Is It Necessary to Perform the Pharmacological Interventions for Intrahepatic Cholestasis of Pregnancy? A Bayesian Network Meta-Analysis
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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.
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).
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.
This NMA of the RCTs clarified that the current intervention has no favorable effect on pruritus and other symptoms in ICP patients.
We are grateful to the guidelines of the National Institute for Health and Excellence Decision Support Units (NICEDSU) for providing the BUGS code.
Conceptualization: YS JZ GQ. Formal analysis: JZ SZ XLW YLJ SH YYW WCL JGS YLL XZ. Funding acquisition: GQ JGS JZ. Methodology: JZ SZ. Software: YS JZ SZ XLW GQ. Validation: YS JZ GQ. Writing – original draft: YS JZ SZ. Writing – review and editing: YS GQ. All authors approved the final version of the manuscript.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no competing interests.
This study was supported in part by grants from Jiangsu Provincial Department of Science and Technology (BE2015655), China, National Natural Science Foundation of China (81370520), the Nantong Municipal Bureau of Science and Technology (HS2016002), China, and the Postgraduate Research & Practice Innovation Program of Jiangsu Province (KYCX17-1941). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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