Declaration of interests: There is no conflict of interest for this study.
Meta-Analysis and Systematic Review
l-ornithine-l-aspartate for hepatic encephalopathy in patients with cirrhosis: A meta-analysis of randomized controlled trials
Article first published online: 25 APR 2013
© 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd
Journal of Gastroenterology and Hepatology
Volume 28, Issue 5, pages 783–792, May 2013
How to Cite
Bai, M., Yang, Z., Qi, X., Fan, D. and Han, G. (2013), l-ornithine-l-aspartate for hepatic encephalopathy in patients with cirrhosis: A meta-analysis of randomized controlled trials. Journal of Gastroenterology and Hepatology, 28: 783–792. doi: 10.1111/jgh.12142
- Issue published online: 25 APR 2013
- Article first published online: 25 APR 2013
- Accepted manuscript online: 21 FEB 2013 02:41AM EST
- Manuscript Accepted: 30 JAN 2013
- hepatic encephalopathy;
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.
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.
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).
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.