Rifaximin vs conventional oral therapy for hepatic encephalopathy:A meta-analysis
AIM: To characterize the efficacy of rifaximin in the management of hepatic encephalopathy (HE) as several randomized controlled studies have shown contradictory results on its effectiveness in comparison to other oral agents. METHODS: We performed a systematic review and random effects meta-analysi...
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Veröffentlicht in: | World journal of gastroenterology : WJG 2012-02, Vol.18 (8), p.767-777 |
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description | AIM: To characterize the efficacy of rifaximin in the management of hepatic encephalopathy (HE) as several randomized controlled studies have shown contradictory results on its effectiveness in comparison to other oral agents. METHODS: We performed a systematic review and random effects meta-analysis of all eligible trials identifi ed through electronic and manual searches. Twelve randomized controlled trials met the inclusion criteria with a total of 565 patients. RESULTS: The clinical effectiveness of rifaximin was equivalent to disaccharides or other oral antibiotics[odds ratio (OR) 0.96; 95% CI: 0.94-4.08] but with a better safety profi le (OR 0.27; 95% CI: 0.12-0.59). At the completion of treatment protocols, patients receiving rifaximin showed lower serum ammonia levels [weighted mean difference (WMD) = -10.65; 95% CI: -23.4-2.1; P = 0.10], better mental status (WMD = -0.24; 95% CI: -0.57-0.08; P = 0.15) and less asterixis (WMD -0.1; 95% CI -0.26-0.07; P = 0.25) without reaching statistical signifi cance. On the other hand, other psychometric outcomes such as electroencephalographic response and grades of portosystemic encephalopathy were superior in patients treated with rifaximin in comparison to the control group (WMD = 0.21, 95% CI: -0.33-0.09, P = 0.0004; and WMD = -2.33, 95% CI: -2.68-1.98, P = 0.00001, respectively). Subgroup and sensitivity analysis did not show any signifi cant difference in the above fi ndings. CONCLUSION: Rifaximin appears to be at least as effective as other conventional oral agents for the treatment of HE with a better safety profile. |
doi_str_mv | 10.3748/wjg.v18.i8.767 |
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METHODS: We performed a systematic review and random effects meta-analysis of all eligible trials identifi ed through electronic and manual searches. Twelve randomized controlled trials met the inclusion criteria with a total of 565 patients. RESULTS: The clinical effectiveness of rifaximin was equivalent to disaccharides or other oral antibiotics[odds ratio (OR) 0.96; 95% CI: 0.94-4.08] but with a better safety profi le (OR 0.27; 95% CI: 0.12-0.59). At the completion of treatment protocols, patients receiving rifaximin showed lower serum ammonia levels [weighted mean difference (WMD) = -10.65; 95% CI: -23.4-2.1; P = 0.10], better mental status (WMD = -0.24; 95% CI: -0.57-0.08; P = 0.15) and less asterixis (WMD -0.1; 95% CI -0.26-0.07; P = 0.25) without reaching statistical signifi cance. On the other hand, other psychometric outcomes such as electroencephalographic response and grades of portosystemic encephalopathy were superior in patients treated with rifaximin in comparison to the control group (WMD = 0.21, 95% CI: -0.33-0.09, P = 0.0004; and WMD = -2.33, 95% CI: -2.68-1.98, P = 0.00001, respectively). Subgroup and sensitivity analysis did not show any signifi cant difference in the above fi ndings. CONCLUSION: Rifaximin appears to be at least as effective as other conventional oral agents for the treatment of HE with a better safety profile.</description><identifier>ISSN: 1007-9327</identifier><identifier>EISSN: 2219-2840</identifier><identifier>DOI: 10.3748/wjg.v18.i8.767</identifier><identifier>PMID: 22371636</identifier><language>eng</language><publisher>United States: Baishideng Publishing Group Co., Limited</publisher><subject>Anti-Infective Agents - therapeutic use ; Brief ; Databases, Factual ; Disaccharides - therapeutic use ; Hepatic Encephalopathy - drug therapy ; Humans ; Odds Ratio ; Randomized Controlled Trials as Topic ; Rifamycins - therapeutic use ; Treatment Outcome ; 临床效果 ; 口服抗生素 ; 大规模杀伤性武器 ; 治疗方案 ; 灵敏度分析 ; 肝性脑病 ; 随机对照试验 ; 随机效应</subject><ispartof>World journal of gastroenterology : WJG, 2012-02, Vol.18 (8), p.767-777</ispartof><rights>2012 Baishideng Publishing Group Co., Limited. All rights reserved. 