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l ‐ornithine‐ l ‐aspartate for hepatic encephalopathy in patients with cirrhosis: A meta‐analysis of randomized controlled trials
Author(s) -
Bai Ming,
Yang Zhiping,
Qi Xingshun,
Fan Daiming,
Han Guohong
Publication year - 2013
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12142
Subject(s) - medicine , hepatic encephalopathy , placebo , gastroenterology , confidence interval , cirrhosis , randomized controlled trial , lactulose , relative risk , adverse effect , meta analysis , incidence (geometry) , pathology , alternative medicine , physics , optics
Background and Aim Several randomized, controlled trials that evaluated the effectiveness of l ‐ornithine‐ l ‐aspartate ( LOLA ) in the treatment of hepatic encephalopathy ( HE ) have been published recently. The purpose of this study was to update the meta‐analysis to reevaluate the safety and efficacy of LOLA on HE in patients with cirrhosis. Methods The following databases were searched from inception to J une 2012: M edline, E mbase, and the C ochrane C entral R egister of C ontrolled T rials (Issue 6). Differences between groups were assessed by the pooled risk ratio ( RR ) or mean difference ( MD ). Possible sources of heterogeneity were assessed by sensitivity analyses. Results Eight randomized controlled trials with 646 patients were included. When comparing placebo/no‐intervention control, LOLA was significantly more effective in the improvement of HE in the total ( RR : 1.49, 95% confidence interval [ CI ]: 1.10 to 2.01), overt HE ( RR : 1.33, 95% CI : 1.04 to 1.69), and minimal HE patients ( RR : 2.25, 95% CI : 1.33 to 3.82). Furthermore, the reduction of fasting ammonia significantly favored LOLA (post‐treatment value, MD : −18.26, 95% CI : −26.96 to −9.56; change, MD : 8.59, 95% CI : 5.22 to 11.96). The tolerance ratio, incidence of adverse events, and mortality were not significantly different between LOLA and the placebo/no‐intervention control. LOLA and lactulose demonstrated similar effectiveness in the improvement of HE ( RR : 0.88, 95% CI : 0.57 to 1.35). Conclusions LOLA benefits both overt and minimal HE patients in the improvement of HE by reducing the serum ammonia concentration compared with the placebo/no‐intervention control. Further, evaluations between LOLA and other effective treatments are needed.