title: Combination Therapy Using Chelating Agent and Zinc for Wilson's Disease.
abstract: There is no clear international consensus regarding the optimal medication therapy for treating Wilson's disease (WD). This study systematically reviews the effectiveness of various medication therapies in common use, specifically focusing on preliminary findings concerning the combination of a chelating agent and zinc. A systematic PubMed search was executed to locate original studies on the effectiveness of commonly used medications for WD published between January 1989 and August 2014. The results were used to conduct a systematic review of studies on combination therapies. A total of 17 combination therapy studies involving 1056 patients were reviewed. These were analyzed in terms of data on effectiveness, adverse effects, and mortality. Results from a pooled analysis indicate that combination therapies for hepatic patients were significantly less effective than the same therapies for neurological manifestations (47.1 vs. 78.6 %; pooled relative risk ratio (RR): 0.63, 95 % confidence interval CI 0.43-0.94;p= 0.02). Data from a subgroup analysis show that the combination therapy of penicillamine plus zinc sulfate resulted in a significantly higher mortality rate compared to all other combination therapy types (16.3 vs. 4.7 %; RR: 3.51, 95 % CI 1.54-8.00;p< 0.001). The use of combination therapies involving zinc and a chelator should be carefully monitored with close clinical observations and frequent biochemical tests, especially for WD patients with hepatic manifestations.
authors.affiliation: Department of Computer Science and Information Engineering, Asia University, Taichung, 41354 Taiwan.
authors.forename: Jui-Chi
authors.initials: JC
authors.lastname: Chen
authors.affiliation: Department of Computer Science and Information Engineering, Asia University, Taichung, 41354 Taiwan ; Department of Medical Research, China Medical University Hospital, Taichung, 40402 Taiwan.
authors.forename: Cheng-Hung
authors.initials: CH
authors.lastname: Chuang
authors.affiliation: Department of Computer Science and Information Engineering, Asia University, Taichung, 41354 Taiwan ; Department of Biomedical Informatics, Asia University, Taichung, 41354 Taiwan.
authors.forename: Jing-Doo
authors.initials: JD
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, Ben Tang Cheng Ching Hospital, Taichung, 41364 Taiwan.
authors.forename: Chi-Wei
authors.initials: CW
authors.lastname: Wang
keywords: Biomedical informatics; Combination therapy; Effectiveness; Safety; Wilson’s disease