l-ornithine-l-aspartate for hepatic encephalopathy in patients with cirrhosis: A meta-analysis of randomized controlled trials

Authors

  • Ming Bai,

    1. Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
    2. Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
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  • Zhiping Yang,

    1. Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
    2. Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
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  • Xingshun Qi,

    1. Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
    2. Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
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  • Daiming Fan,

    1. Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
    2. Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
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  • Guohong Han

    Corresponding author
    1. Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
    • Department of Liver Disease, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an, Shaanxi, China
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  • Declaration of interests: There is no conflict of interest for this study.

Correspondence

Professor Guohong Han, Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, No.127 Changlexi Road, Xi'an, Shaanxi Province 710032, China. Email: hangh2009@gmail.com; hangh@fmmu.edu.cn

Abstract

Background and Aim

Several randomized, controlled trials that evaluated the effectiveness of l-ornithine-l-aspartate (LOLA) in the treatment of hepatic encephalopathy (HE) have been published recently. The purpose of this study was to update the meta-analysis to reevaluate the safety and efficacy of LOLA on HE in patients with cirrhosis.

Methods

The following databases were searched from inception to June 2012: Medline, Embase, and the Cochrane Central Register of Controlled Trials (Issue 6). Differences between groups were assessed by the pooled risk ratio (RR) or mean difference (MD). Possible sources of heterogeneity were assessed by sensitivity analyses.

Results

Eight randomized controlled trials with 646 patients were included. When comparing placebo/no-intervention control, LOLA was significantly more effective in the improvement of HE in the total (RR: 1.49, 95% confidence interval [CI]: 1.10 to 2.01), overt HE (RR: 1.33, 95% CI: 1.04 to 1.69), and minimal HE patients (RR: 2.25, 95% CI: 1.33 to 3.82). Furthermore, the reduction of fasting ammonia significantly favored LOLA (post-treatment value, MD: −18.26, 95% CI: −26.96 to −9.56; change, MD: 8.59, 95% CI: 5.22 to 11.96). The tolerance ratio, incidence of adverse events, and mortality were not significantly different between LOLA and the placebo/no-intervention control. LOLA and lactulose demonstrated similar effectiveness in the improvement of HE (RR: 0.88, 95% CI: 0.57 to 1.35).

Conclusions

LOLA benefits both overt and minimal HE patients in the improvement of HE by reducing the serum ammonia concentration compared with the placebo/no-intervention control. Further, evaluations between LOLA and other effective treatments are needed.

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