nominally significantP = 0.01
The overall pooled analysis, combining both designs, yielded a nominally significant result (RR = 0.45, 95% CI: 0.24–0.84; P = 0.01; I2 = 61%) ( Figure 3A ); however, this finding is driven entirely by the non-randomized studies and should be interpreted with caution given the lack of confirmation in RCTs and the methodological limitations of pooling disparate designs.