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Yan Zhang,1,2,* Sainan Li,1,* Lei He,1 Fan Wang,1 Kan Chen,1 Jingjing Li,1 Tong Liu,1 Yuanyuan Zheng,1 Jianrong Wang,1,3 Wenxia Lu,1,3 Yuqing Zhou,1,4 Qin Yin,1,4 Yujing Xia,1 Yingqun Zhou,1 Jie Lu,1 Chuanyong Guo1 1Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 2Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 3The First Clinical Medical College of Nanjing Medical University, Nanjing, 4The First Affiliated Hospital of Soochow University, Suzhou, People’s Republic of China *These authors contributed equally tothis work Background: Although the effectiveness of treatment with ursodeoxycholic acid (UDCA) and fenofibrate for primary biliary cirrhosis (PBC) has been suggested by small trials, a systematic review to summarize the evidence has not yet been carried out.Methods: A meta-analysis of all long-term randomized controlled trials comparing the combination of UDCA and fenofibrate with UDCA monotherapy was performed via electronic searches.Results: Six trials, which included 84 patients, were assessed. Combination therapy with UDCA and fenofibrate was more effective than UDCA monotherapy in improving alkaline phosphatase (mean difference [MD]: -90.44 IU/L; 95% confidence interval [CI]: -119.95 to -60.92; P

Huawei Zhang,1,2,* Jing Yang,1,* Rong Zhu,1,3 Yuanyuan Zheng,1 Yuqing Zhou,1,2 Weiqi Dai,1 Fan Wang,1 Kan Chen,1 Jingjing Li,1 Chengfen Wang,1 Sainan Li,1 Tong Liu,1 Huerxidan Abudumijiti,1 Zheng Zhou,1,3 Jianrong Wang,1,3 Wenxia Lu,1,3 Junshan Wang,1 Yujing Xia,1 Yingqun Zhou,1 Jie Lu,1 Chuanyong Guo1 1Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, 2The First Affiliated Hospital of Soochow University, Suzhou, 3The First Clinical Medical College of Nanjing Medical University, Nanjing, People’s Republic of China *These authors contributed equally to this work and should be considered co-first authors Abstract: In this study, a meta-analysis of randomized controlled trials comparing ursodeoxycholic acid (UDCA) monotherapy with combination therapies utilizing UDCA and budesonide was performed. We found that combination therapy with UDCA and budesonide was more effective than UDCA monotherapy for primary biliary cirrhosis–autoimmune hepatitis overlap syndrome. Moreover, compared to prednisone, budesonide has fewer side effects. Keywords: meta-analysis, UDCA, budesonide, combination therapy, PBC–AIH overlap syndrome