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Review
. 2016 Jul 23;16(8):e38558.
doi: 10.5812/hepatmon.38558. eCollection 2016 Aug.

Ursodeoxycholic Acid and S-adenosylmethionine for the Treatment of Intrahepatic Cholestasis of Pregnancy: A Meta-analysis

Yang Zhang  1 , Linlin Lu  2 , David W Victor  3 , Yongning Xin  4 , Shiying Xuan  4
Affiliations
Review

Ursodeoxycholic Acid and S-adenosylmethionine for the Treatment of Intrahepatic Cholestasis of Pregnancy: A Meta-analysis

Yang Zhang et al. Hepat Mon. .

Abstract

Context: An optimal therapeutic strategy has not yet been identified for the pharmacological treatment of intrahepatic cholestasis of pregnancy (ICP). The aim of this study was to evaluate the efficacy and safety of ursodeoxycholic acid (UDCA) and S-adenosylmethionine (SAMe) in the treatment of ICP, both individually and in combination.

Evidence acquisition: A meta-analysis of all randomized controlled trials (RCTs) comparing UDCA, SAMe, and combination therapy was performed. We carried out a literature search using pubmed, embase, the cochrane register of controlled trials, and the science citation index of web of science. The maternal clinical and biochemical responses, including pruritus scores, total bilirubin, total bile acids, alanine aminotransferase, and aspartate transaminase, were evaluated. Safety assessments, including preterm delivery, cesarean section, and meconium-stained amniotic fluid, were also analyzed.

Results: Five RCTs including 311 patients were evaluated. In comparison to SAMe, UDCA significantly reduced the pruritus score (OR = -0.45, 95% confidence interval [CI]: -0.66 to -0.25, P < 0.0001) and improved the levels of total bile acids (TBAs; OR = -0.59, 95% CI: -0.99 to -0.30, P < 0.0001) and alanine aminotransferase (ALT; OR = -0.38, 95% CI: -0.66 to -0.09, P = 0.01). UDCA was associated with significantly lower preterm delivery rates than SAMe (RR = 0.48, 95% CI: 0.32-0.72, P = 0.0004). Interestingly, combination therapy significantly reduced total bilirubin (TB; vs. SAMe, OR = -0.41, 95% CI, -0.74 to -0.08, P = 0.02), aspartate transaminase (AST; vs. UDCA, OR = -0.40, 95% CI, -0.74 to -0.06, P = 0.02), and the rate of preterm delivery (vs. SAMe, OR = 0.62, 95% CI, 0.42 - 0.91, P = 0.02), in comparison with either drug administered alone.

Conclusions: UDCA decreased the pruritus score, TBA, and ALT levels more effectively than SAMe, reducing the rate of preterm delivery for ICP.

Keywords: Intrahepatic Cholestasis of Pregnancy; S-Adenosylmethionine; Ursodeoxycholic Acid.

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Figures

Figure 1.
Figure 1.. Effects of UDCA, SAMe, and UDCA + SAMe on Pruritus Score
A, UDCA and SAMe; B, UDCA + SAMe and UDCA; C, UDCA + SAMe and SAMe.
Figure 2.
Figure 2.. Effects of UDCA, SAMe, and UDCA + SAMe on total bilirubin
A, UDCA and SAMe; B, UDCA + SAMe and UDCA; C, UDCA + SAMe and SAMe.
Figure 3.
Figure 3.. Effects of UDCA, SAMe, and UDCA + SAMe on Total Bile Acids
A, UDCA and SAMe; B, UDCA + SAMe and UDCA, C, UDCA + SAMe and SAMe.
Figure 4.
Figure 4.. Effects of UDCA, SAMe, and UDCA + SAMe on Alanine Aminotransferase
A, UDCA and SAMe, B, UDCA + SAMe and UDCA, C , UDCA + SAMe and SAMe.
Figure 5.
Figure 5.. Effects of UDCA, SAMe, and UDCA + SAMe on Aspartate Transaminase
A, UDCA and SAMe; B, UDCA+SAMe and UDCA; C, UDCA + SAMe and SAMe.
Figure 6.
Figure 6.. Effects of UDCA, SAMe, and UDCA + SAMe on rate of preterm deliveries
A,UDCA and SAMe; B, UDCA + SAMe and UDCA, C, UDCA + SAMe and SAMe.
Figure 7.
Figure 7.. Effects of UDCA, SAMe, and UDCA + SAMe on Rate of Cesarean Sections
A, UDCA and SAMe; B, UDCA + SAMe and UDCA; C, UDCA + SAMe and SAMe.
Figure 8.
Figure 8.. Effects of UDCA, SAMe, and UDCA + SAMe on Rate of Meconium-Stained Amniotic Fluid
A, UDCA and SAMe; B, UDCA + SAMe and UDCA; C, UDCA + SAMe and SAMe.
See this image and copyright information in PMC

References

    1. Kondrackiene J, Kupcinskas L. Intrahepatic cholestasis of pregnancy-current achievements and unsolved problems. World J Gastroenterol. 2008;14(38):5781–8. - PMC - PubMed
    1. Arrese M, Reyes H. Intrahepatic cholestasis of pregnancy: a past and present riddle. Ann Hepatol. 2006;5(3):202–5. - PubMed
    1. Lee NM, Brady CW. Liver disease in pregnancy. World J Gastroenterol. 2009;15(8):897–906. - PMC - PubMed
    1. Ahmed KT, Almashhrawi AA, Rahman RN, Hammoud GM, Ibdah JA. Liver diseases in pregnancy: diseases unique to pregnancy. World J Gastroenterol. 2013;19(43):7639–46. doi: 10.3748/wjg.v19.i43.7639. - DOI - PMC - PubMed
    1. Williamson C, Geenes V. Intrahepatic cholestasis of pregnancy. Obstet Gynecol. 2014;124(1):120–33. doi: 10.1097/AOG.0000000000000346. - DOI - PubMed

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