Article

Ursodeoxycholic acid for cystic fibrosis-related liver disease

c/o Cochrane Cystic Fibrosis & Genetic Disorders Review Group, Institute of Child Health, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, UK, L12 2AP.
Cochrane database of systematic reviews (Online) (Impact Factor: 5.94). 01/2012; 10(10):CD000222. DOI: 10.1002/14651858.CD000222.pub2
Source: PubMed

ABSTRACT Cystic fibrosis-related liver disease peaks in adolescence with up to 20% of people with cystic fibrosis developing chronic liver disease. Early changes in the liver may ultimately result in end-stage liver disease with people needing transplantation. One therapeutic option currently used is ursodeoxycholic acid.
To analyse evidence that ursodeoxycholic acid improves indices of liver function, reduces the risk of developing chronic liver disease and improves outcomes in general in cystic fibrosis.
We searched the Cochrane CF and Genetic Disorders Group Trials Register comprising references identified from comprehensive electronic database searches, handsearches of relevant journals and abstract books of conference proceedings. We also contacted drug companies.Date of the most recent search of the Group's trials register: 10 July 2012.
Randomised controlled trials of the use of ursodeoxycholic acid for at least three months compared with placebo or no additional treatment in people with cystic fibrosis.
Two authors independently assessed trial eligibility and quality.
Ten trials have been identified, of which three trials involving 118 participants were included. The complex design used in two trials meant that data could only be analysed for subsets of participants. There was no significant difference in weight change, mean difference -0.90 kg (95% confidence interval -1.94 to 0.14) based on 30 participants from two trials. Improvement in biliary excretion was reported in only one trial and no significant change after treatment was shown. Long-term outcomes such as death or need for liver transplantation were not reported.
There are few trials assessing the effectiveness of ursodeoxycholic acid. There is insufficient evidence to justify its routine use in cystic fibrosis.

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    • "There is evidence of improved liver biochemistry (Desmond et al., 2007) shortly after introducing UDCA and improved histological features of liver disease afterwards (Linblad et al., 1998). However, evidence of improved outcomes such as reduced need for transplantations or improved survival is lacking (Cheng et al., 2000). UCDA is widely used as it is the only available therapeutic agent and is generally well tolerated with few side effects. "
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