{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T13:30:22Z","timestamp":1768311022455,"version":"3.49.0"},"reference-count":50,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2015,2,13]],"date-time":"2015-02-13T00:00:00Z","timestamp":1423785600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Interventional treatment for overt hepatic encephalopathy (<jats:styled-content style=\"fixed-case\">OHE<\/jats:styled-content>), includes non\u2010absorbable disaccharides, neomycin, rifaximin, L\u2010ornithine\u2010L\u2010aspartate and branched chain amino acids (<jats:styled-content style=\"fixed-case\">BCAA<\/jats:styled-content>). However, the optimum regimen remains inconclusive.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To compare interventions in terms of patients\u2019 adverse events and major clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Literature search of PubMed, Embase, Scopus, and Cochrane Library studies published up to July 31 2014. <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s of above interventions in <jats:styled-content style=\"fixed-case\">OHE<\/jats:styled-content> patients were included. Network meta\u2010analysis combined direct and indirect evidence to estimate odds ratios (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content>s) and mean difference (<jats:styled-content style=\"fixed-case\">MD<\/jats:styled-content>) between treatments and the probabilities of ranking for treatment based on clinical outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty eligible <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s were included. When compared with observation, only L\u2010ornithine\u2010L\u2010aspartate (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 3.71, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001) and <jats:styled-content style=\"fixed-case\">BCAA<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 3.37, <jats:italic>P\u00a0<\/jats:italic>&lt;\u00a00.001) improved clinical efficacy significantly. However, when L\u2010ornithine\u2010L\u2010aspartate was compared with <jats:styled-content style=\"fixed-case\">BCAA<\/jats:styled-content>, non\u2010absorbable disaccharides and neomycin, there was a trend suggesting that L\u2010ornithine\u2010L\u2010aspartate may be the most effective intervention with respect to clinical improvement (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.10), rifaximin (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 1.31), non\u2010absorbable disaccharides (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.75), neomycin (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.22). In addition, L\u2010ornithine\u2010L\u2010aspartate (<jats:styled-content style=\"fixed-case\">MD<\/jats:styled-content> \u221220.18, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u221240.12 to \u22120.27) provided a significant reduction in blood ammonia concentration compared with observation. Neomycin appeared to be associated with more adverse events in comparison with non\u2010absorbable disaccharides (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 10.15), rifaximin (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 17.31), L\u2010ornithine\u2010L\u2010aspartate (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 3.16) or <jats:styled-content style=\"fixed-case\">BCAA<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 7.69).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>L\u2010ornithine\u2010L\u2010aspartate treatment may show a trend in superiority for clinical efficacy among standard interventions for <jats:styled-content style=\"fixed-case\">OHE<\/jats:styled-content>. Rifaximin shows the greatest reduction in blood ammonia concentration, and treatment with neomycin demonstrates a higher probability in causing adverse effects among the five compared interventions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.13122","type":"journal-article","created":{"date-parts":[[2015,2,13]],"date-time":"2015-02-13T13:20:21Z","timestamp":1423833621000},"page":"624-635","source":"Crossref","is-referenced-by-count":73,"title":["Systematic review with network meta\u2010analysis: the comparative effectiveness and safety of interventions in patients with overt hepatic encephalopathy"],"prefix":"10.1111","volume":"41","author":[{"given":"G.\u2010Q.","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Infection and Liver Diseases Liver Research Center the First Affiliated Hospital of Wenzhou Medical University Wenzhou China"},{"name":"School of the First Clinical Medical Sciences Wenzhou Medical University Wenzhou 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