Carvedilol for prevention of variceal bleeding: a systematic review and meta-analysis
| Autor: | Konstantinos Malandris, Maria Sarigianni, Panagiotis Andreadis, Eleni Athanasiadou, Apostolos Manolopoulos, Apostolos Tsapas, Evangelos Akriviadis, Paschalis Paschos, Anastasia Katsoula |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
Cirrhosis MEDLINE Placebo law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine Medicine variceal bleeding Carvedilol business.industry Gastroenterology medicine.disease Confidence interval meta-analysis 030220 oncology & carcinogenesis Relative risk Meta-analysis 030211 gastroenterology & hepatology Original Article business medicine.drug |
| Zdroj: | Annals of Gastroenterology |
| ISSN: | 1792-7463 1108-7471 |
| Popis: | Background Beta-blockers are used for prophylaxis of variceal bleeding. Our aim was to assess the efficacy and safety of carvedilol for primary or secondary prevention of variceal bleeding in patients with cirrhosis. Methods We searched Medline, Embase, CENTRAL and gray literature sources for randomized controlled trials (RCTs) comparing carvedilol with placebo or any active intervention. We synthesized data using random effects models. We summarized the strength of evidence using GRADE criteria. Results We included 13 trials with 1598 patients. Carvedilol was as efficacious as endoscopic variceal ligation (EVL) (4 RCTs, risk ratio [RR] 0.74, 95% confidence interval [CI] 0.37-1.49) or propranolol (3 RCTs, RR 0.76, 95%CI 0.27-2.14) for primary prevention of variceal bleeding. Likewise, carvedilol was as efficacious as EVL (3 RCTs, RR 1.10, 95%CI 0.75-1.61), non-selective beta-blockers (NSBBs) plus isosorbide-5-mononitrate (2 RCTs, RR 1.02, 95%CI 0.70-1.51) or propranolol (2 RCTs, RR 0.39, 95%CI 0.15-1.03) for secondary prevention of variceal bleeding. Carvedilol was associated with lower all-cause mortality compared to EVL (3 RCTs, RR 0.51, 95%CI 0.33-0.79). There was no difference in any other efficacy outcome. Finally, there were no significant differences in the safety profiles compared with EVL and NSBBs. Our confidence in the effect estimates for all outcomes was very low. Conclusion Carvedilol is as efficacious and safe as standard-of-care interventions for the primary and secondary prevention of variceal bleeding. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|