Selection of second-line drugs for adult autoimmune hepatitis: A Meta-analysis / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the clinical effect and safety of second-line drugs in the treatment of adult patients with autoimmune hepatitis (AIH) through a Meta-analysis of related articles. MethodsPubMed, EMBASE, Cochrane Library, Web of Science, CNKI, CBM, Wanfang Data, and VIP were searched for the articles on second-line drugs for AIH published up to December 31, 2019. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of articles, related data were extracted, and Meta-Analyst software was used to perform the Meta-analysis. ResultsA total of 22 articles were included, with 636 patients in total. The Meta-analysis showed that mycophenolate mofetil (MMF), tacrolimus (TAC), cyclosporine, and budesonide had a pooled response rate of 56.1%, 76.0%, 62.7%, and 57.3%, respectively, and their pooled incidence rates of adverse events were 22.5%, 47.4%, 48.4%, and 33.0%, respectively. The patients treated with MMF were divided into groups based on intolerance or no response to the first-line treatment, and a comparative analysis of these groups showed a relative risk of 1.965 (95% confidence interval 1.181-3.269, I2=0.665, P=0.014). ConclusionSelection of second-line drugs for adult AIH patients should consider response rate and incidence rate of adverse reactions. Both MMF and tacrolimus are good second-line drugs, and TAC may be a better choice for patients with no response to first-line treatment.