Review finds only two efficacious medications to treat gastroparesis

Clebopride ranked first for efficacy, followed by domperidone, and no other drug was superior to placebo for improving symptoms of gastroparesis, according to a recent meta-analysis.

Only two drugs, the dopamine antagonists clebopride and domperidone, were more efficacious than placebo for treating gastroparesis symptoms, a systematic review and network meta-analysis found.

Researchers conducted a meta-analysis of randomized controlled trials (RCTs) through September 2022 to assess the efficacy of medications on global symptoms of gastroparesis and individual symptoms including nausea, vomiting, abdominal pain, bloating, or fullness, as well as safety according to total adverse events and adverse events leading to study withdrawal. They gathered 29 RCTs involving 3,772 patients. Results were published Dec. 26, 2022, by Gastroenterology.

To guide clinicians in prescribing the most efficacious therapy, researchers ranked medications by P-score. Based on global symptoms, clebopride ranked first for efficacy (relative risk [RR], 0.30 [95% CI, 0.16 to 0.57]; P-score, 0.99), followed by domperidone (RR, 0.69 [95% CI, 0.48 to 0.98]; P-score, 0.76). No other drug was superior to placebo. When comparing drug classes collectively, only two were efficacious: oral dopamine antagonists (RR, 0.58 [95% CI, 0.44 to 0.77]; P-score, 0.96) and tachykinin-1 antagonists (RR, 0.69 [95% CI, 0.52 to 0.93]; P-score, 0.83). None of the other drug classes was superior to placebo.

Nine RCTs involving 1,559 patients showed the drugs' failure to improve nausea. Oral metoclopramide, a prokinetic antiemetic, ranked the highest, based on one small trial, but the confidence interval reached 1.00 (RR, 0.46 [95% CI, 0.21 to 1.00]; P-score, 0.95). That trial also led metoclopramide to be the highest-ranked medication for treating fullness (RR, 0.67 [95% CI, 0.35 to 1.28]; P-score, 0.86) and bloating (RR, 0.53 [95% CI, 0.30 to 0.93]; P-score, 0.97), although the confidence interval crossed 1.00 for the former symptom. Only prucalopride, a serotonin receptor agonist, was more likely to be associated with adverse events than placebo.

Despite recently updated guidelines for gastroparesis management, the condition remains a challenging one to diagnose and treat, the study authors said. “[The results] should be a cause for concern among patients, physicians, pharmaceutical companies, and regulatory agencies,” they wrote. “Given the fact that there has been a large expansion in novel therapies for other gastrointestinal conditions, such as inflammatory bowel disease, which are highly profitable for industry, developing new drugs for a condition like gastroparesis may be viewed as a high-risk strategy. Nevertheless, there is a clear unmet need for efficacious therapies for patients with gastroparesis.”