Clinical Research Papers:
Optimal drug regimens for primary biliary cirrhosis: a systematic review and network meta-analysis
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Abstract
Gui-Qi Zhu1,2,*, Sha Huang1,2,*, Gui-Qian Huang1,3,*, Li-Ren Wang1,2, Yi-Qian Lin1,3, Yi-Ming Wu1,2, Ke-Qing Shi1,4, Jiang-Tao Wang1,2, Zhi-Rui Zhou5, Martin Braddock6, Yong-Ping Chen1,4, Meng-Tao Zhou7 and Ming-Hua Zheng1,4
1 Department of Infection and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
2 School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China
3 Renji School of Wenzhou Medical University, Wenzhou, China
4 Institute of Hepatology, Wenzhou Medical University, Wenzhou, China
5 Department of Radiation Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
6 Global Medicines Development, AstraZeneca R&D, Loughborough, United Kingdom
7 Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
* These authors are Co-first author
Correspondence to:
Ming-Hua Zheng, email:
Meng-Tao Zhou, email:
Keywords: primary biliary cirrhosis, UDCA-based therapy, adverse events, network meta-analysis, indirect comparison
Received: April 11, 2015 Accepted: May 22, 2015 Published: June 19, 2015
Abstract
Objective: Most comprehensive treatments for PBC include UDCA, combination of methotrexate (MTX), corticosteroids (COT), colchicine (COC) or bezafibrate (BEF), cyclosporin A (CYP), D-penicillamine (DPM), methotrexate (MTX), or azathioprine (AZP). Since the optimum treatment regimen remains inconclusive, we aimed to compare these therapies in terms of patient mortality or liver transplantation (MOLT) and adverse event (AE).
Methods: We searched PubMed, Embase, Scopus and the Cochrane Library for randomized controlled trials until August 2014. We estimated HRs for MOLT and ORs for AE. The sensitivity analysis based on dose of UDCA was also performed.
Results: The search identified 49 studies involving 12 different treatment regimens and 4182 patients. Although no statistical significance can be found in MOLT, COT plus UDCA was ranked highest for efficacy outcome amongst all the treatment regimes. While for AEs, compared with OBS or UDCA, monotherapy with COC (OR 5.6, P < 0.001; OR 5.89, P < 0.001), CYP (OR 3.24, P < 0.001; OR 3.42, P < 0.001), DPM (OR 8.00, P < 0.001; OR 8.45, P < 0.001) and MTX (OR 5.31, P < 0.001; OR 5.61, P < 0.001) were associated with statistically significant increased risk of AEs. No significant differences were found for other combination regimes. Effect estimates from indirect comparisons matched closely to estimates derived from pairwise comparisons. Consistently, in the sensitivity analysis, results closely resembled our primary analysis.
Conclusions: COT plus UDCA was the most efficacious among treatment regimens both for MOLT and AEs.
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