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Meta-Analysis
. 2006 Oct 18;2006(4):CD003045.
doi: 10.1002/14651858.CD003045.pub2.

Anabolic-androgenic steroids for alcoholic liver disease

A Rambaldi  1 , C Gluud
Affiliations
Meta-Analysis

Anabolic-androgenic steroids for alcoholic liver disease

A Rambaldi et al. Cochrane Database Syst Rev. .

Abstract

Background: Alcohol is one of the most common causes of liver disease in the Western World. Randomised clinical trials have examined the effects of anabolic-androgenic steroids for alcoholic liver disease.

Objectives: To assess the beneficial and harmful effects of anabolic-androgenic steroids for patients with alcoholic liver disease based on the results of randomised clinical trials.

Search strategy: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, The Cochrane Controlled Trials Register in The Cochrane Library, MEDLINE, EMBASE, LILACS, and Science Citation Index Expanded until June 2006. Electronic searches were combined with full text searches. Manufacturers and researchers in the field were also contacted.

Selection criteria: Randomised clinical trials studying patients with alcoholic steatosis, alcoholic fibrosis, alcoholic hepatitis, and/or alcoholic cirrhosis were included. Interventions encompassed anabolic-androgenic steroids at any dose or duration versus placebo or no intervention. The trials could be double blind, single blind, or unblinded. The trials could be unpublished or published, and no language limitations were applied.

Data collection and analysis: Outcomes are assessed at maximal follow-up. All analyses were performed according to the intention-to-treat method. The statistical package RevMan Analyses was used. The methodological quality of the randomised clinical trials was assessed.

Main results: Combining the results of five randomised clinical trials randomising 499 patients with alcoholic hepatitis and/or cirrhosis demonstrated no significant effects of anabolic-androgenic steroids on mortality (relative risk (RR) 1.01, 95% confidence interval (CI) 0.79 to 1.29), liver-related mortality (RR 0.83, 95% CI 0.60 to 1.15), complications of liver disease (RR 1.25, 95% CI 0.74 to 2.10), and liver histology. Anabolic-androgenic steroids did not significantly affect a number of other outcome measures, including sexual function and liver biochemistry. Anabolic-androgenic steroids were not associated with a significantly increased risk of non-serious adverse events (RR 1.14, 95% CI 0.50 to 2.59) or with serious adverse events (RR 4.54, 95% CI 0.57 to 36.30).

Authors' conclusions: This systematic review could not demonstrate any significant beneficial effects of anabolic-androgenic steroids on any clinically important outcomes (mortality, liver-related mortality, liver complications, and histology) of patients with alcoholic liver disease.

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Conflict of interest statement

Christian Gluud has been the principle and coordinating investigator on a randomised trial on testosterone for alcoholic cirrhosis (CSL 1986) as well as the author of two previous meta‐analyses on the topic (Gluud 1984; Gluud 1988a).

Figures

1.1
1.1. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 1 Mortality.
1.2
1.2. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 2 Liver‐related mortality.
1.3
1.3. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 3 Ascites.
1.4
1.4. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 4 Hepatic encephalopathy.
1.5
1.5. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 5 Hepatocellular carcinoma.
1.6
1.6. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 6 Total number of complications (ascites, hepatic encephalopathy, hepatocellular carcinoma).
1.7
1.7. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 7 Pretibial edema.
1.8
1.8. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 8 Gynaecomastia.
1.9
1.9. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 9 Prostatic hypertrophia.
1.10
1.10. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 10 Sexual dysfunction.
1.11
1.11. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 11 Weight (kg).
1.12
1.12. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 12 Portal pressure (mmHg).
1.13
1.13. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 13 Indocyanine green clearance (ml plasma/min).
1.14
1.14. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 14 Galactose elimination capacity (mmol/min).
1.15
1.15. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 15 Biopsy finding, improvement (fat).
1.16
1.16. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 16 Biopsy finding, significant improvement in follow‐up specimens (fatty).
1.17
1.17. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 17 Biopsy finding, improvement (inflammatory cells).
1.18
1.18. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 18 Biopsy finding, significant improvement in follow‐up specimens (hepatitis).
1.19
1.19. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 19 Biopsy finding, improvement (acute necrosis).
1.20
1.20. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 20 Biopsy finding, significant improvement in follow‐up specimens (focal necrosis).
1.21
1.21. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 21 Serum‐bilirubin (mg/dl).
1.22
1.22. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 22 Prothrombin time.
1.23
1.23. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 23 Serum‐albumin (g/dl).
1.24
1.24. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 24 Serum‐alkaline phosphatases (U/l).
1.25
1.25. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 25 Serum‐aspartate aminotransferase (U/l).
1.26
1.26. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 26 Blood‐haemoglobin (mmol/l).
1.27
1.27. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 27 Serum‐testosterone (nmol/l).
1.28
1.28. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 28 Serum‐creatinine (umol/l).
1.29
1.29. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 29 Serum‐immunoglobulin G (g/l).
1.30
1.30. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 30 Serum‐immunoglobuilin A (g/l).
1.31
1.31. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 31 Serum‐immunoglobulin M (g/l).
1.32
1.32. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 32 Number of days with normal activity within the last 100 days at 12 months follow‐up.
1.33
1.33. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 33 Number of days in hospital within the last 100 days at 12 months follow‐up.
1.34
1.34. Analysis
Comparison 1 Anabolic‐androgenic steroids versus control, Outcome 34 Sexual dysfunction at 12 months follow‐up.
2.1
2.1. Analysis
Comparison 2 Adverse events, Outcome 1 Non‐serious adverse events.
2.2
2.2. Analysis
Comparison 2 Adverse events, Outcome 2 Serious adverse events.
3.1
3.1. Analysis
Comparison 3 Sensitivity analyses, Outcome 1 Mortality ‐ worst‐case scenario.
3.2
3.2. Analysis
Comparison 3 Sensitivity analyses, Outcome 2 Mortality and generation of the allocation sequence.
3.3
3.3. Analysis
Comparison 3 Sensitivity analyses, Outcome 3 Mortality and allocation concealment.
3.4
3.4. Analysis
Comparison 3 Sensitivity analyses, Outcome 4 Mortality and double blinding.
3.5
3.5. Analysis
Comparison 3 Sensitivity analyses, Outcome 5 Mortality and follow‐up.
3.6
3.6. Analysis
Comparison 3 Sensitivity analyses, Outcome 6 Mortality ‐ duration of follow‐up.
3.7
3.7. Analysis
Comparison 3 Sensitivity analyses, Outcome 7 Mortality ‐ different treatment.
3.8
3.8. Analysis
Comparison 3 Sensitivity analyses, Outcome 8 Mortality ‐ stage of alcoholic liver disease.
3.9
3.9. Analysis
Comparison 3 Sensitivity analyses, Outcome 9 Mortality ‐ according to co‐intervention.
See this image and copyright information in PMC

Update of

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