Table1_Effectiveness Comparisons of Drug Therapy on Chronic Subdural Hematoma Recurrence: A Bayesian Network Meta-Analysis and Systematic Review.DOCX

Objectives: We aim to compare the effectiveness of different drug treatments in improving recurrence in patients with chronic subdural hematoma (CSDH).Methods: Eligible randomized controlled trials (RCTs) and prospective trials were searched in PubMed, Cochrane Library, and Embase, from database inception to December 2021. After the available studies following inclusion and exclusion criteria were screened, the main outcome measures were strictly extracted. Taking the random-effects model, dichotomous data were determined and extracted by odds ratio (OR) with 95% credible interval (CrI), and a surface under the cumulative ranking curve (SUCRA) was generated to calculate the ranking probability of comparative effectiveness among each drug intervention. Moreover, we used the node-splitting model to evaluate inconsistency between direct and indirect comparisons of our network meta-analysis (NMA). Funnel plots were used to evaluate publication bias.Results: From the 318 articles found during initial citation screening, 11 RCTs and 3 prospective trials (n = 3,456 participants) were ultimately included in our study. Our NMA results illustrated that atorvastatin + dexamethasone (ATO+DXM) (OR = 0.06, 95% CrI 0.01, 0.89) was the most effective intervention to improve recurrence in patients with CSDH (SUCRA = 89.40%, 95% CrI 0.29, 1.00). Four drug interventions [ATO+DXM (OR = 0.06, 95% CrI 0.01, 0.89), DXM (OR = 0.18, 95% CrI 0.07, 0.41), tranexamic acid (TXA) (OR = 0.26, 95% CrI 0.07, 0.41), and ATO (OR = 0.41, 95% CrI 0.12, 0.90)] achieved statistical significance in improving recurrence in CSDH patients compared with the placebo (PLB) or standard neurosurgical treatment (SNT) group.Conclusion: Our NMA showed that ATO+DXM, DXM, ATO, and TXA had definite efficacy in improving recurrence in CSDH patients. Among them, ATO+DXM is the best intervention for improving recurrence in patients with CSDH in this particular population. Multicenter rigorous designed prospective randomized trials are still needed to evaluate the role of various drug interventions in improving neurological function or outcome.Systematic Review Registration: (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299491), identifier (CRD 42022299491).

研究目标：本研究的旨在比较不同药物治疗在改善慢性硬脑膜下血肿（CSDH）患者复发率方面的有效性。研究方法：从数据库建立之初至2021年12月，在PubMed、Cochrane图书馆和Embase数据库中检索了符合纳入和排除标准的合格随机对照试验（RCTs）和前瞻性研究。在筛选出符合条件的研究后，严格提取了主要结局指标。采用随机效应模型，通过计算优势比（OR）及其95%置信区间（CrI）确定二元数据，并生成累积排序曲线下面积（SUCRA）以计算各药物干预的相对有效性排名概率。此外，我们运用节点拆分模型评估了网络meta分析（NMA）中直接和间接比较的不一致性。采用漏斗图评估发表偏倚。研究结果：在初步文献筛选中发现的318篇文章中，最终纳入了11项RCTs和3项前瞻性研究（共3456名参与者）。我们的NMA结果表明，阿托伐他汀+地塞米松（ATO+DXM）（OR = 0.06，95% CrI 0.01，0.89）是改善CSDH患者复发的最有效干预措施（SUCRA = 89.40%，95% CrI 0.29，1.00）。四种药物干预[ATO+DXM（OR = 0.06，95% CrI 0.01，0.89）、DXM（OR = 0.18，95% CrI 0.07，0.41）、氨甲环酸（TXA）（OR = 0.26，95% CrI 0.07，0.41）和阿托伐他汀（ATO）（OR = 0.41，95% CrI 0.12，0.90）]与安慰剂（PLB）或标准神经外科治疗（SNT）组相比，在改善CSDH患者复发率方面具有统计学意义。结论：我们的NMA表明，ATO+DXM、DXM、ATO和TXA在改善CSDH患者复发率方面具有确切的疗效。其中，ATO+DXM是改善特定人群CSDH患者复发率的最优干预措施。仍需进行多中心严格设计的前瞻性随机试验，以评估各种药物干预在改善神经功能或结果中的作用。系统评价注册：[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299491]，标识符（CRD 42022299491）。