Qing Liu, Chen-Chen Feng, Er-Man Wang, Xiu-Juan Yan, Sheng-Liang Chen, Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Institute of Digestive Disease, Shanghai Jiao Tong University, Shanghai 200001, China.
World J Gastroenterol. 2013 Dec 21;19(47):9111-8. doi: 10.3748/wjg.v19.i47.9111.
To assess the potential benefits of mosapride plus proton pump inhibitors (PPIs) in the treatment of gastroesophageal reflux disease.
A literature search was performed through MEDLINE, EMBASE, and the ISI Web of Knowledge. The clinical trials that compared the benefit of mosapride plus PPI treatment with that of PPI monotherapy were analyzed. The rate of responders was evaluated by the pooled relative risk (PRR) and improvement in symptom scores was assessed by single effect size of a standardized mean, while Hedges'g was used as the effect size. Pooled effect sizes with 95%CIs were calculated using a fixed-effects model. Between-study heterogeneity was assessed using Q test and I (2) analyses. In addition, studies that assessed the additional efficacy of mosapride in PPI-resistant patients were also reviewed.
This systematic review included information on a total of 587 patients based on 7 trials. Four trials compared the efficacy of combination therapy of mosapride plus a PPI with that of PPI monotherapy. The statistical analysis for the effect of additional mosapride showed equivocal results (PRR = 1.132; 95%CI: 0.934-1.372; P = 0.205; Hedges'g = 0.24; 95%CI: 0.03-0.46; P = 0.023). No heterogeneity and publication bias were found among the studies. Three open-labeled trials assessed the additional efficacy of mosapride in PPI-resistant patients. However, since these trials did not set the control group, the results may be considerably biased.
Mosapride combined therapy is not more effective than PPI alone as first-line therapy. Whether it is effective in PPI-resistant patients needs to be determined.
评估莫沙必利联合质子泵抑制剂（PPIs）治疗胃食管反流病的潜在益处。
通过 MEDLINE、EMBASE 和 ISI Web of Knowledge 进行文献检索。分析了比较莫沙必利联合 PPI 治疗与 PPI 单药治疗益处的临床试验。通过合并相对风险（PRR）评估应答率，通过标准化均数的单个效应量评估症状评分的改善，同时使用 Hedge's g 作为效应量。使用固定效应模型计算合并效应量及其 95%置信区间。使用 Q 检验和 I ² 分析评估研究间的异质性。此外，还回顾了评估莫沙必利在 PPI 抵抗患者中额外疗效的研究。
本系统评价共纳入了 7 项试验共 587 名患者的信息。4 项试验比较了莫沙必利联合 PPI 治疗与 PPI 单药治疗的疗效。对额外莫沙必利作用的统计学分析结果不一致（PRR = 1.132；95%CI：0.934-1.372；P = 0.205；Hedges'g = 0.24；95%CI：0.03-0.46；P = 0.023）。研究之间无异质性和发表偏倚。3 项开放性试验评估了莫沙必利在 PPI 抵抗患者中的额外疗效。然而，由于这些试验没有设置对照组，结果可能存在较大偏差。
莫沙必利联合治疗并不优于 PPI 单药作为一线治疗。它在 PPI 抵抗患者中的疗效是否有效，还需要进一步确定。
