Systematic review and network meta-analysis: Efficacy of drugs for functional dyspepsia

Ford, Alexander C. and Moayyedi, Paul and Black, Christopher J. and Yuan, Yuhong and Veettil, Sajesh K. and Mahadeva, Sanjiv and Kengkla, Kirati and Chaiyakunapruk, Nathorn and Lee, Yeong Yeh Systematic review and network meta-analysis: Efficacy of drugs for functional dyspepsia. Alimentary Pharmacology & Therapeutics, 53 (1). pp. 8-21. ISSN 0269-2813, DOI

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Background Functional dyspepsia (FD) is a relapsing and remitting condition affecting between 5% and 10% of people. Efficacious therapies are available, but their relative efficacy is unknown. Aim To perform a systematic review with network meta-analysis to resolve this uncertainty. Methods We searched the medical literature through July 2020 for randomised controlled trials (RCTs) assessing efficacy of drugs for adults with FD, compared with each other, or placebo. Trials reported a dichotomous assessment of symptom status after completion of therapy. We pooled data using a random effects model. Efficacy was reported as a pooled relative risk (RR) of remaining symptomatic with a 95% confidence interval (CI) to summarise efficacy of each comparison tested. Relative ranking was assessed with surface under the cumulative ranking curve (SUCRA) probabilities. Results We identified 71 eligible RCTs (19 243 participants). Tricyclic antidepressants (TCAs) were ranked second for efficacy (RR of remaining symptomatic = 0.71; 95% CI 0.58-0.87, SUCRA 0.87), and first when only low risk of bias trials were included. Most RCTs that used TCAs recruited patients who were refractory to other drugs included in the network. Although sulpiride or levosulpiride were ranked first for efficacy (RR = 0.49; 95% CI 0.36-0.69, SUCRA 0.99), trial quality was low and only 86 patients received active therapy. TCAs were more likely to cause adverse events than placebo. Conclusions TCAs, histamine-(2)receptor antagonists, standard- and low-dose proton pump inhibitors, sulpiride or levosulpiride, itopride and acotiamide were all more efficacious than placebo for FD.

Item Type: Article
Funders: Fundamental Research Grant Scheme (FRGS) 203 PPSP.6171192Fundamental Research Grant Scheme (FRGS) (203), Fundamental Research Grant Scheme (FRGS) (PPSP.6171192)
Uncontrolled Keywords: Systematic review; Network meta-analysis; Drug efficacy; Functional dyspepsia
Subjects: R Medicine > R Medicine (General)
R Medicine > RM Therapeutics. Pharmacology
Divisions: Faculty of Medicine > Medicine Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 05 Sep 2022 01:53
Last Modified: 05 Sep 2022 01:53

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