Objective To investigate the clinical effect and safety of second-line drugs in the treatment of adult patients with autoimmune hepatitis( AIH) through a Meta-analysis of related articles. Methods PubMed,EMBASE,Cochrane Library,Web of Science,CNKI,CBM,Wanfang Data,and VIP were searched for the articles on second-line drugs for AIH published up to December 31,2019. The Newcastle-Ottawa Scale( NOS) was used to assess the quality of articles,related data were extracted,and Meta-Analyst software was used to perform the Meta-analysis. Results A total of 22 articles were included,with 636 patients in total. The Meta-analysis showed that mycophenolate mofetil( MMF),tacrolimus( TAC),cyclosporine,and budesonide had a pooled response rate of 56. 1%,76. 0%,62. 7%,and 57. 3%,respectively,and their pooled incidence rates of adverse events were 22. 5%,47. 4%,48. 4%,and 33. 0%,respectively.The patients treated with MMF were divided into groups based on intolerance or no response to the first-line treatment,and a comparative analysis of these groups showed a relative risk of 1. 965( 95% confidence interval: 1. 181-3. 269,I2= 0. 665,P = 0. 014). Conclusion Selection of second-line drugs for adult AIH patients should consider response rate and incidence rate of adverse reactions. Both MMF and tacrolimus are good second-line drugs,and TAC may be a better choice for patients with no response to first-line treatment.
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