Clebopride and domperidone efficacious options for alleviating gastroparesis symptoms

The researchers of this study have highlighted the lack of efficacious drugs for managing gastroparesis. The issue is a cause of concern for doctors, patients, pharma companies and regulatory agencies.

There has been an expansion in managing GIT conditions like inflammatory bowel disease. Following the same for gastroparesis may be viewed as a high-risk strategy.

Considering this concerning background, researchers did a meta-analysis of RCTs to check the relative efficacy and safety of drugs used in gastroparesis, as the data remains unknown in this context.

They searched the literature till September 7, 2022.

The drug efficacy was judged based on gastroparesis symptoms like nausea, vomiting, abdominal pain, bloating, and safety as per adverse events leading to withdrawal.

The study results include the following:

• Twenty-nine identified RCTs had 3772 patients.
• For efficacy, clebopride ranked first with an RR of 0.30
• This was followed by domperidone with RR 0.68.
• No other drug had superiority compared to the placebo.
• Two drug classes were efficacious in rank order, oral dopamine antagonists of RR 0.58 followed by tachykinin-1 antagonists with RR 0.69.
• Regarding symptoms, oral metoclopramide ranked first for nausea, fullness and bloating with RR 0.46, 0.67 and 0.53. These findings were based on one small trial.
• When compared to placebo, only prucalopride was related to adverse events.

To conclude, oral dopamine antagonists and tachykinin-1 antagonists were more efficacious than placebo for gastroparesis.

They said our findings could make practical recommendations consistent with advice from regulatory agencies.

Metoclopramide, in liquid or tablet form, has a maximum dosage of 10 mg before each meal and 10 mg at bedtime for three months.

Domperidone at a dose of 10 mg 4 times daily requires special guidance provided by the FDA, with a precautionary QT interval measurement on an electrocardiogram before the prescription.

To abort the emesis cycle, prescribing aprepitant 80 mg daily for three days could be prescribed.

There is a need for efficacious therapies for patients with gastroparesis.

Further reading:

Ingrosso, Maria Rosa, et al. “Efficacy and Safety of Drugs for Gastroparesis: Systematic Review and Network Meta-analysis.” Gastroenterology, Elsevier BV, Dec. 2022. Crossref,https://doi.org/10.1053/j.gastro.2022.12.014.