Esophagus to Small Intestine
Gastroenterology. 2023;164(4):642–54
Efficacy and safety of drugs for gastroparesis: Systematic review and network meta-analysis
Background and aims: Although there have been multiple drugs tested in gastroparesis, their relative efficacy and safety are unknown. The au-thors evaluated this in a network meta-analysis of randomized controlled trials (RCTs).
Methods: They searched the literature to September 7, 2022 and judged the efficacy of drugs based on global symptoms of gastroparesis; indi-vidual symptoms, including nausea, vomiting, abdominal pain, bloating, or fullness; and safety according to total adverse events and adverse events leading to withdrawal. Data were extracted 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: The authors 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 = 0.68; 95% CI: 0.48–0.98; p-score = 0.76). 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 = 0.96) and tachykinin-1 antago-nists (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 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 gas-troparesis, but confidence in the evidence was low to moderate for most comparisons. There is an unmet need for efficacious therapies for gas-troparesis.