A Systematic Review And Network Meta-analysis For Optimal Drug Regimens In Primary Biliary Cholangitis

ObjectiveTo investigate the efficacy,safety and optimal drug regimens in primary biliary cholangitis by a systematic and network meta-analysis.MethodsThe literature retrieval was performed by means of a lot of databases according to the Cochrane strategy and principle,and the criteria of inclusion together with exclusion,data screening and quality evaluation were completed by two specialists according to PICO.The heterogeneity and publication bias of the data were performed by Revman 5.3,and then the inconsistency statistic test,the consistency analysis and probability ranking were performed by ADDIS 1.16.8 software.ResultsA total of 27 literature-studies and eight therapeutic regimens consisted of seven drugs as intervention were included,add up to 1420 patients with PBC.A systematic meta-analysis of monotherapy showed that 95%CI of SMD in serum ALP,GGT,ALT,TBIL,IgM and AST of PBC treated by Fenofibrate plus UDCA vs.UDCA were relevantly-0.91(-1.14,-0.69),-0.51(-0.82,-0.91),-0.38(-0.61,-0.16),-0.42(-0.77,-0.07),-0.74(-1.18,-0.31),-0.21(-0.42,0.03).And that of SMD in serum ALP?GGT and TBIL of PBC treated by Bezafibrate plus UDCA vs.UDCA were respectively-1.38(-1.76,-0.99),-1.03(-1.42,-0.65),-0.93(-1.45,-0.41),but that of its ALT and IgM were not significantly differences as apparent heterogeneity.And that of serum TBIL of PBC treated by budesonide plus UDCA vs.UDCA was-0.36,(-0.73,-0.02),but that of ALP and IgMwere not significantly differences as apparent heterogeneity.And that of effective OR of PBC treated by OCA+UDCA?UDCA was 13.95(5.77,33.73).A network meta-analysis of inconsistency model and its significant difference test showed that it was unique of effective value in ALP(p>0.05)after comparing one to another among seven drugs,and these pairwise drugs included Bezafibrate plus UDCA vs.UDCA,Fenofibrate plus UDCA vs.UDCA,Bezafibrate plus UDCA vs.Fenofibrate plus UDCA,10 mgOCA plus UDCA vs.UDCA,10 mgOCA plus UDCA vs.5-10 mgOCA plus UDCA,5-10 mgOCA plus UDCA vs.UDCA.The consistency model analysis of serum ALP effective 95%CI showed that Bezafibrate plus UDCA compared with 10 mgOCA plus UDCA,5-10 mgOCA plus UDCA,Fenofibrate plus UDCA and UDCA were respectively-172.06(-375.35,28.62),-243.41(-439.32,-43.78),-120.33(-228.5,-11.72)and-257.21(-337.64,-175.7).So was10 mgOCA plus UDCA vs.5-10 mgOCA plus UDCA,its 95%CI was-70.83(-255.62,114.85).And then the orders of rank Probability was set up,further their ranks from 1 to 5 were respectively Bezafibrate plus UDCA,10 mgOCA plus UDCA,Fenofibrate plus UDCA,5-10 mgOCA plus UDCA and monotheraoy of UDCA.In GGT and ALT,there were significant differences between Bezafibrate plus UDCA vs.UDCA(95%CI)or Fenofibrate plus UDCA vs.UDCA(95%CI),which were real and and actual of the rank probability of the drugs from Fenofibrate plus UDCA to Bezafibrate plus UDCA in GGT,and that of others in ALT improved by Bezafibrate plus UDCA was better than Fenofibrate plus UDCA.ConclusionsThe combination therapy of Fibrates or OCA plus UDCA significantly improved serum ALP index in patients with PBC.The effect of Bezafibrate plus UDCA was better in effective value of ALP than that of other drugs for PBC.