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Combination Therapy Using Chelating Agent and Zinc for Wilson's Disease.

Chen JC, Chuang CH, Wang JD, Wang CW - J Med Biol Eng (2015)

Bottom Line: This study systematically reviews the effectiveness of various medication therapies in common use, specifically focusing on preliminary findings concerning the combination of a chelating agent and zinc.A systematic PubMed search was executed to locate original studies on the effectiveness of commonly used medications for WD published between January 1989 and August 2014.These were analyzed in terms of data on effectiveness, adverse effects, and mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Computer Science and Information Engineering, Asia University, Taichung, 41354 Taiwan.

ABSTRACT

There is no clear international consensus regarding the optimal medication therapy for treating Wilson's disease (WD). This study systematically reviews the effectiveness of various medication therapies in common use, specifically focusing on preliminary findings concerning the combination of a chelating agent and zinc. A systematic PubMed search was executed to locate original studies on the effectiveness of commonly used medications for WD published between January 1989 and August 2014. The results were used to conduct a systematic review of studies on combination therapies. A total of 17 combination therapy studies involving 1056 patients were reviewed. These were analyzed in terms of data on effectiveness, adverse effects, and mortality. Results from a pooled analysis indicate that combination therapies for hepatic patients were significantly less effective than the same therapies for neurological manifestations (47.1 vs. 78.6 %; pooled relative risk ratio (RR): 0.63, 95 % confidence interval CI 0.43-0.94; p = 0.02). Data from a subgroup analysis show that the combination therapy of penicillamine plus zinc sulfate resulted in a significantly higher mortality rate compared to all other combination therapy types (16.3 vs. 4.7 %; RR: 3.51, 95 % CI 1.54-8.00; p < 0.001). The use of combination therapies involving zinc and a chelator should be carefully monitored with close clinical observations and frequent biochemical tests, especially for WD patients with hepatic manifestations.

No MeSH data available.


Related in: MedlinePlus

Forest plot of studies on combination therapies for hepatic phenotype versus neurological phenotype examining relative risk of effectiveness
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Fig5: Forest plot of studies on combination therapies for hepatic phenotype versus neurological phenotype examining relative risk of effectiveness

Mentions: We then searched for relationships between phenotype and combination therapy effectiveness, and found that less than one half (47.1 %, 95 % CI 38.2–56.0 %) of the TBs in the hepatic group (mixed phenotype excluded) responded well to combination therapy, compared to 78.6 % (95 % CI 70.7–86.6 %) of TBs in the neurological group (Table 2). According to our subgroup analyses (two-phenotype stratification), a statistically significant difference exists between the two subgroups (p = 0.02) (Fig. 5). The RR of the overall effectiveness rate was 0.63 (95 % CI 0.43–0.94), indicating that the combination therapies were 31.5 % (95 % CI 18.8–44.3 %) less effective for the hepatic patients than for the neurological patients. Note that the total number of TBs involving patients in different phenotype groups does not equal the overall effectiveness number since some of the studies in the sample did not give specific statistics for different phenotypes. A comparison of all phenotypes and combination therapy effectiveness revealed statistically significant correlations between the two factors (χ2(3) = 26.666, p < 0.001) (data not shown); medium–low positive correlations between the two variables were noted in the form of Cramer’s V value (0.321, significant at 0.001). In contrast, results from correlation and difference tests involving various combination therapy types and overall effectiveness were not statistically significant (χ2(1) = 0.373, p = 0.541 and Z = −0.611, p = 0.271). In other words, the data indicate that similar results are produced by all of the combination therapy types reviewed for this paper.Fig. 5


Combination Therapy Using Chelating Agent and Zinc for Wilson's Disease.

Chen JC, Chuang CH, Wang JD, Wang CW - J Med Biol Eng (2015)

Forest plot of studies on combination therapies for hepatic phenotype versus neurological phenotype examining relative risk of effectiveness
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4666238&req=5

Fig5: Forest plot of studies on combination therapies for hepatic phenotype versus neurological phenotype examining relative risk of effectiveness
Mentions: We then searched for relationships between phenotype and combination therapy effectiveness, and found that less than one half (47.1 %, 95 % CI 38.2–56.0 %) of the TBs in the hepatic group (mixed phenotype excluded) responded well to combination therapy, compared to 78.6 % (95 % CI 70.7–86.6 %) of TBs in the neurological group (Table 2). According to our subgroup analyses (two-phenotype stratification), a statistically significant difference exists between the two subgroups (p = 0.02) (Fig. 5). The RR of the overall effectiveness rate was 0.63 (95 % CI 0.43–0.94), indicating that the combination therapies were 31.5 % (95 % CI 18.8–44.3 %) less effective for the hepatic patients than for the neurological patients. Note that the total number of TBs involving patients in different phenotype groups does not equal the overall effectiveness number since some of the studies in the sample did not give specific statistics for different phenotypes. A comparison of all phenotypes and combination therapy effectiveness revealed statistically significant correlations between the two factors (χ2(3) = 26.666, p < 0.001) (data not shown); medium–low positive correlations between the two variables were noted in the form of Cramer’s V value (0.321, significant at 0.001). In contrast, results from correlation and difference tests involving various combination therapy types and overall effectiveness were not statistically significant (χ2(1) = 0.373, p = 0.541 and Z = −0.611, p = 0.271). In other words, the data indicate that similar results are produced by all of the combination therapy types reviewed for this paper.Fig. 5

Bottom Line: This study systematically reviews the effectiveness of various medication therapies in common use, specifically focusing on preliminary findings concerning the combination of a chelating agent and zinc.A systematic PubMed search was executed to locate original studies on the effectiveness of commonly used medications for WD published between January 1989 and August 2014.These were analyzed in terms of data on effectiveness, adverse effects, and mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Computer Science and Information Engineering, Asia University, Taichung, 41354 Taiwan.

ABSTRACT

There is no clear international consensus regarding the optimal medication therapy for treating Wilson's disease (WD). This study systematically reviews the effectiveness of various medication therapies in common use, specifically focusing on preliminary findings concerning the combination of a chelating agent and zinc. A systematic PubMed search was executed to locate original studies on the effectiveness of commonly used medications for WD published between January 1989 and August 2014. The results were used to conduct a systematic review of studies on combination therapies. A total of 17 combination therapy studies involving 1056 patients were reviewed. These were analyzed in terms of data on effectiveness, adverse effects, and mortality. Results from a pooled analysis indicate that combination therapies for hepatic patients were significantly less effective than the same therapies for neurological manifestations (47.1 vs. 78.6 %; pooled relative risk ratio (RR): 0.63, 95 % confidence interval CI 0.43-0.94; p = 0.02). Data from a subgroup analysis show that the combination therapy of penicillamine plus zinc sulfate resulted in a significantly higher mortality rate compared to all other combination therapy types (16.3 vs. 4.7 %; RR: 3.51, 95 % CI 1.54-8.00; p < 0.001). The use of combination therapies involving zinc and a chelator should be carefully monitored with close clinical observations and frequent biochemical tests, especially for WD patients with hepatic manifestations.

No MeSH data available.


Related in: MedlinePlus