung, Shuen Bai, Wayne Tam, Matthew Wong, Yu Jun Cortés Martínez, Jordi|||0000-0002-3764-0795 Cobo Valeri, Erik|||0000-0002-3534-5602 González Alastrué, José Antonio|||0000-0002-3113-4779 González Abraldes, Juan |
| author |
Alsaeid, Mohammad |
| author_facet |
Alsaeid, Mohammad Sung, Shuen Bai, Wayne Tam, Matthew Wong, Yu Jun Cortés Martínez, Jordi|||0000-0002-3764-0795 Cobo Valeri, Erik|||0000-0002-3534-5602 González Alastrué, José Antonio|||0000-0002-3113-4779 González Abraldes, Juan |
| author_role |
author |
| author2 |
Sung, Shuen Bai, Wayne Tam, Matthew Wong, Yu Jun Cortés Martínez, Jordi|||0000-0002-3764-0795 Cobo Valeri, Erik|||0000-0002-3534-5602 González Alastrué, José Antonio|||0000-0002-3113-4779 González Abraldes, Juan |
| author2_role |
author author author author author author author author |
| dc.subject.none.fl_str_mv |
Medical statistics Estadística mèdica Classificació AMS::62 Statistics::62H Multivariate analysis Àrees temàtiques de la UPC::Matemàtiques i estadística::Estadística aplicada::Estadística biosanitària |
| topic |
Medical statistics Estadística mèdica Classificació AMS::62 Statistics::62H Multivariate analysis Àrees temàtiques de la UPC::Matemàtiques i estadística::Estadística aplicada::Estadística biosanitària |
| description |
Background: It has been suggested that a relevant proportion of patients do not respond to nonselective beta-blockers (NSBB)s, which raises questions regarding the need for individualized therapy. The existence of potential heterogeneity in the treatment response can be assessed using the variability ratio (VR) of the outcome measurement (in this case, HVPG) between the treated and placebo groups. We conducted a systematic review and meta-analysis of randomized controlled trials to assess the potential heterogeneity in the portal pressure response to NSBBs. Methods: After a systematic search, we quantified the heterogeneity of treatment response with the VR between the treatment and control groups, with VR > 1 indicating potential heterogeneity. We used a similar approach to compare carvedilol with propranolol and statins with placebo. Results: We identified 18 studies that included 965 patients. A comparison between beta-blockers and placebo showed a pooled VR of 0.99 (95% CI:0.87–1.14), which suggests a homogeneous HVPG response to NSBB at the individual patient level (ie, no evidence to support that some patients responded to beta-blockers and others did not). For the comparison between carvedilol and propranolol, pooled VR was 0.97 (95% CI 0.82–1.14), suggesting that carvedilol achieves a greater average response (rather than an increase in the proportion of responders). There was no evidence of a heterogeneous response to statins. Conclusion: Our analysis did not support the existence of a heterogeneous patient-by-patient response to NSBBs in cirrhosis. These findings challenge the concept of personalized therapy based on portal pressure response and indicate that routine portal pressure measurement may not be necessary to guide NSBB therapy. |
| publishDate |
2024 |
| dc.date.none.fl_str_mv |
2024 2024-02-01 2024 2024-02-05 |
| dc.type.none.fl_str_mv |
journal article http://purl.org/coar/resource_type/c_6501 VoR http://purl.org/coar/version/c_970fb48d4fbd8a85 |
| dc.type.openaire.fl_str_mv |
info:eu-repo/semantics/article |
| format |
article |
| dc.identifier.none.fl_str_mv |
https://hdl.handle.net/2117/400928 https://dx.doi.org/10.1097/HC9.0000000000000321 |
| url |
https://hdl.handle.net/2117/400928 https://dx.doi.org/10.1097/HC9.0000000000000321 |
| dc.language.none.fl_str_mv |
Inglés eng |
| language_invalid_str_mv |
Inglés |
| language |
eng |
| dc.relation.none.fl_str_mv |
Agencia Estatal de Investigación http://doi.org/10.13039/501100011033 Plan Estatal de Investigación Científica y Técnica y de Innovación 2017-2020 PID2019-104830RB-I00 METODOLOGIAS ESTADISTICAS PARA DATOS CLINICOS Y OMICOS Y SUS APLICACIONES EN CIENCIAS DE LA SALUD |
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open access http://purl.org/coar/access_right/c_abf2 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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info:eu-repo/semantics/openAccess |
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open access http://purl.org/coar/access_right/c_abf2 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
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openAccess |
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application/pdf |
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