L-Ornithine-l-aspartate in the management of hepatic encephalopathy: a meta-analysis.
OBJECTIVE
Hepatic encephalopathy continues to be a major clinical problem and the current decade has not witnessed major therapeutic breakthroughs in this area. L-ornithine-l-aspartate (LOLA) is not frequently used as there are still some reservations about its benefits. The present study aimed to assess the effectiveness and safety of LOLA in the management of hepatic encephalopathy.


METHODS
We used the method recommended by the Cochrane Collaboration to perform a meta-analysis of randomized controlled trials of LOLA therapy for hepatic encephalopathy including three randomized controlled trials.


RESULTS
Three randomized trials randomizing 212 patients were included. LOLA versus placebo had a significant effect on improvement of hepatic encephalopathy (relative risk 1.89; 95% CI 1.32 to 2.71; P = 0.0005). This comparison showed no statistical heterogeneity (P = 0.85 and chi(2) = 0.09). Subgroup analysis showed that LOLA could be effective versus placebo in trials with grade I or II overt hepatic encephalopathy patients (relative risk 1.87; 95% CI 1.30 to 2.68; P = 0.0007) and had no significant effect in trials with subclinical hepatic encephalopathy patients (relative risk 1.69; 95% CI 0.72 to 3.94; P = 0.23). Adverse effects were observed in only three patients treated with LOLA in one report.


CONCLUSIONS
LOLA benefited patients with overt hepatic encephalopathy (I or II), whereas these data do not support the use of LOLA for patients with subclinical hepatic encephalopathy.
Jiang
Qian
Q
Department of Clinical Pharmacy, West China School of Pharmacy, Sichuan University, Chengdu, China.
Jiang
Xue-Hua
XH
Zheng
Ming-Hua
MH
Chen
Yong-Ping
YP
D004151:Dipeptides / Q000009:adverse effects / Q000627:therapeutic use*; D006501:Hepatic Encephalopathy / Q000188:drug therapy*; D006801:Humans; D018579:Patient Selection; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D016896:Treatment Outcome
D004151:Dipeptides; C002939:ornithylaspartate