In another, there was limited evidence of greater efficacy than azathioprine in people with pemphigus vulgaris (Martin 2009)

In another, there was limited evidence of greater efficacy than azathioprine in people with pemphigus vulgaris (Martin 2009). a number of non\randomised studies during the search, the results of which we considered in the Discussion. Data collection and analysis We followed standard Cochrane methodology. Main results We recognized no new trials during this update of the review. In previous versions of this review we recognized only very low quality evidence for four different interventions published in four studies. Each study experienced a high risk of bias in at least one respect. One RCT with 19 participants comparing interferon beta\1a and placebo showed no ST3932 clinically important difference in any end result between groups. Another with 10 participants comparing brain\derived neurotrophic factor and placebo showed no clinically important difference in any end result between groups. A third with 37 participants comparing cerebrospinal fluid filtration and plasma exchange also showed no clinically important difference in any end result between groups. In a fourth with 43 participants, the risk ratio for an improvement by one or more disability grade after eight weeks was greater with the Chinese herbal medicine tripterygium polyglycoside than with corticosteroids (risk ratio 1.47; 95% confidence interval 1.02 to 2.11); other outcomes in this trial showed no difference. Serious adverse events were uncommon with each of these treatments and in the control groups. Authors’ conclusions The quality of the evidence was very low. Three small RCTs, comparing interferon beta\1a or brain\derived neurotrophic factor with placebo, and cerebrospinal fluid filtration with ST3932 plasma exchange, showed no significant benefit or harm for any of the interventions. A fourth small trial showed that this Chinese herbal medicine, tripterygium polyglycoside, hastened recovery in people with GBS to a greater extent than corticosteroids, but this result requires confirmation. We were unable to draw any useful conclusions from your few observational studies we recognized. (Higgins 2011). A third review author (RB) independently assessed risk of bias and data extraction for Bensa 2000 and Pritchard 2003 as these studies involved two review authors as trial authors. We considered the following characteristics: explicit diagnostic criteria, sequence generation, allocation concealment, blinding, completeness of follow\up, freedom from selective reporting and other sources of bias. We graded these items as at low, high or unclear risk of bias and explained the evidence on which we based our conclusions in a ‘Risk of bias’ table. If the assessments differed, we obtained agreement by consensus, if necessary in consultation with a third author. Steps of treatment effect If meta\analysis of more than one trial of the same or comparable agents had been possible we would have calculated a weighted treatment effect across trials using the Cochrane statistical package, Review Manager (RevMan) 5 (RevMan 5). For dichotomous outcomes, such as ‘improvement by one or more GBS disability grade after four weeks’, we ST3932 used RevMan to calculate a risk ratio (RR). For continuous outcomes we tested MDs. We expressed uncertainty with 95% confidence intervals (CIs). We used a fixed\effect approach for the analyses. Dealing with missing data We sought missing data from your trial authors and reported its absence when not available. Assessment of heterogeneity If there had been multiple trials of one intervention and evidence of significant heterogeneity between studies had been detected using the I2 statistic, we would have sought explanations for the heterogeneity and, if none had been found, would have used a random\effects analysis. Assessment of reporting biases If there had been sufficient trials of one intervention we would have constructed funnel plots and inspected them for evidence of publication bias. Data synthesis If meta\analysis of more than one trial of the same or comparable agents had been possible we would have calculated a weighted treatment effect across trials using RevMan. ‘Summary of findings’ tables We have provided a ‘Summary of findings’ table for each comparison and reported in them the primary and secondary outcomes for this review. We used the five GRADE considerations (study limitations, regularity of effect, imprecision, indirectness and publication bias) to assess the quality of a body of evidence (studies that contribute data for the prespecified outcomes), according to methods explained in the (Schunemann 2011). We used GRADEpro software to prepare the furniture (GRADEpro 2008). Using our assessments we drew conclusions about the quality of the evidence within the text of the review. Subgroup analysis and investigation of heterogeneity We would have liked to examine the effect of treatments in the following subgroups, KRT17 chosen because of their prognostic importance in previous prospective studies and trials. Younger and older participants (children aged less than 18 years; adults from age 18 to 49 years.