TY - JOUR
T1 - Efficacy and Safety of Drugs for Gastroparesis: Systematic Review and Network Meta-analysis
AU - Ingrosso, Maria Rosa
AU - Camilleri, Michael
AU - Tack, Jan
AU - Ianiro, Gianluca
AU - Black, Christopher J.
AU - Ford, Alexander C.
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - Drugs
KW - Efficacy
KW - Safety
KW - RCT Comparison
KW - Gastroparesis
KW - Drugs
KW - Efficacy
KW - Safety
KW - RCT Comparison
KW - Gastroparesis
UR - http://hdl.handle.net/10807/302130
U2 - 10.1053/j.gastro.2022.12.014
DO - 10.1053/j.gastro.2022.12.014
M3 - Article
SN - 0016-5085
VL - 164
SP - 642
EP - 654
JO - Gastroenterology
JF - Gastroenterology
ER -