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. 2015 Jul 22;15(7):e29052.
doi: 10.5812/hepatmon.29052v2. eCollection 2015 Jul.

Efficacy of Hepatoprotective Agents With or Without Antiviral Drugs on Liver Function and Fibrosis in Patients With Hepatitis B: A Meta-Analysis

Li-Hui Long  1 , Cai-Qin Xue  1 , Jun-Feng Shi  1 , Juan-Ni Dong  1 , Li Wang  2
Affiliations

Efficacy of Hepatoprotective Agents With or Without Antiviral Drugs on Liver Function and Fibrosis in Patients With Hepatitis B: A Meta-Analysis

Li-Hui Long et al. Hepat Mon. .

Abstract

Context: To systematically evaluate the effects of hepatoprotective agents, when delivered either alone or in combination with other antiviral or non-antiviral drugs in patients with hepatitis B and hepatic fibrosis.

Objectives: The current randomized controlled clinical trials aimed to evaluate the efficacy of combinations of antiviral and non-antiviral hepatoprotective agents on indexes of liver function and liver fibrosis in patients with hepatitis B.

Data sources: Published literatures in Chinese and English on hepatoprotective treatment strategies for chronic hepatitis B and liver fibrosis were searched in three databases and randomized controlled clinical trials were selected.

Study selection: Data were extracted according to a variety of inclusion and exclusion criteria. Meta-analysis was employed to analyze the data.

Results: A total of 22 randomized controlled trials encompassing 1,714 cases were considered in the meta-analysis. The obtained results indicated that the combination of antiviral drug and hepatoprotective agent was better than antiviral drug alone to improve liver function. Similarly, regarding liver fibrosis, using two different hepatoprotective agents was better than using one agent. The normalization rates of Aminotransferase (ALT) and total Bilirubin (TBil) were improved 25.7% by two hepatoprotective agents compared to the single agent. Acetylcysteine was superior to ursodeoxycholic acid or silibinin to reduce ALT. Ursodeoxycholic acid was superior to acetylcysteine or silibinin to reduce TBIL.

Conclusions: Hepatoprotective agents combined with antiviral drugs can significantly improve liver function and liver fibrosis parameters in patients with hepatitis B.

Keywords: Acetylcysteine; Hepatitis B; Liver Cirrhosis; Meta-Analysis; Silibinin; Ursodeoxycholic Acid (UDCA).

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Figures

Figure 1.
Figure 1.. Meta-Analysis Forest Plots for Effects on ALT, AST, ALP and TBIL Levels
In patients with chronic hepatitis B infection treated with combination hepatoprotective and antiviral drug vs. antiviral drug alone. Data are presented as pooled mean difference using a random-effects model and 95% confidence intervals.
Figure 2.
Figure 2.. Meta-Analysis Forest Plots Indicating Reduced Amounts of ALT
In patients with chronic hepatitis B infection treated with hepatoprotective drugs vs. placebo. Data are presented as pooled mean difference using a random-effect model and 95 % confidence intervals.
Figure 3.
Figure 3.. Meta-Analysis Forest Plots Describing the Effects of Hepatoprotective Agents vs. Placebo on TBIL Levels
In patients with chronic hepatitis B infection. Data are presented as pooled relative risks using a fixed-effect model and 95 % confidence intervals.
Figure 4.
Figure 4.. Meta-Analysis Forest Plots for Effects
In patients with chronic hepatitis B infection treated with the combination of two liver protective drugs vs. one liver protective drug. Data are presented as pooled mean difference using a random-effect model, and 95% confidence intervals.
Figure 5.
Figure 5.. Meta-Analysis Forest Plots Indicating the Normalization Rates of ALT and TBIL
In patients with chronic hepatitis B infection treated with two vs. one hepatoprotective agent. Data are presented as pooled relative risks, adopted fixed-effect model and 95 % confidence intervals, by trial.
Figure 6.
Figure 6.. Meta-Analysis With Forest Plots Effects of two Hepatoprotective Agents vs. a Single Hepatoprotective Agent on Levels of HA, IV-C and PIIIP
In patients with liver fibrosis. Data are presented as pooled mean difference using a random-effects model and 95 % confidence intervals, by trials.
Figure 7.
Figure 7.. Meta-Analysis Forest Plots of LN Levels in Patients With Liver Fibrosis Infection Treated with Two vs. one Hepatoprotective Agents
Data are presented as pooled mean difference using a random-effects model, and 95% confidence intervals.
Figure 8.
Figure 8.. A Funnel plot analysis of the effects of hepatoprotective agents on normalization of ALT, AST and TBIL, in patients with hepatitis B
See this image and copyright information in PMC

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