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Flumazenil vs placebo in hepatic encephalopathy in patients with cirrhosis: a meta-analysis Goulenok C; Bernard B; Cadranel JF; Thabut D; Di Martino V; Opolon P; Poynard TAliment Pharmacol Ther 2002[Mar]; 16 (3): 361-72BACKGROUND: Randomized controlled trials testing flumazenil in hepatic encephalopathy have shown conflicting results. AIM: To compare flumazenil and placebo in hepatic encephalopathy in patients with cirrhosis. METHODS: An overview of randomized controlled trials comparing flumazenil and placebo in hepatic encephalopathy in patients with cirrhosis was performed. For each end-point, heterogeneity and treatment efficacy were assessed by Peto and Der Simonian methods. As most trials were crossover in nature, a sensitivity analysis was performed including the two treatment periods. RESULTS: Six double-blind randomized controlled trials, including 641 patients (326 treated with flumazenil and 315 with placebo), were identified. The treatment duration ranged from 5 min to 3 days. Heterogeneity tests between control groups were not significant. The mean percentages of patients with clinical improvement (five trials) were 27% in treated groups and 3% in placebo groups. This difference was significant by both methods (Peto: odds ratio=6.15; 95% confidence interval, 4.0-9.5; P < 0.001; Der Simonian: mean rate difference, 29%; 95% confidence interval, 17-41; P < 0.001). The mean percentages of patients with electroencephalographic improvement were 19% in treated groups and 2% in placebo groups. This difference was significant only with the Peto method (odds ratio=5.8; 95% confidence interval, 3.4-9.7; P < 0.001). The sensitivity analysis showed similar results. CONCLUSIONS: This meta-analysis shows that flumazenil induces clinical and electroencephalographic improvement of hepatic encephalopathy in patients with cirrhosis.|Coma/complications/drug therapy/physiopathology[MESH]|Double-Blind Method[MESH]|Electroencephalography[MESH]|Female[MESH]|Flumazenil/*therapeutic use[MESH]|Hepatic Encephalopathy/*complications/*drug therapy/physiopathology[MESH]|Humans[MESH]|Liver Cirrhosis/*complications/physiopathology[MESH]|Male[MESH]|Odds Ratio[MESH]|Patient Selection[MESH]|Placebos[MESH]|Randomized Controlled Trials as Topic[MESH]|Research Design[MESH]|Surveys and Questionnaires[MESH]|Treatment Outcome[MESH] |
