title: Network meta-analysis of randomized controlled trials: efficacy and safety of UDCA-based therapies in primary biliary cirrhosis.
abstract: Major ursodeoxycholic acid (UDCA)-based therapies for primary biliary cirrhosis (PBC) include UDCA only, or combined with either methotrexate (MTX), corticosteroids (COT), colchicine (COC), or bezafibrate (BEF). As the optimum treatment regimen is unclear and warrants exploration, we aimed to compare these therapies in terms of patient mortality or liver transplantation (MOLT) and adverse events (AE).PubMed, the Cochrane Library, and Scopus were searched for randomized controlled trials up to August 31, 2014. We estimated the hazard ratios (HRs) for MOLT and odds ratios (ORs) for AE. A sensitivity analysis based on the dose of UDCA was also executed.Thirty-one eligible articles were included. Compared with COT plus UDCA, UDCA (HR 0.38, 95% confidence interval [CI] 0.09-1.39), BEF plus UDCA (HR 0.29, 95% CI 0.02-4.83), COC plus UDCA (HR 0.39, 95% CI 0.07-2.25), MTX plus UDCA (HR 0.28, 95% CI 0.05-1.63), or OBS (HR 0.49, 95% CI 0.11-2.01) all provided an increased risk of MOLT. With respect to drug AE profile, although not differing appreciably, BEF plus UDCA was associated with more AEs compared with UDCA (OR 3.16, 95% CI 0.59-20.67), COT plus UDCA (OR 2.27, 95% CI 0.15-33.36), COC plus UDCA (OR 1.00, 95% CI 0.09-12.16), MTX plus UDCA (OR 2.03, 95% CI 0.23-17.82), or OBS (OR 3.00, 95% CI 0.53-20.75). The results of sensitivity analyses were highly consistent with previous analyses.COT plus UDCA was the optimal UDCA-based regimen for both MOLT and AEs. BEF plus UDCA was most likely to cause AEs, whereas monotherapy with UDCA and coadministriation of COT plus UDCA appeared to be associated with the fewest AEs for PBC treatment.
authors: From the Department of Infection and Liver Diseases (G-QZ, K-QS, SH, G-QH, Y-QL, Y-PC, M-HZ), Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University; School of the First Clinical Medical Sciences (G-QZ, SH); Institute of Hepatology (K-QS, Y-PC, M-HZ), Wenzhou Medical University; Renji School of Wenzhou Medical University (G-QH, Y-QL), Wenzhou; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, and Department of Oncology(Z-RZ), Shanghai Medical College, Fudan University, Shanghai, China; and Global Medicines Development (MB), AstraZeneca R&D, Alderley Park, United Kingdom.
authors: Gui-Qi
authors: GQ
authors: Zhu
authors: Ke-Qing
authors: KQ
authors: Shi
authors: Sha
authors: S
authors: Huang
authors: Gui-Qian
authors: GQ
authors: Huang
authors: Yi-Qian
authors: YQ
authors: Lin
authors: Zhi-Rui
authors: ZR
authors: Zhou
authors: Martin
authors: M
authors: Braddock
authors: Yong-Ping
authors: YP
authors: Chen
authors: Ming-Hua
authors: MH
authors: Zheng
mesh_terms: D004359:Drug Therapy, Combination; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
chemical_list: D014580:Ursodeoxycholic Acid