2012</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-a720d61b7220ed70ce380cbec63508e5966650034a1d549d0d0131e8c450f60d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Uhttp://image.cqvip.com/vip1000/qk/84123X/84123X.jpg</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286139/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286139/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22371636$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eltawil, Karim M</creatorcontrib><creatorcontrib>Laryea, Marie</creatorcontrib><creatorcontrib>Peltekian, Kevork</creatorcontrib><creatorcontrib>Molinari, Michele</creatorcontrib><title>Rifaximin vs conventional oral therapy for hepatic encephalopathy:A meta-analysis</title><title>World journal of gastroenterology : WJG</title><addtitle>World Journal of Gastroenterology</addtitle><description>AIM: To characterize the efficacy of rifaximin in the management of hepatic encephalopathy (HE) as several randomized controlled studies have shown contradictory results on its effectiveness in comparison to other oral agents. METHODS: We performed a systematic review and random effects meta-analysis of all eligible trials identifi ed through electronic and manual searches. Twelve randomized controlled trials met the inclusion criteria with a total of 565 patients. RESULTS: The clinical effectiveness of rifaximin was equivalent to disaccharides or other oral antibiotics[odds ratio (OR) 0.96; 95% CI: 0.94-4.08] but with a better safety profi le (OR 0.27; 95% CI: 0.12-0.59). At the completion of treatment protocols, patients receiving rifaximin showed lower serum ammonia levels [weighted mean difference (WMD) = -10.65; 95% CI: -23.4-2.1; P = 0.10], better mental status (WMD = -0.24; 95% CI: -0.57-0.08; P = 0.15) and less asterixis (WMD -0.1; 95% CI -0.26-0.07; P = 0.25) without reaching statistical signifi cance. On the other hand, other psychometric outcomes such as electroencephalographic response and grades of portosystemic encephalopathy were superior in patients treated with rifaximin in comparison to the control group (WMD = 0.21, 95% CI: -0.33-0.09, P = 0.0004; and WMD = -2.33, 95% CI: -2.68-1.98, P = 0.00001, respectively). Subgroup and sensitivity analysis did not show any signifi cant difference in the above fi ndings. CONCLUSION: Rifaximin appears to be at least as effective as other conventional oral agents for the treatment of HE with a better safety profile.</description><subject>Anti-Infective Agents - therapeutic use</subject><subject>Brief</subject><subject>Databases, Factual</subject><subject>Disaccharides - therapeutic use</subject><subject>Hepatic Encephalopathy - drug therapy</subject><subject>Humans</subject><subject>Odds Ratio</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Rifamycins - therapeutic use</subject><subject>Treatment Outcome</subject><subject>临床效果</subject><subject>口服抗生素</subject><subject>大规模杀伤性武器</subject><subject>治疗方案</subject><subject>灵敏度分析</subject><subject>肝性脑病</subject><subject>随机对照试验</subject><subject>随机效应</subject><issn>1007-9327</issn><issn>2219-2840</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkc9q3DAQxkVpaDZprz0W95STnZFkS_KlEEL-FAKBNjkLrTxeK9iSY3k32Vfps_Sd8gpRyXZpLxrE_Oabj_kI-Uyh4LJUp08Pq2JDVeFUIYV8RxaM0TpnqoT3ZEEBZF5zJg_JUYwPAIzzin0gh4xxSQUXC_Lzh2vNsxuczzYxs8Fv0M8ueNNnYUrP3OFkxm3WhinrcDSzsxl6i2Nn-pC-3fbl96-zbMDZ5CZNbaOLH8lBa_qIn3b1mNxfXtydX-c3t1ffz89ucstlNedGMmgEXUrGABsJFrkCu0QreAUKq1oIUQHw0tCmKusGGqCcorJlBa2Ahh-Tb2-643o5YGOT82RZj5MbzLTVwTj9f8e7Tq_CRnOmBOV1EjjZCUzhcY1x1oOLFvveeAzrqGtW1oIrBoks3kg7hRgnbPdbKOg_QegUhE5BaKd0CiINfPnX2x7_e_kEfN0pdsGvHp1f7ZkyAQBp8yswJpNY</recordid><startdate>20120228</startdate><enddate>20120228</enddate><creator>Eltawil, Karim M</creator><creator>Laryea, Marie</creator><creator>Peltekian, Kevork</creator><creator>Molinari, Michele</creator><general>Baishideng Publishing Group Co., Limited</general><scope>2RA</scope><scope>92L</scope><scope>CQIGP</scope><scope>W91</scope><scope>~WA</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20120228</creationdate><title>Rifaximin