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

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.