Department of Psychiatry, Renmin Hospital of Wuhan University, Hubei Zhang Road (Formerly Ziyang Road), Wuchang District No. 99, Jiefang Road 238, Wuhan, Hubei Province, China.
Department of General Surgery, Renmin Hospital of Wuhan University, Hubei Zhang Road (formerly Ziyang Road), Wuchang District No. 99, Jiefang Road 238, Wuhan, Hubei Province, China.
Dig Dis Sci. 2022 Jan;67(1):187-207. doi: 10.1007/s10620-021-06846-1. Epub 2021 Feb 15.
Patients with functional dyspepsia often select different pharmacological treatments. We aimed to compare and rank the efficacy of different pharmacological interventions in treating functional dyspepsia.
We searched EMBASE, PubMed, Cochrane, Web of Science and MEDLINE from the date of database inception to March 28, 2019. A random-effects model was selected to conduct traditional meta-analysis to directly examine the efficacy of different pharmacological interventions. The consistency model was selected to conduct a network meta-analysis to evaluate the relative effects and rank probability of different pharmacological interventions.
We included 58 trials (15,629 participants and 21 pharmacological treatments). Network meta-analysis showed that cisapride, domperidone, itopride, and levosulpiride were better than placebo, especially in short term (< 4 weeks). And levosulpiride was significantly more effective than 15 other drugs and placebo (ORs ranging between 0.05 and 0.15). Cisapride was significantly more effective than lansoprazole (OR 0.30, 95% CrI 0.09-0.99) and tegaserod (OR 0.26, 95% CrI 0.07-0.98). The rank probability showed that levosulpiride was most likely to be rank 1 (77%), cinitapride rank 2 (17%), and cisapride rank 3 (23%).
Our study confirmed the effectiveness of several pharmacological treatments for ameliorating functional dyspepsia. Furthermore, levosulpiride relatively ranked the best in managing FD. Physicians should be encouraged to apply promising pharmacological interventions (e.g., levosulpiride and cisapride). However, the results should be interpreted with caution due to small study effects.
功能性消化不良患者常选择不同的药物治疗。本研究旨在比较和排序不同药物干预治疗功能性消化不良的疗效。
我们检索了 EMBASE、PubMed、Cochrane、Web of Science 和 MEDLINE，检索时间从数据库建立到 2019 年 3 月 28 日。采用随机效应模型进行传统的荟萃分析，以直接检验不同药物干预的疗效。采用一致性模型进行网络荟萃分析，以评估不同药物干预的相对疗效和排序概率。
我们纳入了 58 项试验（15629 名参与者和 21 种药物治疗）。网络荟萃分析显示，西沙必利、多潘立酮、伊托必利和左旋舒必利优于安慰剂，尤其是在短期（<4 周）内。左旋舒必利明显优于其他 15 种药物和安慰剂（比值比范围为 0.05 至 0.15）。西沙必利明显优于兰索拉唑（比值比 0.30，95%可信区间 0.09-0.99）和替加色罗（比值比 0.26，95%可信区间 0.07-0.98）。排序概率表明，左旋舒必利最有可能排名第一（77%），西尼必利排名第二（17%），西沙必利排名第三（23%）。
本研究证实了几种药物治疗改善功能性消化不良的疗效。此外，左旋舒必利在治疗 FD 方面相对排名最佳。应鼓励医生应用有前途的药物干预措施（如左旋舒必利和西沙必利）。然而，由于研究效应较小，结果应谨慎解释。
