Comparative effectiveness of peroxisome proliferator-activated receptor agonists as second-line therapies for primary biliary cholangitis: A systematic review and network meta-analysis.

For patients with inadequate response or intolerance to ursodeoxycholic acid, peroxisome proliferator-activated receptor (PPAR) agonists have emerged as second-line options.

对于对熊去氧胆酸反应不足或不耐受的患者，过氧化物酶体增殖物激活受体（PPAR）激动剂已成为二线治疗选择。

This study assessed the comparative effectiveness and safety of PPAR agonists in primary biliary cholangitis through a systematic reviewand network meta-analysis.

本研究通过系统评价和网络荟萃分析评估了PPAR激动剂在原发性胆汁性胆管炎中的比较有效性和安全性。

approach_and_results

A systematic reviewidentified randomized controlled trials evaluating PPAR agonists versus ursodeoxycholic acid, with or without placebo.

系统评价识别了评估PPAR激动剂与熊去氧胆酸（无论是否加安慰剂）比较的随机对照试验。

A frequentist network meta-analysisassessed biochemical response (primary outcome) and ALP normalization (secondary outcome).

一项频率学派网络荟萃分析评估了生化反应（主要结果）和碱性磷酸酶（ALP）正常化（次要结果）。

Pairwise meta-analyses were performed for percentage change in ALP and total bilirubin, and adverse events leading to treatment discontinuation.

进行了成对荟萃分析，以评估碱性磷酸酶（ALP）和总胆红素的百分比变化，以及导致治疗中断的不良事件。

Data were stratified by baseline ALP, and a random-effects model was used.

数据根据基线碱性磷酸酶（ALP）进行了分层，并使用了随机效应模型。

Eight randomized controlled trials (727 participants) evaluating 4 PPAR agonists were included.

纳入了8项评估4种PPAR激动剂的随机对照试验（共727名参与者）。

All agents outperformed placebo in achieving biochemical response and ALP normalization.

所有药物在实现生化反应和碱性磷酸酶正常化方面均优于安慰剂。

Bezafibrate ranked highest for the primary outcome; both bezafibrate and seladelpar ranked highest for the secondary outcome.

贝扎贝特在主要结果指标上排名最高；贝扎贝特和塞拉德帕在次要结果指标上均排名最高。

Percentage ALP reduction did not vary by baseline ALP.

基线碱性磷酸酶（ALP）水平不同，其降低的百分比并未发生变化。

Total bilirubin changes were similar across arms, and treatment discontinuations due to adverse events were infrequent.

各组总胆红素的变化相似，且因不良事件导致的治疗中断不常见。

Conclusions

PPAR agonists are effective second-line therapies for primary biliary cholangitis.

PPAR激动剂是原发性胆汁性胆管炎二线治疗的有效药物。

Treatment ranking differences likely reflect variations in outcomes, populations, and drug mechanisms.

治疗排名的差异可能反映了结果、人群和药物机制的变化。

In the absence of head-to-head trials, network meta-analysisprovides important insights into comparative effectiveness.

在缺乏直接比较试验的情况下，网络荟萃分析为我们提供了关于比较效果的重要见解。

Further studies are warranted to confirm long-term safety and improve the evaluation of patient-centered outcomes.

需要进一步的研究来确认长期安全性并改进以患者为中心的结果评估。