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Evidence summaries

D-Penicillamine for Primary Biliary Cirrhosis

D-penicillamine appears not to reduce the mortality of patients with primary biliary cirrhosis and increases the occurrence of adverse events. Level of evidence: "B"

A Cochrane review [Abstract] 1 included seven studies with a total of 706 subjects with primary biliary cirrhosis. D-penicillamine compared with placebo/no intervention tended to increase mortality (RR 1.34, 95% CI 1.09 to 1.64, fixed; RR 1.46, 95% CI 0.85 to 2.50, random). However, there was substantial heterogeneity. No significant differences were detected regarding the risks of mortality or liver transplantation, pruritus, liver complications, progression of liver histological stage, or the levels of liver biochemical variables (except alanine aminotransferase). D-penicillamine versus placebo/no intervention significantly increased the risk of adverse events (RR 3.11, 95% CI 2.33 to 4.16, fixed; RR 4.18, 95% CI 1.38 to 12.69, random).

Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies).

    References

    • Gong Y, Frederiksen SL, Gluud C. D-penicillamine for primary biliary cirrhosis. Cochrane Database Syst Rev 2004 Oct 18;(4):CD004789. [PubMed]

Primary/Secondary Keywords