Tang Gang, Zhang Jie, Zhang Linyu, Xia Lingying, Tang Xiaojuan, Chen Rui, Zhou Rongxing
Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Center for Translational Medicine, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Front Pharmacol. 2024 Jul 22;15:1432814. doi: 10.3389/fphar.2024.1432814. eCollection 2024.
Peroxisome proliferator-activated receptor (PPAR) agonists are recognised as a promising treatment for primary biliary cholangitis (PBC). However, the effects and safety of these agonists on PBC remain unexplored. Our study aimed to investigate the efficacy and safety of PPAR agonists in treating PBC.
We searched Cochrane Library, and Web of Science, PubMed, and Embase databases from inception to 15 March 2024 for randomised controlled studies (RCTs) that enrolled individuals with PBC treated with PPAR agonists compared with placebo. The primary outcomes were biochemical response and normalization of the alkaline phosphatase (ALP) level.
Eight RCTs involving 869 participants in total were included. The meta-analysis revealed that compared to placebo, PPAR agonists increased the rate of biochemical response (RR: 5.53; 95% CI: 3.79, 8.06) and normalization of the ALP level (RR: 17.18; 95% CI: 5.61, 52.61). In addition, PPAR agonists can also reduce alanine aminotransferase (ALT) (MD: -12.69 U/L; 95% CI: -18.03, -7.35), aspartate aminotransferase (AST) (MD: -4.18 U/L; 95% CI: -7.28, -1.08), ALP (MD: -142.95 U/L; 95% CI: -167.29, -118.60), γ-glutamyltransferase (GGT) (MD: -63.03 U/L; 95% CI: -92.08, -33.98), and total cholesterol (TC) levels (SMD: -0.71; 95% CI: -1.38, -0.04), and there was no significant difference in overall adverse reactions (RR: 0.99; 95% CI: 0.92, 1.05), serious adverse reactions (RR: 1.10; 95% CI: 0.70, 1.72) between the two groups.
PPAR agonists are safe and well-tolerated in patients with PBC and are effective in improving the rate of biochemical response and related biomarkers.
过氧化物酶体增殖物激活受体（PPAR）激动剂被认为是原发性胆汁性胆管炎（PBC）的一种有前景的治疗方法。然而，这些激动剂对PBC的疗效和安全性仍未得到探索。我们的研究旨在调查PPAR激动剂治疗PBC的疗效和安全性。
我们检索了Cochrane图书馆、Web of Science、PubMed和Embase数据库，从数据库建立至2024年3月15日，查找将接受PPAR激动剂治疗的PBC患者与接受安慰剂治疗的患者进行比较的随机对照试验（RCT）。主要结局为生化反应和碱性磷酸酶（ALP）水平正常化。
共纳入8项RCT，总计869名参与者。荟萃分析显示，与安慰剂相比，PPAR激动剂提高了生化反应率（RR：5.53；95%CI：3.79, 8.06）和ALP水平正常化率（RR：17.18；95%CI：5.61, 52.61）。此外，PPAR激动剂还可降低丙氨酸氨基转移酶（ALT）（MD：-12.69 U/L；95%CI：-18.03, -7.35）、天冬氨酸氨基转移酶（AST）（MD：-4.18 U/L；95%CI：-7.28, -1.08）、ALP（MD：-142.95 U/L；95%CI：-167.29, -118.60）、γ-谷氨酰转移酶（GGT）（MD：-63.03 U/L；95%CI：-92.08, -33.98）和总胆固醇（TC）水平（SMD：-0.71；95%CI：-1.38, -0.04），两组间总体不良反应（RR：0.99；95%CI：0.92, 1.05）、严重不良反应（RR：1.10；95%CI：0.70, 1.72）无显著差异。
PPAR激动剂在PBC患者中安全且耐受性良好，可有效提高生化反应率及相关生物标志物水平。
