Comparison 1.
Methotrexate vs. Dactinomycin
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|---|---|---|---|
| 1 Primary cure (remission) | 5 | 513 | Risk Ratio (M-H, Random, 95% CI) | 0.64 [0.54, 0.76] |
| 1.1 Weekly IM MTX vs. pulsed IV DACT | 3 | 393 | Risk Ratio (M-H, Random, 95% CI) | 0.62 [0.48, 0.80] |
| 1.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 0.76 [0.57, 1.00] |
| 1.3 Eight-day IM MTX-FA vs. 5-day IV DACT | 1 | 45 | Risk Ratio (M-H, Random, 95% CI) | 0.57 [0.40, 0.81] |
| 2 Failure of first line therapy | 5 | 513 | Risk Ratio (M-H, Random, 95% CI) | 3.81 [1.64, 8.86] |
| 2.1 Weekly IM MTX vs. pulsed IV DACT | 3 | 393 | Risk Ratio (M-H, Random, 95% CI) | 3.54 [1.12, 11.16] |
| 2.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 3.2 [1.17, 8.78] |
| 2.3 Eight-day IM MTX-FA vs. 5-day IV DACT | 1 | 45 | Risk Ratio (M-H, Random, 95% CI) | 18.58 [1.16, 297.18] |
| 3 Chemotherapy cycles to primary cure | 4 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 3.1 Weekly IM MTX vs. pulsed IV DACT | 2 | 346 | Mean Difference (IV, Random, 95% CI) | 3.04 [0.93, 5.14] |
| 3.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Mean Difference (IV, Random, 95% CI) | −2.20 [−2.87, −1.53] |
| 3.3 Eight-day IM MTX-FA vs. 5-day IV DACT | 1 | 45 | Mean Difference (IV, Random, 95% CI) | 0.63 [−0.27, 1.53] |
| 4 Adverse effects: Nausea | 4 | 466 | Risk Ratio (M-H, Random, 95% CI) | 0.61 [0.29, 1.26] |
| 4.1 Weekly IM MTX vs. pulsed IV DACT | 3 | 391 | Risk Ratio (M-H, Random, 95% CI) | 0.42 [0.11, 1.62] |
| 4.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 1.18 [0.72, 1.93] |
| 5 Adverse effects: Vomiting | 3 | 420 | Risk Ratio (M-H, Random, 95% CI) | 0.75 [0.32, 1.73] |
| 5.1 Weekly IM MTX vs. pulsed IV DACT | 2 | 345 | Risk Ratio (M-H, Random, 95% CI) | 0.56 [0.24, 1.32] |
| 5.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 1.43 [0.50, 4.05] |
| 6 Adverse effects: Diarrhoea | 3 | 419 | Risk Ratio (M-H, Random, 95% CI) | 1.43 [0.85, 2.41] |
| 6.1 Weekly IM MTX vs. pulsed IV DACT | 2 | 344 | Risk Ratio (M-H, Random, 95% CI) | 1.34 [0.57, 3.16] |
| 6.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 1.5 [0.58, 3.85] |
| 7 Adverse effects: Constitutional | 3 | 420 | Risk Ratio (M-H, Random, 95% CI) | 1.00 [0.84, 1.19] |
| 7.1 Weekly IM MTX vs. pulsed IV DACT | 2 | 345 | Risk Ratio (M-H, Random, 95% CI) | 0.97 [0.79, 1.18] |
| 7.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 1.10 [0.78, 1.55] |
| 8 Adverse effects: Alopecia | 3 | Risk Ratio (M-H, Random, 95% CI) | Subtotals only | |
| 8.1 Weekly IM MTX vs. pulsed IV DACT | 1 | 131 | Risk Ratio (M-H, Random, 95% CI) | 0.71 [0.27, 1.83] |
| 8.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 1.33 [0.41, 4.30] |
