胃轻瘫药物的有效性和安全性（荟萃分析）
- ①纳入29项随机对照试验（共3772名参与者），总结胃轻瘫药物的疗效和安全性；
- ②疗效上，氯波必利和多潘立酮改善整体症状的有效性分别为70%、31%，其他药物均不优于安慰剂；
- ③按药物类型分，仅口服多巴胺拮抗剂和速激肽-1拮抗剂有效；
- ④从个别症状看，口服胃复安在改善恶心、腹胀方面最有效，没有药物在改善腹痛和呕吐方面优于安慰剂；
- ⑤普卡洛必利的不良事件风险显著高于安慰剂，去甲替林造成的停药风险最高，而卡米西纳的不良事件风险最低。
主编推荐语
胃轻瘫综合征是一种上消化道运动障碍，以胃排空延缓为临床特征，主要表现为过早饱腹、腹胀、恶心、干呕、呕吐、腹痛等。胃轻瘫病因多样，主要有糖尿病性、手术后及特发性等，给患者造成不良影响。Gastroenterology近日发表了一项系统性综述和荟萃分析，系统总结了胃轻瘫治疗药物的疗效和安全性，强调了新药开发的必要性。
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Efficacy and Safety of Drugs for Gastroparesis: Systematic Review and Network Meta-analysis
胃轻瘫药物的有效性和安全性：系统性评价和网络荟萃分析
10.1053/j.gastro.2022.12.014
2022-12-26, Systemic Review & Meta-analysis
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Background & Aims: Although there have been multiple drugs tested in gastroparesis, their relative efficacy and safety is unknown. We evaluated this in a network meta-analysis of randomized controlled trials (RCTs).
Methods: We searched the literature to 7th September 2022. We judged drugs’ efficacy 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 0.99) followed by domperidone (RR = 0.69; 95% CI 0.48-0.98, P-score 0.76). No other drug was superior to placebo. Only two drug classes were efficacious: in rank order, oral dopamine antagonists (RR = 0.58; 95% CI 0.44-0.77, P-score 0.96) and tachykinin-1 antagonists (RR = 0.69; 95% CI 0.52-0.93, P-score 0.83). For individual symptoms, oral metoclopramide ranked first for nausea (RR 0.46; 95% CI 0.21-1.00, P-score 0.95), fullness (RR 0.67; 95% CI 0.35-1.28, P-score 0.86), and bloating (RR 0.53; 95% CI 0.30-0.93, P-score 0.97), based on only one 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 tachkinin-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.
First Authors:
Maria Rosa Ingrosso
Correspondence Authors:
Christopher J Black,Alexander C Ford
All Authors:
Maria Rosa Ingrosso,Michael Camilleri,Jan Tack,Gianluca Ianiro,Christopher J Black,Alexander C Ford
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