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).
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.
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.
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.