Original ResearchFull Report: Clinical—LiverComparative Effectiveness of Pharmacological Interventions for Severe Alcoholic Hepatitis: A Systematic Review and Network Meta-analysis
Section snippets
Methods
This systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was conducted following a priori established protocol.17, 18 We also followed good research practices as outlined in the ISPOR (International Society for Pharmacoeconomics and Outcomes Research) report on interpreting indirect treatment comparisons and network meta-analysis for health-care decision making.19
Results
From a total of 614 unique studies identified using the search strategy, we included 22 RCTs in this network meta-analysis.2, 4, 5, 6, 7, 8, 9, 10, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 Six RCTs of CS therapy were excluded (because of unclear definition of severe AH or inclusion of non-severe AH,42, 43, 44, 45 too short duration of CS therapy).46, 47 Two RCTs comparing prednisolone to budesonide and combination of prednisolone and metadoxine were excluded due to lack of
Discussion
In this systematic review and network meta-analysis, we combined direct and indirect evidence from 22 RCTs involving 2,621 patients with severe AH, to estimate the relative efficacy of all pharmacological interventions for decreasing short-term mortality. We made several key observations: (a) CS alone, CS+NAC and CS+PTX decrease short-term mortality in patients with severe AH, with moderate confidence in estimates; PTX alone also reduces short-term mortality, but with low confidence in
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This article has an accompanying continuing medical education activity on page e15. Learning Objective: Upon completion of this exam, successful learners will be able to (1) compare the relative efficacy of treatments for acute severe alcoholic hepatitis, (2) assess the efficacy of pharmacologic treatment for medium-term mortality for severe alcoholic hepatitis, (3) assess the impact of pharmacologic treatment on acute kidney injury, and (4) assess the impact of pharmacologic treatment on infection in patients with severe alcoholic hepatitis.
Conflicts of interest None of the authors have any conflicts of interest to declare.
Funding This work was supporte in part by National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism grant U01AA021788 (V.H.S.).
Author names in bold designate shared co-first authors.