[Assessment for Resolving Clinical Questions Using Meta-analysis and Basic Studies].

Although clinical questions regarding treatment and disease mechanisms frequently arise in clinical practice, clear answers may not always be available. Investigating these issues could lead to new therapeutic strategies and further advancements in clinical pharmacies. This review presents three examples in which meta-analysis was used as a link between basic and clinical studies to resolve clinical questions. First, the effect of non-steroidal anti-inflammatory drugs (NSAIDs) on the risk of cisplatin-induced nephrotoxicity (CIN) was examined. A meta-analysis indicated that NSAID use was a risk factor (odds ratio: 1.88; 95% confidence interval: 1.44-2.45). Based on these results, basic studies that used rat kidney cells revealed that 17 NSAIDs have varying effects on CIN. Second, the dose-dependency of magnesium sulfate, a known preventive agent for CIN, was evaluated. Although a basic study suggested dose dependency, clinical evidence is limited. A meta-regression analysis demonstrated a dose-dependent preventive effect of magnesium sulfate within 5-20 mEq, supporting a rational dose setting in clinical practice. Third, we assessed the effect of acid suppressants (ASs) on the efficacy of immune checkpoint inhibitors (ICIs). A meta-analysis showed that AS use was associated with reduced overall survival in patients treated with ICIs. Subgroup analysis revealed that, although proton pump inhibitors (PPIs) negatively affected survival, histamine-2 receptor antagonists (H2RAs) did not, suggesting that H2RAs are potential alternatives to PPIs in ICI-treated patients. These studies suggest that meta-analyses based on reverse translational research are useful in resolving clinical questions and are expected to contribute to further advances in clinical pharmacies.