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Pharmacological interventions for primary sclerosing cholangitis: an attempted network meta-analysis
Francesca Saffioti1,2, Kurinchi Selvan Gurusamy3, Neil Hawkins4
1The Royal Free Sheila Sherlock Liver Centre, Royal Free Hampstead NHS Foundation Trust and UCL Institute of Liver and Digestive Health, Pond Street, Hampstead, London, UK, NW3 2QG.
The Cochrane Database of Systematic Reviews
|April 19, 2017
Summary
Current treatments for primary sclerosing cholangitis (PSC) lack proven benefits. More high-quality trials are needed to find effective therapies for this chronic liver disease.
Area of Science:
- Hepatology and Gastroenterology
- Clinical Pharmacology
- Evidence Synthesis
Background:
- Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease.
- PSC is associated with hepatobiliary and colorectal malignancies, cirrhosis, and complications.
- Optimal pharmacological treatment for PSC remains controversial.
Purpose of the Study:
- To assess comparative benefits and harms of pharmacological interventions for PSC.
- To rank interventions by safety and efficacy using network meta-analysis.
- Standard Cochrane methods were used due to limitations in assessing effect modifiers.
Main Methods:
- Searched multiple databases (CENTRAL, MEDLINE, Embase) for randomized clinical trials (RCTs) up to February 2017.
- Included RCTs diagnosed with PSC, excluding liver-transplanted participants.
- Analyzed data using fixed-effect and random-effects models, assessing risk of bias and evidence quality (GRADE).
Main Results:
- Eleven RCTs (706 participants) provided data for outcomes.
- No significant differences found in mortality or health-related quality of life between interventions and placebo.
- Limited data on secondary outcomes like liver transplantation or cholangiocarcinoma incidence; trials had short follow-up and small sample sizes.
Conclusions:
- Insufficient evidence exists to demonstrate the effectiveness of current pharmacological interventions for PSC.
- Trials reviewed had high risk of bias, small participant numbers, and short follow-up periods.
- Well-designed RCTs with adequate follow-up are urgently needed to identify effective PSC treatments.