Abstract
EFFICACY OF SIMVASTATIN PLUS NON-SELECTIVE BETA BLOCKER IN IMPROVING SURVIVAL OF CIRRHOTIC PATIENTS WITH VARICEAL BLEED: A SYSTEMATIC REVIEW AND META ANALYSIS
Fajardo, Jemimah Andrea P., MD; Soliman, Gian Paulo Alberto V., MD; Bellido, Sarah Jean C. MD
St. Luke’s Medical Center, Quezon City, Philippines
Methodology: A comprehensive search through Pubmed, Cochrane and Google Scholar was done which included studies that used statin plus beta blocker in improving survival in cirrhotic patients with variceal bleed. Two reviewers screened and reviewed all available studies. Inclusion and exclusion criteria was made for selecting included studies. The Cochrane Risk-of-Bias tool was used to assess possible bias. Data was analyzed using RevMan5.4 and GRADEPro. The primary outcome measured was improvement in survival with a secondary outcome of rebleeding. The effect measure used was relative risk, with confidence interval of 95%
Results: The search yielded 235 articles, with 3 RCTs included. There was a significant survival benefit among patients given simvastatin with a risk-ratio of 0.43 (95%CI 0.26-0.73; p=0.002) with minimal heterogeneity. The secondary outcome of rebleeding showed a trend towards benefit with a risk-ratio of 0.72. However, it was not statistically significant (95%CI; 0.47-1.09; p=0.12).
Conclusion: Among cirrhotic patients with variceal bleeding, addition of simvastatin provides a significant benefit in survival, but not in rebleeding. However, there remains a need for larger studies to strengthen this evidence, and explore its safety profile in cirrhotic patients specifically
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |