title: Systematic review and meta-analysis: D-Penicillamine vs. placebo/no intervention in patients with primary biliary cirrhosis--Cochrane Hepato-Biliary Group.
abstract: BACKGROUND
  D-Penicillamine is used for patients with primary biliary cirrhosis due to its ability to decrease hepatic copper and modulate the immune response. The results on effects of D--penicillamine in randomized-clinical trials of primary biliary cirrhosis patients are inconsistent.
  
  
  OBJECTIVE
  To systematically evaluate the benefits and harms of D-penicillamine for patients with primary biliary cirrhosis.
  
  
  METHODS
  We have performed a systematic review with meta-analyses of randomized-clinical trials to evaluate the effects of D-penicillamine for primary biliary cirrhosis. The primary outcomes are mortality and mortality or liver transplantation. We analysed the data by fixed-effect and random-effect models.
  
  
  RESULTS
  Seven randomized trials including 706 patients were analysed. d-Penicillamine was without significant effects on mortality (RR 1.08, 95% CI: 0.82-1.43, P = 0.56), mortality or liver transplantation (RR 1.11, 95% CI: 0.74-1.68, P = 0.62), pruritus, liver complications, progression of liver histological stage and liver biochemical variables. D--Penicillamine significantly decreased serum alanine aminotransferase activity (weighted mean difference -45 IU/L, 95% CI: -75 to -15, P < 0.05) and led to significantly more adverse events (RR 4.18, 95% CI: 1.38-12.69, P = 0.01).
  
  
  CONCLUSIONS
  D-Penicillamine did not appear to reduce the risk of mortality or morbidity, and led to more adverse events in patients with primary biliary cirrhosis.
authors.affiliation: Copenhagen Trial Unit, Centre for Clinical Intervention Research, H:S Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. ygong@ctu.rh.dk
authors.forename: Y
authors.initials: Y
authors.lastname: Gong
authors.forename: S L
authors.initials: SL
authors.lastname: Klingenberg
authors.forename: C
authors.initials: C
authors.lastname: Gluud
mesh_terms: D002614:Chelating Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010396:Penicillamine / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic
chemical_list: D002614:Chelating Agents; D010396:Penicillamine