Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha 410011, China; Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, China.
Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha 410011, China.
Phytomedicine. 2023 Jul 25;116:154883. doi: 10.1016/j.phymed.2023.154883. Epub 2023 May 18.
Entecavir (ETV) has disadvantages, such as poor improvement in liver function, during the treatment of Chronic hepatitis B (CHB). Thus ETV is often used in clinical therapy with glycyrrhizic acid (GA) preparations. However, due to the lack of reliable and direct clinical studies, it remains controversial whether glycyrrhizic acid preparations have the best efficacy in CHB. Therefore, we aimed to compare and rank the different GA preparations in the treatment of CHB using network meta-analysis (NMA).
We systematically searched MEDLINE, EMBASE, Cochrane Library, Web of Science, China national knowledge internet (CNKI), Wanfang, VIP, and SinoMed databases as of August 4, 2022. Literature was screened according to predefined inclusion and exclusion criteria to extract meaningful information. A Bayesian approach was used for random effects model network meta-analysis, and Stata 17 software was used for data analysis.
From 1074 papers, we included 53 relevant randomized clinical trials (RCTs). For the primary outcome, we used the overall effective rate in assessing the effectiveness of treatment for CHB (31 RCTs including 3007 patients): CGI, CGT, DGC and MgIGI significantly reduced the incidence of overall response compared to controls (RRs range from 1.16 to 1.24); SUCRA results showed that MgIGI was the best (SUCRA 0.923). In terms of secondary outcomes, we assessed the effect of treatment for CHB according to the level of reduction in ALT and AST: for ALT (37 RCTs including 3752 patients), CGI, CGT, DGC, DGI and MgIGI significantly improved liver function index compared to controls (MD range from 14.65 to 20.41); SUCRA results showed that CGI was the best (SUCRA 0.87); for AST, GI, CGT, DGC, DGI and MgIGI significantly improved liver function index compared to the control group (MD range from 17.46 to 24.42); SUCRA results showed that MgIGI was the best (SUCRA 0.871).
In this study, we verified that the combination of GA and Entecavir is more effective than entecavir monotherapy in the treatment of hepatitis B. MgIGI and CGI showed clinically significant effects on liver function recovery compared with other GA preparations. MgIGI appeared to be the best choice among all GA preparations for the treatment of CHB. Our study provides some references for the treatment of CHB.
恩替卡韦（ETV）在治疗慢性乙型肝炎（CHB）时存在肝功能改善不佳等缺点，因此常与甘草酸制剂联合用于临床治疗。然而，由于缺乏可靠和直接的临床研究，甘草酸制剂在 CHB 中的最佳疗效仍存在争议。因此，我们旨在通过网络荟萃分析（NMA）比较和排名不同甘草酸制剂在 CHB 治疗中的疗效。
我们系统地检索了 MEDLINE、EMBASE、Cochrane 图书馆、Web of Science、中国知网（CNKI）、万方、VIP 和 SinoMed 数据库，截至 2022 年 8 月 4 日。根据预设的纳入和排除标准筛选文献，以提取有意义的信息。采用贝叶斯随机效应模型网络荟萃分析，使用 Stata 17 软件进行数据分析。
从 1074 篇论文中，我们纳入了 53 项相关的随机对照试验（RCTs）。对于主要结局，我们使用总有效率评估 CHB 的治疗效果（31 项 RCTs，包括 3007 名患者）：CGI、CGT、DGC 和 MgIGI 显著降低了总反应的发生率（RR 范围为 1.16 至 1.24）；SUCRA 结果显示 MgIGI 为最佳（SUCRA 0.923）。对于次要结局，我们根据 ALT 和 AST 降低水平评估 CHB 的治疗效果：对于 ALT（37 项 RCTs，包括 3752 名患者），CGI、CGT、DGC、DGI 和 MgIGI 与对照组相比显著改善肝功能指标（MD 范围为 14.65 至 20.41）；SUCRA 结果显示 CGI 为最佳（SUCRA 0.87）；AST 方面，GI、CGT、DGC、DGI 和 MgIGI 与对照组相比显著改善肝功能指标（MD 范围为 17.46 至 24.42）；SUCRA 结果显示 MgIGI 为最佳（SUCRA 0.871）。
本研究证实，GA 与恩替卡韦联合治疗乙型肝炎的效果优于恩替卡韦单药治疗。与其他 GA 制剂相比，MgIGI 和 CGI 对肝功能恢复具有显著的临床效果。在所有 GA 制剂中，MgIGI 似乎是治疗 CHB 的最佳选择。我们的研究为 CHB 的治疗提供了一些参考。
