A Cochrane review [Abstract] 1 included 29 studies. In one trial, ursodeoxycholic acid (UDCA) versus placebo significantly reduced the risk of hepatitis B surface antigen positivity at the end of treatment and serum HBV DNA level at the end of follow-up. In another trial, UDCA versus no intervention for chronic hepatitis B significantly reduced the risk of having abnormal serum transaminase activities at the end of treatment. Twenty-five trials compared bile acids (21 trials UDCA; 4 trials tauro-UDCA) versus placebo or no intervention for chronic hepatitis C. Bile acids did not significantly reduce the risk of having detectable serum HCV RNA (RR 0.99, 95% CI 0.91 to 1.07), cirrhosis, or portal and periportal inflammation score at the end of treatment. Bile acids decreased the risk of having abnormal serum alanine aminotransferase activity at the end of treatment (RR 0.82, 95% CI 0.76 to 0.90) and follow-up (RR 0.91, 95% CI 0.85 to 0.98). Bile acids increased the Knodell score (WMD 0.20, 95% CI 0.08 to 0.31) at the end of treatment.
Comment: The quality of evidence is downgraded by limitations in study quality (e.g. unclear allocation concealment and inadequate follow-up) and by imprecise results (limited study size for each comparison).
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