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Compared to other prokinetics, Metoclopramide and Cinitapride might exhibit superior effectiveness for managing functional dyspepsia, with Cinitapride potentially presenting a reduced likelihood of overall adverse events.
In a recent systematic review and network meta-analysis on the treatment of functional dyspepsia, researchers have identified noteworthy advancements in the efficacy and safety of prokinetics, shedding light on potential game-changers in the field. Functional dyspepsia, an ailment marked by continual discomfort in the upper abdomen, has long posed a challenge for effective treatment. Previous meta-analyses explored the use of prokinetics, but the landscape has evolved with new studies and the emergence of Cinitapride as a novel prokinetic agent.
Researchers sought to explore the efficacy and safety of prokinetics for functional dyspepsia. The research team conducted a meticulous update to the study search, spanning Web of Science, Cochrane Library, EMBASE, and PubMed. The emphasis was on randomized controlled trials (RCTs) involving adult functional dyspepsia patients. The key endpoint ascertained was the total efficacy rate, with adverse events as the secondary endpoint.
A Bayesian network meta-analysis, utilizing R software, offered a comprehensive evaluation. Overall, 28 studies were incorporated in the analysis. Notably, Metoclopramide demonstrated a superior total efficacy rate compared to several prokinetics, including Mosapride (Odds ratio [OR]: 3.53), Domperidone (OR: 2.29), Itopride (OR: 2.77), Acotiamide (OR: 2.63), and even placebo (OR: 5.68). Surprisingly, Cinitapride (OR: 1.62) exhibited comparable effectiveness to Metoclopramide, signifying a potential breakthrough in functional dyspepsia treatment.
The network meta-analysis revealed that Cinitapride outperformed Mosapride (OR: 2.18) and placebo (OR: 3.52) in terms of total effectiveness rate. Additionally, Cinitapride exhibited a lower hazard of total adverse events in comparison with Domperidone. Intriguingly, no profound difference was witnessed in the risk of drug-associated adverse events among the various prokinetics. The findings suggest that both Metoclopramide and Cinitapride could emerge as frontrunners in functional dyspepsia treatment, showcasing enhanced effectiveness over other prokinetics.
Importantly, Cinitapride's potential for a lower risk of adverse events adds another layer to its appeal. However, the researchers emphasize the need for further studies utilizing standardized definitions or validated tools to measure the total effectiveness rate.
BMC Gastroenterology
Prokinetics for the treatment of functional dyspepsia: an updated systematic review and network meta-analysis
Qingqing Qi et al.
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