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. 2016 Jun 9;2016(6):CD007102. doi: 10.1002/14651858.CD007102.pub4

Comparison 1. Methotrexate vs. Actinomycin D.

Outcome or subgroup title No. of studies No. of participants Statistical method Effect size
1 Primary cure (remission) 6 577 Risk Ratio (M‐H, Random, 95% CI) 0.65 [0.57, 0.75]
1.1 Weekly IM MTX vs. pulsed IV Act D 3 393 Risk Ratio (M‐H, Random, 95% CI) 0.62 [0.48, 0.80]
1.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 1 45 Risk Ratio (M‐H, Random, 95% CI) 0.57 [0.40, 0.81]
1.4 Eight‐day IM MTX‐FA vs. pulsed IV Act D 1 64 Risk Ratio (M‐H, Random, 95% CI) 0.68 [0.50, 0.93]
2 Failure of first line therapy 6 577 Risk Ratio (M‐H, Random, 95% CI) 3.55 [1.81, 6.95]
2.1 Weekly IM MTX vs. pulsed IV Act D 3 393 Risk Ratio (M‐H, Random, 95% CI) 3.54 [1.12, 11.16]
2.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 1 45 Risk Ratio (M‐H, Random, 95% CI) 18.58 [1.16, 297.18]
2.4 Eight‐day IM MTX‐FA vs. pulsed IV Act D 1 64 Risk Ratio (M‐H, Random, 95% CI) 3.25 [1.19, 8.90]
3 Chemotherapy cycles to primary cure 4   Mean Difference (IV, Random, 95% CI) Subtotals only
3.1 Weekly IM MTX vs. pulsed IV Act D 2 346 Mean Difference (IV, Random, 95% CI) 3.04 [0.93, 5.14]
3.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 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 Act D 3 391 Risk Ratio (M‐H, Random, 95% CI) 0.42 [0.11, 1.62]
4.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 2 345 Risk Ratio (M‐H, Random, 95% CI) 0.56 [0.24, 1.32]
5.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 2 344 Risk Ratio (M‐H, Random, 95% CI) 1.34 [0.57, 3.16]
6.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 2 345 Risk Ratio (M‐H, Random, 95% CI) 0.97 [0.79, 1.18]
7.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 1 131 Risk Ratio (M‐H, Random, 95% CI) 0.71 [0.27, 1.83]
8.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 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 Act D 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 Act D 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 Act D 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 Act D 2 345 Risk Ratio (M‐H, Random, 95% CI) 0.66 [0.38, 1.15]
11.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 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 Act D 1 214 Risk Ratio (M‐H, Random, 95% CI) 0.36 [0.12, 1.11]
12.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 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 Act D 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 Act D 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 Act D 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 Act D 1 131 Risk Ratio (M‐H, Random, 95% CI) 0.62 [0.13, 2.94]
15.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 3 391 Risk Ratio (M‐H, Random, 95% CI) 0.61 [0.35, 1.04]
16.2 Five‐day IM MTX vs. pulsed IV Act D 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 Act D 1 49 Risk Ratio (M‐H, Random, 95% CI) 0.12 [0.02, 0.88]