Retracted: Efficacy of different drugs in the treatment of minimal hepatic encephalopathy: A network meta‐analysis involving 826 patients based on 10 randomized controlled trials

Abstract

Minimal hepatic encephalopathy (MHE), a complex neuropsychological complication of cirrhosis, is characterized by delayed reaction time and the inhibition of abnormal response. This network meta-analysis (NMA) was adopted to compare the efficacy of five drugs including lactulose, probiotics, rifaximin, acetyl-L-carnitine (ALC), and L-Ornithine L-aspartate (LOLA) in the treatment of MHE. The Cochrane Library, PubMed, and Embase databases were searched for any existing entail on these five drugs from the inception to February 2018, including Randomized controlled trials (RCTs). The NMA of the five drugs, accounting for both direct and indirect comparisons to assess WMD (weighted mean difference) and SUCRA (surface under the cumulative ranking curves) was conducted. In total, 10 RTCS with 826 MHE patients met the inclusion criteria and were included in the NMA. The meta-analysis revealed that compared with placebo, lactulose, and probiotics had better efficacy in reducing ammonia serum levels and total SIP (Sickness Impact Profil) score; ALC had better efficacy in lowering serum level of ammonia and increasing the serum level of albumin; rifaximin and LOLA had better efficacy in reducing total SIP score. The results from SUCRA revealed that in terms of ammonia and albumin serums, ALC presented with the highest rankings when it comes to efficacy (serum ammonia: 87.2%; serum albumin: 92.25%). Hence, the key findings from the present study highly suggested that ALC had the best efficacy in the treatment of MHE patients.

Advances in Gut Microbiota of Viral Hepatitis Cirrhosis

“…The most common commercialized probiotics are lactose-fermenting Lactobacilli and Bifidobacteria . A meta-analysis made by Cai et al [49], involving 826 minimal HE patients, indicated that probiotics had better efficacy in decreasing ammonia serum levels, endotoxemia levels, and hospitalization rates. Dhiman et al [50] enrolled 130 cirrhosis patients including 21 HBV- or HCV-derived cirrhosis, and either probiotic VSL#3 or a placebo is given for 6 months.…”

Efficacy and Safety of Rifaximin Versus Placebo or Other Active Drugs in Critical ill Patients With Hepatic Encephalopathy

“…To date, 10 meta-analyses including seven systematic reviews (Jiang et al, 2008;Eltawil et al, 2012;Hu and Tang, 2013;Wu et al, 2013;Kimer et al, 2014;Wang, 2015;Zhuo et al, 2019) and three network meta-analyses (Zhu et al, 2015;Cai et al, 2018;Dhiman et al, 2020), have been published on efficacy or safety of rifaximin for HE treatment. Most of these meta-analyses focused on one control arm or one type of HE, and their results seem equivocal and inconsistent.…”

Loss of skeletal muscle mass affects the incidence of minimal hepatic encephalopathy: a case control study

“…Although various drugs have been given for patients with MHE [ 40 – 44 ] to decrease ammonia levels or improve mental status, drugs that are effective against MHE are unclear. We showed that the concentration of BCAA correlated with the presence of MHE, suggesting that administration of BCAA may be a reasonable treatment for MHE, because of its potential efficacy ameliorating skeletal muscle mass loss.…”