vs conventional oral therapy for hepatic encephalopathy:A meta-analysis</title><author>Eltawil, Karim M ; Laryea, Marie ; Peltekian, Kevork ; Molinari, Michele</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-a720d61b7220ed70ce380cbec63508e5966650034a1d549d0d0131e8c450f60d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Anti-Infective Agents - therapeutic use</topic><topic>Brief</topic><topic>Databases, Factual</topic><topic>Disaccharides - therapeutic use</topic><topic>Hepatic Encephalopathy - drug therapy</topic><topic>Humans</topic><topic>Odds Ratio</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Rifamycins - therapeutic use</topic><topic>Treatment Outcome</topic><topic>临床效果</topic><topic>口服抗生素</topic><topic>大规模杀伤性武器</topic><topic>治疗方案</topic><topic>灵敏度分析</topic><topic>肝性脑病</topic><topic>随机对照试验</topic><topic>随机效应</topic><toplevel>online_resources</toplevel><creatorcontrib>Eltawil, Karim M</creatorcontrib><creatorcontrib>Laryea, Marie</creatorcontrib><creatorcontrib>Peltekian, Kevork</creatorcontrib><creatorcontrib>Molinari, Michele</creatorcontrib><collection>中文科技期刊数据库</collection><collection>中文科技期刊数据库-CALIS站点</collection><collection>中文科技期刊数据库-7.0平台</collection><collection>中文科技期刊数据库-医药卫生</collection><collection>中文科技期刊数据库- 镜像站点</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>World journal of gastroenterology : WJG</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Eltawil, Karim M</au><au>Laryea, Marie</au><au>Peltekian, Kevork</au><au>Molinari, Michele</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Rifaximin vs conventional oral therapy for hepatic encephalopathy:A meta-analysis</atitle><jtitle>World journal of gastroenterology : WJG</jtitle><addtitle>World Journal of Gastroenterology</addtitle><date>2012-02-28</date><risdate>2012</risdate><volume>18</volume><issue>8</issue><spage>767</spage><epage>777</epage><pages>767-777</pages><issn>1007-9327</issn><eissn>2219-2840</eissn><abstract>AIM: To characterize the efficacy of rifaximin in the management of hepatic encephalopathy (HE) as several randomized controlled studies have shown contradictory results on its effectiveness in comparison to other oral agents. METHODS: We performed a systematic review and random effects meta-analysis of all eligible trials identifi ed through electronic and manual searches. Twelve randomized controlled trials met the inclusion criteria with a total of 565 patients. RESULTS: The clinical effectiveness of rifaximin was equivalent to disaccharides or other oral antibiotics[odds ratio (OR) 0.96; 95% CI: 0.94-4.08] but with a better safety profi le (OR 0.27; 95% CI: 0.12-0.59). At the completion of treatment protocols, patients receiving rifaximin showed lower serum ammonia levels [weighted mean difference (WMD) = -10.65; 95% CI: -23.4-2.1; P = 0.10], better mental status (WMD = -0.24; 95% CI: -0.57-0.08; P = 0.15) and less asterixis (WMD -0.1; 95% CI -0.26-0.07; P = 0.25) without reaching statistical signifi cance. On the other hand, other psychometric outcomes such as electroencephalographic response and grades of portosystemic encephalopathy were superior in patients treated with rifaximin in comparison to the control group (WMD = 0.21, 95% CI: -0.33-0.09, P = 0.0004; and WMD = -2.33, 95% CI: -2.68-1.98, P = 0.00001, respectively). Subgroup and sensitivity analysis did not show any signifi cant difference in the above fi ndings. CONCLUSION: Rifaximin appears to be at least as effective as other conventional oral agents for the treatment of HE with a better safety profile.</abstract><cop>United States</cop><pub>Baishideng Publishing Group Co., Limited</pub><pmid>22371636</pmid><doi>10.3748/wjg.v18.i8.767</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Anti-Infective Agents - therapeutic use Brief Databases, Factual Disaccharides - therapeutic use Hepatic Encephalopathy - drug therapy Humans Odds Ratio Randomized Controlled Trials as Topic Rifamycins - therapeutic use Treatment Outcome 临床效果 口服抗生素 大规模杀伤性武器 治疗方案 灵敏度分析 肝性脑病 随机对照试验 随机效应 |
title | Rifaximin vs conventional oral therapy for hepatic encephalopathy:A meta-analysis |
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