Exploring Drug Re-Purposing for Treatment of Abdominal Aortic Aneurysms: a Systematic Review and Meta-analysis
Bibliographic record
Abstract
WHAT THIS PAPER ADDSThis systematic review and meta-analysis found no supplement, medication, or drug class to effectively reduce the growth rate, risk of repair, or rupture rate of abdominal aortic aneurysms (AAAs).The potential benefits of metformin are under investigation in randomised controlled trials (RCTs), but publication bias may have influenced the positive finding in this study.Statins showed a significant reduction in growth rate, warranting consideration of a RCT.Recommended are improved measurements of exposure, doseeresponse curves, and utilisation of standard outcome measures (e.g., growth rate per group and mean difference) in observational studies related to the field of AAAs and medication.Objective: Large abdominal aortic aneurysms (AAAs) present a significant mortality risk.While numerous medical interventions have been proposed, no drugs have convincingly reduced AAA progression, rupture rates, or repair risk.This systematic review and meta-analysis aimed to assess the impact of re-purposed drugs or dietary supplements on slowing expansion rates, reducing the risk of rupture, or minimising the risk of repair for individuals with AAA.Methods: A systematic search was conducted in five databases.Both observational studies and randomised controlled trials were included.Unpublished data from two screening trials were incorporated.Risk of bias was assessed using the NewcastleeOttawa scale and revised Cochrane risk of bias tool.Meta-analyses were performed for each identified drug subclass and were stratified by overall risk of bias.Results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results: Of 7 484 screened studies, 39 met the inclusion criteria.No studies on dietary supplements were included.A total of 84 cohorts were derived from the included studies, and twelve distinct drug groups underwent meta-analyses.Two drug groups, metformin and statins, were statistically significant in slowing AAA growth.No low risk of bias studies were included for these two drug groups, and the results had very high heterogeneity (I 2 > 80%).Both groups had a GRADE certainty of very low.Metformin, excluding high risk of bias studies, presented an estimated mean growth difference of AAA diameter between users and non-users of e0.73 mm/year, whilst statins had an overall estimated mean difference of e0.84 mm/year.Conclusion: This systematic review and meta-analysis suggests that metformin and statins may provide some effect in slowing AAA progression.However, no definitive evidence was found for any of the investigated drugs included in this study.Further research is needed to identify effective medical treatments for AAA progression with more robust methodology.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.033 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.020 | 0.046 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".