Evidence map›Paper›PMID 33132643›Full record

SynthesisWorld journal of gastroenterology2020

Tacrolimus and mycophenolate mofetil as second-line treatment in autoimmune hepatitis: Is the evidence of sufficient quality to develop recommendations?

Mohammadreza Abdollahi, Neda Khalilian Ekrami, Morteza Ghojazadeh, H Marike Boezen, Mohammadhossein Somi, Behrooz Z Alizadeh

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in World journal of gastroenterology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Guideline
  2. Pooled it
  3. Review
  4. Review
  5. Advances in the Treatment of Autoimmune Hepatitis.Journal of clinical and translational hepatology · 2024
    Review
  6. Article
  7. [Treatment of Autoimmune Hepatitis].The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi · 2023
    Review
  8. Review
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Mohammadreza AbdollahiDepartment of Epidemiology, University of Groningen, Groningen 9700 RB, Netherlands. m.abdollahi@umcg.nl.
Neda Khalilian EkramiDepartment of Epidemiology, University of Groningen, Groningen 9700 RB, Netherlands.
Morteza GhojazadehResearch Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz 5166614766, Iran.
H Marike BoezenDepartment of Epidemiology, University of Groningen, Groningen 9700 RB, Netherlands.
Mohammadhossein SomiLiver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz 5166614766, Iran.
Behrooz Z AlizadehDepartment of Epidemiology, University of Groningen, Groningen 9700 RB, Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe standard management of autoimmune hepatitis (AIH) is based on corticosteroids, alone or in combination with azathioprine. Second-line treatments are needed for patients who have refractory disease. However, high-quality data on the alternative management of AIH are scarce.

aimTo evaluate the efficacy and safety of tacrolimus and mycophenolate mofetil (MMF) and the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE).

methodsA systematic review and meta-analysis of the available data were performed. We calculated pooled event rates for three outcome measures: Biochemical remission, adverse events, and mortality, with their corresponding 95% confidence intervals (CI).

resultsThe pooled biochemical remission rate was 68.9% (95%CI: 60.4-76.2) for tacrolimus, and 59.6% (95%CI: 54.8-64.2) for MMF, and rates of adverse events were 25.5% (95%CI: 12.4-45.3) for tacrolimus and 24.1% (95%CI: 15.4-35.7) for MMF. The pooled mortality rate was estimated at 11.5% (95%CI: 7.1-18.1) for tacrolimus and 9.01% (95%CI: 6.2-12.8) for MMF. Pooled biochemical remission rates for tacrolimus and MMF in patients with intolerance to standard therapy were 56.6% (CI: 43.4-56.6)

conclusionTacrolimus and MMF are in practice considered effective for patients with AIH who are non-responders or intolerant to first-line treatment, but we found no high-quality evidence to support this statement.

Indexed as

Hepatitis, AutoimmuneMycophenolic AcidHumansImmunosuppressive AgentsTacrolimusTreatment OutcomeImmunosuppressive AgentsMycophenolic AcidTacrolimusAutoimmune hepatitisEfficacyGrading of Recommendations Assessment, Development and Evaluation approachMeta-analysisSecond-lineSystematic review

Identifiers

PMID33132643
PMCPMC7579758

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.