Efficacy and Safety of Drugs for Gastroparesis: Systematic Review and Network Meta-analysis.

Autor:	Ingrosso MR; Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e ChirurgiaTraslazionale, Università Cattolica del Sacro Cuore, Rome, Italy., Camilleri M; Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, Minnesota., Tack J; Translational Research Center for Gastrointestinal Diseases (TARGID), Department of Chronic Diseases and Metabolism, University of Leuven, Leuven, Belgium; Department of Gastroenterology, University Hospital Leuven, Leuven, Belgium., Ianiro G; Digestive Disease Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario di Medicina e ChirurgiaTraslazionale, Università Cattolica del Sacro Cuore, Rome, Italy., Black CJ; Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom., Ford AC; Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom. Electronic address: alexf12399@yahoo.com.
Jazyk:	angličtina
Zdroj:	Gastroenterology [Gastroenterology] 2023 Apr; Vol. 164 (4), pp. 642-654. Date of Electronic Publication: 2022 Dec 26.
DOI:	10.1053/j.gastro.2022.12.014
Abstrakt:	Background & Aims: Although there have been multiple drugs tested in gastroparesis, their relative efficacy and safety are unknown. We evaluated this in a network meta-analysis of randomized controlled trials (RCTs). Methods: We searched the literature to September 7, 2022. We judged the efficacy of drugs based on global symptoms of gastroparesis; individual symptoms, including nausea, vomiting, abdominal pain, bloating, or fullness; and safety according to total adverse events and adverse events leading to withdrawal. We extracted data as intention-to-treat analyses, assuming dropouts to be treatment failures and reporting pooled relative risks (RRs) of not improving with 95% confidence intervals (CIs), ranking drugs according to P-score. Results: We identified 29 RCTs (3772 patients). Based on global symptoms, clebopride ranked first for efficacy (RR, 0.30; 95% CI, 0.16-0.57; P-score = .99) followed by domperidone (RR, 0.68; 95% CI, 0.48-0.98; P-score = .76). No other drug was superior to placebo. Only 2 drug classes were efficacious: in rank order, oral dopamine antagonists (RR, 0.58; 95% CI, 0.44-0.77; P-score = .96) and tachykinin-1 antagonists (RR, 0.69; 95% CI, 0.52-0.93; P-score = .83). For individual symptoms, oral metoclopramide ranked first for nausea (RR 0.46; 95% CI, 0.21-1.00; P-score = .95), fullness (RR 0.67; 95% CI, 0.35-1.28; P-score = .86), and bloating (RR 0.53; 95% CI, 0.30-0.93; P-score = .97), based on only 1 small trial. Only prucalopride was more likely to be associated with adverse events than placebo. Conclusions: In a network meta-analysis, oral dopamine antagonists and tachykinin-1 antagonists were more efficacious than placebo for gastroparesis, but confidence in the evidence was low to moderate for most comparisons. There is an unmet need for efficacious therapies for gastroparesis. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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