Systematic ReviewEfficacy of l-Ornithine l-Aspartate for the Treatment of Hepatic Encephalopathy and Hyperammonemia in Cirrhosis: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Section snippets
Search Criteria
This involved electronic and manual searches using appropriate keywords as follows: Search strings: (1) Hepatic Encephalopathy (HE), (2) Overt Hepatic Encephalopathy (OHE), (3) Minimal Hepatic Encephalopathy (MHE), (4) l-Ornithine l-Aspartate (LOLA), (5) Intravenous Formulation (iv), (6) oral formulation (oral), (7) cirrhosis, (8) Randomized Controlled Trial (RCT). Search string: (#1 or #2 or #3) and (#4 or #5) and #7 and #8. Medline, PubMed, the Cochrane Controlled Trials Register (2008),
Results
Electronic searches of the databases identified 43 trials with a further 16 from manual searches. Five full-text articles were excluded for reasons of incompatibility of data presentation required for pooling. Following removal of duplicate citations and elimination of published studies in line with eligibility and inclusion/exclusion criteria, a total of 10 trials were included in the final meta-analysis (Figure 1) where sufficient data were available for pooling. Included trials are
Discussion
Hyperammonemia: Results of the present systematic review and meta-analysis significantly extend the findings of a number of individual RCTs namely that LOLA is effective in lowering blood ammonia in patients with cirrhosis. Pooled data from the eight RCTs in which blood ammonia was measured in all patients with HE revealed that blood ammonia was significantly reduced although the degree of reduction was variable from trial-to-trial, the overall effect was statistically significant (MD: −17.50,
Conflicts of Interest
The authors have none to declare.
References (39)
- et al.
Management of overt hepatic encephalopathy
J Clin Exp Hepatol
(2015) - et al.
Management of covert hepatic encephalopathy
J Clin Exp Hepatol
(2015) - et al.
Hepatic encephalopathy – definition, nomenclature, diagnosis and quantification: final report of the working party at the 11th World Congress of Gastroenterology, Vienna, 1998
Hepatology
(2002) - et al.
Oral l-ornithine-l-aspartate therapy of chronic hepatic encephalopathy: results of a placebo-controlled double-blind study
J Hepatol
(1998) - et al.
Neuropsychological evaluation of hepatic encephalopathy
J Hepatol
(2001) - et al.
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Control Clin Trials
(1996) - et al.
Efficacy of oral l-ornithine l-aspartate in cirrhotic patients with hyperammonemic hepatic encephalopathy. Results of a randomized, lactulose-controlled study
Ann Hepatol
(2006) - et al.
Comparative effectiveness of different pharmacological interventions for the treatment of minimal hepatic encephalopathy: a systematic review with network meta-analysis
J Clin Exp Hepatol
(2016) Diagnosis of overt hepatic encephalopathy
- et al.
Hepatic encephalopathy in chronic liver disease: 2014 practice guidelines by the American Association for the study of Liver Disease and the European Association for the Study of the Liver
Hepatology
(2014)