| 8.3 Eight-day IM MTX-FA vs. 5-day IV DACT | 1 | 49 | Risk Ratio (M-H, Random, 95% CI) | 0.03 [0.00, 0.53] |
| 9 Adverse effects: Mucositis/stomatitis | 2 | Risk Ratio (M-H, Random, 95% CI) | Subtotals only | |
| 9.1 Weekly IM MTX vs. pulsed IV DACT | 1 | 216 | Risk Ratio (M-H, Random, 95% CI) | 0.92 [0.39, 2.17] |
| 9.2 Eight-day IM MTX-FA vs. 5-day IV DACT | 1 | 49 | Risk Ratio (M-H, Random, 95% CI) | 0.14 [0.03, 0.54] |
| 10 Adverse effects: Dermatological | 1 | Risk Ratio (M-H, Random, 95% CI) | Totals not selected | |
| 10.1 Weekly IM MTX vs. pulsed IV DACT | 1 | Risk Ratio (M-H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 11 Adverse effects: Neutropenia | 4 | 469 | Risk Ratio (M-H, Random, 95% CI) | 0.83 [0.48, 1.45] |
| 11.1 Weekly IM MTX vs. pulsed IV DACT | 2 | 345 | Risk Ratio (M-H, Random, 95% CI) | 0.66 [0.38, 1.15] |
| 11.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 2.0 [0.43, 9.20] |
| 11.3 Eight-day IM MTX-FA vs. 5-day IV DACT | 1 | 49 | Risk Ratio (M-H, Random, 95% CI) | 2.44 [0.27, 21.89] |
| 12 Adverse effects: Thrombocytopenia | 3 | 338 | Risk Ratio (M-H, Random, 95% CI) | 0.76 [0.16, 3.55] |
| 12.1 Weekly IM MTX vs. pulsed IV DACT | 1 | 214 | Risk Ratio (M-H, Random, 95% CI) | 0.36 [0.12, 1.11] |
| 12.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 2.5 [0.74, 8.50] |
| 12.3 Eight-day IM MTX-FA vs. 5-day IV DACT | 1 | 49 | Risk Ratio (M-H, Random, 95% CI) | 0.27 [0.01, 6.41] |
| 13 Adverse effects: Anaemia | 1 | Risk Ratio (M-H, Random, 95% CI) | Totals not selected | |
| 13.1 Weekly IM MTX vs. pulsed IV DACT | 1 | Risk Ratio (M-H, Random, 95% CI) | 0.0 [0.0, 0.0] | |
| 14 Adverse effects: Hepatotoxicity | 2 | 263 | Risk Ratio (M-H, Random, 95% CI) | 2.57 [0.39, 16.88] |
| 14.1 Weekly IM MTX vs. pulsed IV DACT | 1 | 214 | Risk Ratio (M-H, Random, 95% CI) | 1.43 [0.56, 3.61] |
| 14.2 Eight-day IM MTX-FA vs. 5-day IV DACT | 1 | 49 | Risk Ratio (M-H, Random, 95% CI) | 10.68 [0.63, 179.70] |
| 15 Adverse effects: Haemoptysis | 2 | 206 | Risk Ratio (M-H, Random, 95% CI) | 0.99 [0.30, 3.31] |
| 15.1 Weekly IM MTX vs. pulsed IV DACT | 1 | 131 | Risk Ratio (M-H, Random, 95% CI) | 0.62 [0.13, 2.94] |
| 15.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 2.0 [0.30, 13.38] |
| 16 Severe adverse events (≥G3) | 5 | 515 | Risk Ratio (M-H, Random, 95% CI) | 0.35 [0.08, 1.66] |
| 16.1 Weekly IM MTX vs. pulsed IV DACT | 3 | 391 | Risk Ratio (M-H, Random, 95% CI) | 0.61 [0.35, 1.04] |
| 16.2 Five-day IM MTX vs. pulsed IV DACT | 1 | 75 | Risk Ratio (M-H, Random, 95% CI) | 0.0 [0.0, 0.0] |
| 16.3 Eight-day IM MTX-FA vs. 5-day IV DACT | 1 | 49 | Risk Ratio (M-H, Random, 95% CI) | 0.12 [0.02, 0.88] |