A network meta-analysis of the efficacy and side effects of udca-based therapies for primary sclerosing cholangitis

Autor: Ke-Qing Shi, Yong-Ping Chen, Gui-Qi Zhu, Yi-Qian Lin, Li-Ren Wang, Martin Braddock, Ming-Hua Zheng, Mengtao Zhou, Gui-Qian Huang
Rok vydání: 2015
Předmět:
Adult
Cholagogues and Choleretics
medicine.medical_specialty
medicine.medical_treatment
Cholangitis
Sclerosing
Liver transplantation
Severity of Illness Index
Gastroenterology
Primary sclerosing cholangitis
Young Adult
clinical efficacy
Metronidazole
Internal medicine
Pathology Section
Severity of illness
Odds Ratio
Humans
Medicine
Adverse effect
network meta-analysis
intervention
Aged
Proportional Hazards Models
Randomized Controlled Trials as Topic
business.industry
Ursodeoxycholic Acid
primary sclerosing cholangitis
Bilirubin
Odds ratio
Middle Aged
Mycophenolic Acid
Hepatology
Alkaline Phosphatase
medicine.disease
Research Paper: Pathology
adverse events
Ursodeoxycholic acid
Liver Transplantation
Surgery
Treatment Outcome
Liver
Oncology
Research Design
Meta-analysis
Disease Progression
business
medicine.drug
Zdroj: Oncotarget
ISSN: 1949-2553
DOI: 10.18632/oncotarget.5610
Popis: Objectives Therapies for treatment of patients with primary sclerosing cholangitis (PSC) include administration of ursodeoxycholic acid (UDCA) alone, or combination with metronidazole (MTZ) or mycophenolate mofetil (MMF), respectively. However, the optimum regimen still remains inconclusive. We aimed to compare interventions in terms of patient mortality or liver transplantation (MOLT), progression of liver histological stage (POLHS), serum bilirubin, alkaline phosphatase (ALP) levels and adverse events (AE). Methods We searched PubMed, Embase and the Cochrane Library for randomized controlled trials until 31, Jan 2015. We estimated hazard ratios (HRs), odds ratios (ORs) and mean difference (MD) between treatments on clinical outcomes. Sensitivity analyses based on the dose of UDCA, quality of trials or treatment duration were also performed. Results Ten RCTs were included. Compared with UDCA plus MTZ, UDCA (HR 0.28, 95%CI 0.01-3.41), UDCA plus MMF (HR 0.08, 95%CI 0.00-4.18), or OBS (HR 0.28, 95%CI 0.01-3.98) all provided an increased risk of MOLT. UDCA provided a significant reduction in bilirubin and ALP levels compared with OBS (MD −13.92, P < 0.001; MD −484.34, P < 0.001; respectively). With respect to POLHS, although differing not significantly, UDCA plus MTZ had a tendency to improve LHS more than UDCA (OR 1.33), UDCA plus MMF (OR 3.24) or OBS (OR 1.08). Additionally, UDCA plus MTZ (MD −544.66, P < 0.001) showed a significant reduction in ALP levels compared with OBS, but appeared to be associated with more AEs compared with UDCA (OR 5.09), UDCA plus MMF (OR 4.80) or OBS (OR 7.21). Conclusions MTZ plus UDCA was the most effective therapy in survival rates and liver histological progression.
Databáze: OpenAIRE
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