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Estatinas para el hígado graso no alcohólico y la esteatohepatitis no alcohólica

Appendices

Appendix 1. Search strategies

Database

Time Span

Search Strategy

Cochrane Hepato‐Biliary Group Controlled Trials Register

March 2013

(statin* OR Lovastatin OR Atorvastatin OR Simvastatin OR Parvovastatin OR Rosuvastatin OR Fluvastatin OR Pravastatin OR 'reductase inhibitor*') AND (liver* OR hepat* OR steatohepat* OR NAFL* OR NASH*)

Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Wiley)

Issue 1, 2013

#1 Statins /explode all trees (MeSH)
#2 HMG‐CoA reductase inhibitors/ explode all trees (MeSH)
#3 Hydroxymethylglutaryl‐CoA reductase inhibitors / explode all trees (MeSH)
#4 Lovastatin or Pravastatin or Rosuvastatin or Atorvastatin or Simvastatin
#5 (#1 or #2 or #3 or #4)
#6 Fatty liver / explode all trees (MeSH)
#7 Liver steatosis / explode all trees (MeSH)
#8 (#6 or #7)
#9 (#5 AND #8)

MEDLINE (OvidSP)

1946 to March 2013

1. exp Hydroxymethylglutaryl‐CoA Reductase Inhibitors/ or exp Lovastatin/ or exp Pravastatin/

2. (statin* or Lovastatin or Atorvastatin or Simvastatin or Parvovastatin or Rosuvastatin or Fluvastatin or Pravastatin or 'reductase inhibitor*').mp. [mp=title, original title, abstract, name of substance word, subject heading word, unique identifier]

3. 1 or 2

4. exp Fatty Liver/

5. ((fatty and (liver* or hepat*)) or steatohepat* or NAFL* or NASH*).mp. [mp=title, original title, abstract, name of substance word, subject heading word, unique identifier]

6. 4 or 5

7. 3 and 6

8. (random* or blind* or placebo* or meta‐analysis).mp. [mp=title, original title, abstract, name of substance word, subject heading word, unique identifier]

9. 7 and 8

EMBASE (OvidSP)

1974 to March 2013

1. exp hydroxymethylglutaryl coenzyme A reductase inhibitor/

2. (statin* or Lovastatin or Atorvastatin or Simvastatin or Parvovastatin or Rosuvastatin or Fluvastatin or Pravastatin or 'reductase inhibitor*').mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer name]

3. 1 or 2

4. exp fatty liver/

5. ((fatty and (liver* or hepat*)) or steatohepat* or NAFL* or NASH*).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer name]

6. 4 or 5

7. 3 and 6

8. (random* or blind* or placebo* or meta‐analysis).mp. [mp=title, abstract, subject headings, heading word, drug trade name, original title, device manufacturer, drug manufacturer name]

9. 7 and 8

Science Citation Index Expanded (http://apps.isiknowledge.com)

1900 to March 2013

#1 TS=(statins OR HMG‐CoA reductase inhibitors OR Hydroxymethylglutaryl‐CoA reductase inhibitors OR Lovastatin OR Pravastatin OR Rosuvastatin OR Atorvastatin OR Simvastatin)
#2 TS=(Fatty liver OR Liver steatosis)
#3 #2 AND #1
#4 TS=(random* OR blind* OR placebo* OR meta‐analysis)

#5 #4 AND #3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Table 1. Search results

Source of the search

Number of records

CHBG Controlled Trial Register

51

Cochrane Central Register of Controlled Trials

78

MEDLINE (Ovid)

116

EMBASE (Ovid)

518

Science Citation Index EXPANDED

91

Total number of references identified

851

Number of duplicates excluded

198

Number of references in final list

653

Figures and Tables -
Table 1. Search results
Table 2. Baseline and after treatment laboratory variables in Nelson et al trial

 

Statin (n = 10)

Placebo  (n = 6)

Before treatment

After treatment

Mean decrease

Before treatment

After treatment

Mean decrease

ALT (U/L)

70.4

49.5

20.9

66.8

75.3

‐8.5

AST (U/L)

43.3

36.5

6.8

42.8

49.3

‐6.5

ALP (U/L)

86.1

89.7

‐3.6

74.3

73

1.3

TG (mg/dL)

388.7

490

‐101.3

335.3

361.7

‐26.4

ALT = alanine aminotransferase
AST = aspartate aminotransferase
ALP = alkaline phosphatase
TG = triglycerides

Figures and Tables -
Table 2. Baseline and after treatment laboratory variables in Nelson et al trial
Table 3. Baseline and after treatment laboratory variables in Athyros et al trial

 

Statin (n = 63)

Fenofibrate  (n = 62)

Before treatment

After treatment

Mean decrease

Before treatment

After treatment

Mean decrease

ALT (U/L)

54

32

22

52

36

16

AST (U/L)

38

25

13

39

27

12

ALP (U/L)

110

75

35

108

78

30

TG (mg/dL)

203.8

142.2

61.6

194.9

115.6

79.3

ALT = alanine aminotransferase
AST = aspartate aminotransferase
ALP = alkaline phosphatases
TG = triglycerides

Figures and Tables -
Table 3. Baseline and after treatment laboratory variables in Athyros et al trial
Table 4. Level of evidence for each outcome

Outcome

Biochemical improvement

 

Radiological improvement

No improvement in histology

Serious adverse effects

Evidence

Low‐quality systematic review

Low‐quality randomised clinical trial

Small sample size in low‐quality randomised clinical trial

Low‐quality systematic review

 

Level of evidence

2

2

2

2

Grade of recommendation

B

B

B

B

Figures and Tables -
Table 4. Level of evidence for each outcome