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

• Published in: Clinical drug investigation 2019-01, Vol.39 (1), p.15-26
• Main Authors: Shen, Yi, Zhou, Jie, Zhang, Sheng, Wang, Xu-Lin, Jia, Yu-Long, He, Shu, Wang, Yuan-Yuan, Li, Wen-Chao, Shao, Jian-Guo, Zhuang, Xun, Liu, Yuan-Lin, Qin, Gang
• Format: Article
• Language: English
• Subjects: Acids; Bayes Theorem; Bile; Cholestasis, Intrahepatic - drug therapy; Clinical trials; Disease; Female; Gallbladder diseases; Humans; Hypothesis testing; Internal Medicine; Medicine; Medicine & Public Health; Meta-analysis; Network Meta-Analysis; Pharmacology/Toxicology; Pharmacotherapy; Pregnancy; Pregnancy Complications - drug therapy; Pregnancy Outcome; Pruritus; Pruritus - etiology; Randomized Controlled Trials as Topic; Studies; Systematic Review; Treatment Outcome; Ursodeoxycholic Acid - therapeutic use; Womens health
• ISSN: 1173-2563; 1179-1918
• DOI: 10.1007/s40261-018-0717-2

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.