Yi Shen1, Jie Zhou1, Sheng Zhang1, Xu-Lin Wang1, Yu-Long Jia1, Shu He1, Yuan-Yuan Wang1, Wen-Chao Li1, Jian-Guo Shao2, Xun Zhuang1, Yuan-Lin Liu3, Gang Qin4. 1. Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China. 2. Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, 60 Mid-Youth Road, Nantong, 226006, Jiangsu, China. 3. Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, China. 4. Center for Liver Diseases, Nantong Third People's Hospital, Nantong University, 60 Mid-Youth Road, Nantong, 226006, Jiangsu, China. tonygqin@ntu.edu.cn.
Abstract
BACKGROUND AND OBJECTIVE: Although many meta-analyses have evaluated the pharmacotherapy of intrahepatic cholestasis of pregnancy (ICP) and recommended ursodeoxycholic acid (UDCA) as an effective treatment, the defect of the pair-wise analyses and the mixture of the control group made the outcome uncertain and unclear. We aimed to employ Bayesian network meta-analysis (NMA) to compare the maternal and fetal outcomes after UDCA, S-adenosylmethionine (SAMe) mono-therapy or the combination treatment of these two drugs for ICP patients. METHODS: Multiple electronic database searches were conducted for articles published up to 1 September 2018. The relevant information was extracted from the published reports with a predefined data extraction sheet, and the risk of bias was assessed with the Cochrane risk-of-bias tool. Poisson Bayesian network meta-analysis was employed to identify the synthesized evidence from the relevant trials, with reporting hazard risks (HRs) and 95% credible intervals (CrIs). RESULTS: The pooled outcomes of the 13 randomized controlled trials (RCTs) with 625 participants indicated that none of the three regimens can significantly improve maternal and fetal outcomes. CONCLUSION: This NMA of the RCTs clarified that the current intervention has no favorable effect on pruritus and other symptoms in ICP patients.
BACKGROUND AND OBJECTIVE: Although many meta-analyses have evaluated the pharmacotherapy of intrahepatic cholestasis of pregnancy (ICP) and recommended ursodeoxycholic acid (UDCA) as an effective treatment, the defect of the pair-wise analyses and the mixture of the control group made the outcome uncertain and unclear. We aimed to employ Bayesian network meta-analysis (NMA) to compare the maternal and fetal outcomes after UDCA, S-adenosylmethionine (SAMe) mono-therapy or the combination treatment of these two drugs for ICP patients. METHODS: Multiple electronic database searches were conducted for articles published up to 1 September 2018. The relevant information was extracted from the published reports with a predefined data extraction sheet, and the risk of bias was assessed with the Cochrane risk-of-bias tool. Poisson Bayesian network meta-analysis was employed to identify the synthesized evidence from the relevant trials, with reporting hazard risks (HRs) and 95% credible intervals (CrIs). RESULTS: The pooled outcomes of the 13 randomized controlled trials (RCTs) with 625 participants indicated that none of the three regimens can significantly improve maternal and fetal outcomes. CONCLUSION: This NMA of the RCTs clarified that the current intervention has no favorable effect on pruritus and other symptoms in ICP patients.
Authors: Caroline Ovadia; Jenna Sajous; Paul T Seed; Kajol Patel; Nicholas J Williamson; George Attilakos; Francesco Azzaroli; Yannick Bacq; Linoy Batsry; Kelsey Broom; Romana Brun-Furrer; Laura Bull; Jenny Chambers; Yue Cui; Min Ding; Peter H Dixon; Maria C Estiú; Fergus W Gardiner; Victoria Geenes; Monika Grymowicz; Berrin Günaydin; William M Hague; Christian Haslinger; Yayi Hu; Ugo Indraccolo; Alexander Juusela; Stefan C Kane; Ayse Kebapcilar; Levent Kebapcilar; Katherine Kohari; Jūratė Kondrackienė; Maria P H Koster; Richard H Lee; Xiaohua Liu; Anna Locatelli; Rocio I R Macias; Riza Madazli; Agata Majewska; Kasia Maksym; Jessica A Marathe; Adam Morton; Martijn A Oudijk; Deniz Öztekin; Michael J Peek; Andrew H Shennan; Rachel M Tribe; Valeria Tripodi; Naciye Türk Özterlemez; Tharni Vasavan; L F Audris Wong; Yoav Yinon; Qianwen Zhang; Keren Zloto; Hanns-Ulrich Marschall; Jim Thornton; Lucy C Chappell; Catherine Williamson Journal: Lancet Gastroenterol Hepatol Date: 2021-04-27