Systematic review and meta-analysis: D-Penicillamine vs. placebo/no intervention in patients with primary biliary cirrhosis - Cochrane Hepato-Biliary Group

Background D-Penicillamine is used for patients with primary biliary cirrhosis due to its ability to decrease hepatic copper and modulate the immune response. The results on effects of D-penicillamine in randomized-clinical trials of primary biliary cirrhosis patients are inconsistent. Aim To systematically evaluate the benefits and harms of D-penicillamine for patients with primary biliary cirrhosis. Methods We have performed a systematic review with meta-analyses of randomized-clinical trials to evaluate the effects of D-penicillamine for primary biliary cirrhosis. The primary outcomes are mortality and mortality or liver transplantation. We analysed the data by fixed-effect and random-effect models. Results Seven randomized trials including 706 patients were analysed. D-Penicillamine was without significant effects on mortality (RR 1.08, 95% CI: 0.82-1.43, P=0.56), mortality or liver transplantation (RR 1.11, 95% CI: 0.74-1.68, P=0.62), pruritus, liver complications, progression of liver histological stage and liver biochemical variables. D-Penicillamine significantly decreased serum alanine aminotransferase activity (weighted mean difference)-45 IU/L, 95% CI:-75 to -15, P < 0.05) and led to significantly more adverse events (RR 4.18, 95% CI: 1.38-12.69, P=0.01). Conclusion D-Penicillamine did not appear to reduce the risk of mortality or morbidity, and led to more adverse events in patients with primary biliary cirrhosis.