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Is It Necessary to Perform the Pharmacological Interventions for Intrahepatic Cholestasis of Pregnancy? A Bayesian Network Meta-Analysis

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Abstract

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.

Methods

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).

Results

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.

Conclusion

This NMA of the RCTs clarified that the current intervention has no favorable effect on pruritus and other symptoms in ICP patients.

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Acknowledgements

We are grateful to the guidelines of the National Institute for Health and Excellence Decision Support Units (NICEDSU) for providing the BUGS code.

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Author notes

  1. Yi Shen and Jie Zhou contributed equally to this work.

Authors and Affiliations

  1. Department of Epidemiology and Medical Statistics, School of Public Health, Nantong University, Nantong, China

    Yi Shen, Jie Zhou, Sheng Zhang, Xu-Lin Wang, Yu-Long Jia, Shu He, Yuan-Yuan Wang, Wen-Chao Li & Xun Zhuang

  2. Center for Liver Diseases, Nantong Third People’s Hospital, Nantong University, 60 Mid-Youth Road, Nantong, 226006, Jiangsu, China

    Jian-Guo Shao & Gang Qin

  3. Department of Obstetrics and Gynecology, Affiliated Hospital of Nantong University, Nantong, China

    Yuan-Lin Liu

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  1. Yi Shen
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Contributions

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.

Corresponding author

Correspondence to Gang Qin.

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Conflict of interest

The authors declare that they have no competing interests.

Funding

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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Shen, Y., Zhou, J., Zhang, S. et al. Is It Necessary to Perform the Pharmacological Interventions for Intrahepatic Cholestasis of Pregnancy? A Bayesian Network Meta-Analysis. Clin Drug Investig 39, 15–26 (2019). https://doi.org/10.1007/s40261-018-0717-2

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