Interventions for primary biliary cirrhosis and osteoporosis in patients with primary biliary cirrhosis : Cochrane reviews with meta-analyses and trial sequential analyses of randomized clinical trials
Intervencije za lečenje primarne bilijarne ciroze: Kohranova analiza sistematskih pregleda sa meta-analizama i sekvencijalnim analizama randomizovanih kliničkih studija
Докторанд
Rudić, Jelena S.Ментор
Krstić, MiodragGluud, Christian
Чланови комисије
Pekmezović, TatjanaĆulafić, Đorđe
Bjelaković, Goran
Метаподаци
Приказ свих података о дисертацијиСажетак
Primary biliary cirrhosis is a chronic autoimmune-mediated liver disease
characterised by progressive destruction of intrahepatic bile ducts, resulting in
chronic cholestasis, portal inflammation, and fibrosis that can lead to cirrhosis
and, ultimately, liver failure and the need for liver transplantation. The disease
primarely affects middle‐aged women and is associated with osteoporosis ‐
either postmenopausal or secondary to the liver disease. Low bone mass is an
important cause of morbidity in patients with primary biliary cirrhosis, leading
to an increased risk of fractures, pain, and deformity. Treatment of primary
biliary cirrhosis and osteoporosis associated with primary biliary cirrhosis is
complicated. A number of drugs have been evaluated for patients with primary
biliary cirrhosis (glucocorticosteroids, methotrexat, azathioprine, colchicine,
cyclosporin, D-penicillamine, and chlorambucil). Ursodeoxycholic acid is the
only drug approved for primary biliary cirrho...sis by the U.S. Food and Drug
Administration. Bezafibrate may be effective for treatment of primary biliary
cirrhosis. Bisphosphonates and hormone replacement may be effective
treatment options for osteoporosis in primary biliary cirrhosis, but the effects
have only had limited assessment in systematic reviews. Therefore,
interventions based on evidence are highly warranted.
Cochrane reviews with meta-analyses and trial sequential analyses of
randomised clinical trials generally provide the best available evidence for
health care interventions and clinical practice. Such Cochrane reviews are used
to assess and summarise benefits and harms of clinical interventions.
Furthermore, Cochrane reviews will also reveal lack of evidence, and define the
specific need for future randomised clinical trials.
Objectives
To summarize the evidence from Cochrane systematic reviews on treatment options for patients with primary biliary cirrhosis and osteoporosis associated
with primary biliary cirrhosis...
Primarna bilijarna ciroza je hronična autoimuna bolest jetre koju karakteriše
progresivna destrukcija intrahepatičnih žučnih puteva sa posledičnom
holestazom, portnom inflamacijom, i fibrozom što dovodi do nastanka ciroze
jetre, i hepatičke insuficijencije sa transplantacijom jetre kao jedinom uspešnom
terapijskom metodom. Više od 90% bolesnika su žene, prosečne starosti oko 50
godina. Najvažnija komplikacija bolesti vezana za holestazu je osteoporoza gde
smanjenje koštane gustine dovodi do velikog rizika za nastanak preloma
kostiju, bola i deformiteta. Lečenje primarne bilijarne ciroze, kao i osteoporoze u
sklopu primarne bilijarne ciroze je veoma komplikovano. Za sada nema
zadovoljavajuće specifične medicinske terapije koja se preporučuje za lečenje
ove bolesti. Evaluirani su mnogi lekovi u terapiji ove bolesti (kortikosteroidi,
metrotreksat, azatioprin, kolhicin, ciklosporin, D-penicilamin, i hlorambucil), ali
do sada prikazani trajali su uglavnom bili kratki, mali i sla...bo kontrolisani.
Ursodeoksiholna kiselina jedini je lek odobren za terapiju primarne bilijarne
ciroze. U nekim kontrolisanim studijama konstatovano je da bezafibrat ima
višestruka pozitivna dejstva kod bolesnika sa primarnom bilijarnom cirozom.
Za bisfosfonate i supstitucionu hormonsku terapiju se očekuje da budu efikasni
u terapiji osteoporoze u sklopu primarne bilijarne ciroze, ali ne postoje za sada
dokazi efikasnoti u sistematskim pregledima.
Kohranovi sistematski pregledi sa meta-analizama i sekvencijalnim analizama
randomizovanih kliničkih studija sintetišu dokaze u cilju dobijanja pouzdanog,
validnog i kompletnog pregleda proverenih dokaza o korisnim i štetnim
efektima terapijskih procedura koristeći metodologiju u kojoj nema pristrasnosti
u tumačenju rezultata i izvođenju zaključaka. Takođe, oni mogu ukazati na
nedostatak dokaza i potrebu za budućim dobro dizajniranim randomizovanim
kliničkim studijama...