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

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 searc...

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Main Authors:	Ford, Alexander C., Moayyedi, Paul, Black, Christopher J., Yuan, Yuhong, Veettil, Sajesh K., Mahadeva, Sanjiv, Kengkla, Kirati, Chaiyakunapruk, Nathorn, Lee, Yeong Yeh
Format:	Article
Published:	Wiley
Subjects:	R Medicine (General) RM Therapeutics. Pharmacology
Online Access:	http://eprints.um.edu.my/34182/
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spelling	my.um.eprints.341822022-09-05T01:53:04Z http://eprints.um.edu.my/34182/ Systematic review and network meta-analysis: Efficacy of drugs for functional dyspepsia Ford, Alexander C. Moayyedi, Paul Black, Christopher J. Yuan, Yuhong Veettil, Sajesh K. Mahadeva, Sanjiv Kengkla, Kirati Chaiyakunapruk, Nathorn Lee, Yeong Yeh R Medicine (General) RM Therapeutics. Pharmacology 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. Wiley Article PeerReviewed 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 https://doi.org/10.1111/apt.16072 <https://doi.org/10.1111/apt.16072>. 10.1111/apt.16072
institution	Universiti Malaya
building	UM Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	Universiti Malaya
content_source	UM Research Repository
url_provider	http://eprints.um.edu.my/
topic	R Medicine (General) RM Therapeutics. Pharmacology
spellingShingle	R Medicine (General) RM Therapeutics. Pharmacology Ford, Alexander C. Moayyedi, Paul Black, Christopher J. Yuan, Yuhong Veettil, Sajesh K. Mahadeva, Sanjiv Kengkla, Kirati Chaiyakunapruk, Nathorn Lee, Yeong Yeh Systematic review and network meta-analysis: Efficacy of drugs for functional dyspepsia
description	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.
format	Article
author	Ford, Alexander C. Moayyedi, Paul Black, Christopher J. Yuan, Yuhong Veettil, Sajesh K. Mahadeva, Sanjiv Kengkla, Kirati Chaiyakunapruk, Nathorn Lee, Yeong Yeh
author_facet	Ford, Alexander C. Moayyedi, Paul Black, Christopher J. Yuan, Yuhong Veettil, Sajesh K. Mahadeva, Sanjiv Kengkla, Kirati Chaiyakunapruk, Nathorn Lee, Yeong Yeh
author_sort	Ford, Alexander C.
title	Systematic review and network meta-analysis: Efficacy of drugs for functional dyspepsia
title_short	Systematic review and network meta-analysis: Efficacy of drugs for functional dyspepsia
title_full	Systematic review and network meta-analysis: Efficacy of drugs for functional dyspepsia
title_fullStr	Systematic review and network meta-analysis: Efficacy of drugs for functional dyspepsia
title_full_unstemmed	Systematic review and network meta-analysis: Efficacy of drugs for functional dyspepsia
title_sort	systematic review and network meta-analysis: efficacy of drugs for functional dyspepsia
publisher	Wiley
url	http://eprints.um.edu.my/34182/
_version_	1744649162230595584
score	13.211869

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

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