�Es efectivo el �cido ursodeoxic�lico en cirrosis biliar primaria?

Rada, Gabriel; Mac-Namara, Macarena

doi:10.5867/medwave.2014.08.6019

Ursodeoxycholic acid is considered as first line treatment in patients with primary biliary cirrhosis. Its mechanism of action in this disease is unknown and there is controversy about its clinical impact. Searching in Epistemonikos database, which is maintained by screening 19 databases, we identified four systematic reviews including 16 studies. We combined the evidence using tables with summary of findings following the GRADE approach and concluded ursodeoxycholic acid may not have any effect on pruritus, and there is uncertainty about its effect on mortality, need for liver transplantation or on any other important outcome for the patient.

Autores: Gabriel Rada[1,2,3,4,5], Macarena Mac-Namara[1,2]

Filiaci�n:
[1] Programa de Salud Basada en Evidencia, Facultad de Medicina, Pontificia Universidad Cat�lica de Chile
[2] Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Cat�lica de Chile
[3] GRADE working group
[4] The Cochrane Collaboration
[5] Fundaci�n Epistemonikos

E-mail: radagabriel@epistemonikos.org

Correspondencia a:
[1] Facultad de Medicina
Pontificia Universidad Cat�lica de Chile
Lira 63,
Santiago Centro
Chile

Citaci�n: Rada G, Mac-Namara M. Is ursodeoxycholic acid effective in primary biliary cirrhosis?. Medwave 2014 Sep;14(8):e6019 doi: 10.5867/medwave.2014.08.6019

Fecha de publicaci�n: 24/9/2014

Ficha PubMed

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Cuál es la evidencia (Véase matriz de evidencia en Epistemonikos más abajo).	Encontramos 4 revisiones sistemáticas [1],[2],[3],[4], que incluyen 16 estudios controlados aleatorizados, reportados en 104 referencias [5-108]*, que comparan ácido ursodeoxicólico versus placebo o no tratamiento en pacientes con cirrosis biliar primaria.
Qué tipo de pacientes incluyeron los estudios.	Casi 90% de los pacientes fueron mujeres. El porcentaje de pacientes con cirrosis biliar avanzada al inicio de los estudios fluctuó entre 15 y 83%.
Qué tipo de intervenciones incluyeron los estudios.	La dosis varió entre 7,7 a 15 mg/kg/día (mediana=10 mg). La duración del tratamiento fue entre 3 y 92 meses (mediana=24 meses).
Qué tipo de desenlaces midieron.	Mortalidad, necesidad de trasplante, morbilidad asociada al daño hepático crónico, síntomas, calidad de vida, efectos adversos atribuibles al medicamento. También se midieron desenlaces sustitutos como parámetros bioquímicos e histología hepática.

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