Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Baiyun District, Guangzhou 510515, China.
Dig Dis Sci. 2013 Jul;58(7):1991-2000. doi: 10.1007/s10620-013-2606-0. Epub 2013 Feb 28.
Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs) has been perplexing most clinicians and users of NSAIDs. Rebamipide is increasingly advocated as a candidate option for the prevention of NSAIDs induced gastrointestinal mucosal injury.
To assess the efficacy and the safety of rebamipide for the prevention and treatment of NSAID-induced gastroenteropathy.
PubMed, Embase, Web of Science, Google Scholar, the Cochrane Library, Japan Science and Technology Information Aggregator, and China Biology Medicine Disc were searched up to December 2011. Randomized controlled trials (RCTs) recruiting subjects with co-prescriptions of NSAIDs and rebamipide were eligible. Efficacy and safety of rebamipide were reevaluated, and dichotomous data were pooled to obtain relative risk (RR) with a 95 % confidence interval. Heterogeneity and publication bias were assessed by the inconsistency index statistic and funnel plot analysis, respectively.
The search identified 338 citations, and 15 RCTs including 965 individuals were eligible. In general, rebamipide acted better than placebo against short-term NSAID-induced gastroduodenal injury. Separate studies showed rebamipide was equal to or not superior to traditional strategies (including PPIs, H2RA and misoprostol treatment). Especially, rebamipide showed a beneficial effect against the small bowel damage (total RR = 2.70, 95 % confidence interval = 1.02-7.16, P = 0.045) when compared with placebo group. The average incidence of adverse events was about 36.1 % (0-70.0 %) but no serious event was recorded.
Current evidences show rebamipide is effective and safe for defending against NSAID-induced gastroduodenal and lower-gastrointestinal injuries. However, more well-designed trials should be conducted to fully confirm the practical value of rebamipide.
非甾体类抗炎药（NSAIDs）的胃肠道毒性一直困扰着大多数临床医生和 NSAIDs 使用者。瑞巴派特作为预防 NSAIDs 诱导的胃肠道黏膜损伤的候选药物越来越受到推崇。
评估瑞巴派特预防和治疗 NSAID 诱导的胃肠病的疗效和安全性。
检索PubMed、Embase、Web of Science、Google Scholar、Cochrane 图书馆、日本科学技术信息聚合和中国生物医学文献数据库，检索截至 2011 年 12 月。符合条件的研究为纳入 NSAIDs 和瑞巴派特联合用药的随机对照试验（RCTs）。重新评估瑞巴派特的疗效和安全性，并对二项数据进行汇总，获得相对风险（RR）及其 95 %置信区间。采用不一致指数统计量和漏斗图分析评估异质性和发表偏倚。
检索共得到 338 条引文，15 项 RCT 纳入 965 例患者。一般来说，瑞巴派特在短期 NSAID 诱导的胃十二指肠损伤方面优于安慰剂。单独的研究表明，瑞巴派特与传统策略（包括质子泵抑制剂、H2 受体拮抗剂和米索前列醇治疗）相当或不优于传统策略。特别是，与安慰剂组相比，瑞巴派特对小肠损伤有有益的影响（总 RR = 2.70，95 %置信区间 = 1.02-7.16，P = 0.045）。不良事件的平均发生率约为 36.1 %（0-70.0 %），但未记录到严重事件。
目前的证据表明，瑞巴派特对预防 NSAID 诱导的胃十二指肠和下胃肠道损伤有效且安全。然而，还需要进行更多精心设计的试验来充分证实瑞巴派特的实际价值。
