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Lu FB, Hu ED, Xu LM, Hu YB, Chen L, Wu JL, Li H, Chen DZ, Chen YP. Comparative efficacy and tolerability of treatments for adult autoimmune hepatitis: A systematic review and network meta-analysis. Exp Ther Med 2018; 15:4838-4850. [PMID: 29904396 PMCID: PMC5996682 DOI: 10.3892/etm.2018.6063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 12/06/2017] [Indexed: 01/30/2023] Open
Abstract
The most suitable treatment regimen for autoimmune hepatitis (AIH) in adults remains unknown and requires further investigation. The current study therefore aimed to integrate evidence to provide hierarchies of the comparative efficacies of treatments measured by clinical and biochemical remission. A Bayesian-framework network meta-analysis of randomized controlled trials (RCTs) was preformed to compare eight treatments for AIH. Eligible RCTs were identified by searching Embase, Pubmed and the Cochrane Library for publications between 1966 and April 2017. All outcomes were independently extracted from the included studies by two authors. A total of six RCTs were subsequently included in the current study. The network of comparisons on remission indicated that patients treated with prednisone (pred) experienced significantly increased rates of remission compared with those treated with azathioprine [AZA; odds ratio (OR), 0.21; 95% confidence interval (CI), 0.06-0.71] and budesonide (bude) + AZA significantly increased remission compared with placebo treatment (OR, 36.66; 95% CI, 1.40-962.49) or AZA (OR, 10.30; 95% CI, 1.50-70.70). Based on the cumulative ranking probabilities, bude + AZA (89.4) was ranked first, pred (69.1) was ranked second, pred + AZA (63.2) was ranked third and placebo (7.8) treatment was ranked last. Bude + AZA may be the most appropriate candidate for the treatment of non-cirrhotic patients. However, bude + AZA as frontline therapy for AIH requires more large-scale studies with a longer duration of follow-up histology and a focus on dose-response. Additionally, development of other prospective treatments, which may be used as alternative therapy or first line therapy, and their subsequent evaluation in clinical RCTs is required.
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Affiliation(s)
- Feng-Bin Lu
- Wenzhou Key Laboratory of Hepatology, Department of Infectious Diseases, Hepatology Institute of Wenzhou Medical University, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - En-De Hu
- Wenzhou Key Laboratory of Hepatology, Department of Infectious Diseases, Hepatology Institute of Wenzhou Medical University, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Lan-Man Xu
- Wenzhou Key Laboratory of Hepatology, Department of Infectious Diseases, Hepatology Institute of Wenzhou Medical University, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Yi-Bing Hu
- Department of Gastroenterology, The Third Affiliated Hospital of Wenzhou Medical University, Jinhua, Zhejiang 321000, P.R. China
| | - Lu Chen
- Wenzhou Key Laboratory of Hepatology, Department of Infectious Diseases, Hepatology Institute of Wenzhou Medical University, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Jin-Lu Wu
- Wenzhou Key Laboratory of Hepatology, Department of Infectious Diseases, Hepatology Institute of Wenzhou Medical University, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Hui Li
- Wenzhou Key Laboratory of Hepatology, Department of Infectious Diseases, Hepatology Institute of Wenzhou Medical University, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Da-Zhi Chen
- State Key Laboratory of Infectious Diseases, Medicine School of Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Yong-Ping Chen
- Wenzhou Key Laboratory of Hepatology, Department of Infectious Diseases, Hepatology Institute of Wenzhou Medical University, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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