Four RCTs (n=432) were included in the meta-analysis.
Two studies reported appropriate generation of allocation sequence, none excluded patients after randomisation, one reported blinded outcome assessment, all reported attrition rates of less than 15%, and all used intention-to-treat analysis.
CPVA was associated with a statistically significant increase in the proportion of patients with AT recurrence-free survival at 12 months compared with ADT: 75.7% versus 18.8%; risk ratio 3.73 (95% CI: 2.47, 5.63, p<0.001). No statistically significant heterogeneity was found (p=0.13; I2=46%).
Statistical tests showed no evidence of significant publication bias (p=0.31 for Begg’s test and p=0.95 for Egger’s test).
Three studies reported no deaths during follow-up. The other study reported one death in each treatment arm during follow-up.
Adverse clinical events were significantly higher in ADT groups compared with CPVA groups (38 out of 218 versus 17 out of 214, p=0.02). The authors stated that some adverse events in the CPVA group (such as stroke) were more severe than those in the ADT group.
The meta-regression showed no significant effect of age, percentage of males or sample size.