Effects of 5-hydroxytryptamine (serotonin) type 3 antagoniosts on symptom relief and constipation in nonconstipated irritable bowel syndrome: A systematic review and meta-analysis of randomized controlled trials
Effects of 5-hydroxytryptamine (serotonin) type 3 antagoniosts on symptom relief and constipation in nonconstipated irritable bowel syndrome: A systematic review and meta-analysis of randomized controlled trials
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DOI：
10.1016/j.cgh.2007.12.015
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发表时间：
2008-05-01
影响因子：
12.6
通讯作者：
Camilleri, Michael
中科院分区：
文献类型：
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作者：
Andresen, Viola;Montori, Victor M.;Camilleri, Michael
背景和目标：我们进行了一项系统回顾和荟萃分析，以评估5-羟色胺（5-羟色胺）（5-HT 3）拮抗剂在非便秘（NC）或肠易激综合征（IBS）患者中的疗效和便秘率。研究方法：两名评审员独立检索MEDLINE、EMBASE和Web of Science（1966年1月1日至2006年12月15日），以寻找5-HT 3拮抗剂治疗IBS的随机对照试验，这些试验报告了IBS综合征的临床终点和安全性参数。研究特征，方法学质量的标志物，以及每项随机对照试验的意向治疗人群的结局都是独立提取的。结果如下：我们发现了14个合格的随机对照试验，阿洛司琼（n = 3024）或西兰司琼（n = 1116）与安慰剂（n = 3043）或美贝维林（n = 304）。随机效应荟萃分析发现，5-HT 3拮抗剂在实现IBS症状的总体改善（合并相对风险，1.60; 95%置信区间[0]，1.49-1.72; I-2 = 0%）和腹痛和不适缓解（合并相对风险，1.30; 95% CI，1.22-1.39; 12 = 22%）方面比对照药物更有效。两种药物在任何性别患者中的获益均明显。这些药物更可能导致便秘（合并相对风险，4.28; 95% CI，3.28-5.60，12 = 65%）;与混合人群相比，D-IBS患者中使用5-HT 3拮抗剂的便秘较少（NC-IBS和D-IBS;相对风险比，0.65; 95% CI，0.41-0.99）。使用5-HT 3拮抗剂的9例患者（0.2%）可能患有缺血性结肠炎，而对照组中无患者。结论：5-HT 3拮抗剂显著改善男性和女性NC-IBS或D-IBS的症状。使用5-HT 3拮抗剂会增加便秘的风险，尽管D-IBS患者的风险较低。
Background & Aims: We performed a systematic review and meta-analyses to estimate treatment efficacy and constipation rate of 5-hydroxytryptamine (serotonin) (5-HT3) antagonists in patients with nonconstipated (NC) or diarrhea-predominant (D)-irritable bowel syndrome (IBS). Methods: Two reviewers independently searched MEDLINE, EMBASE, and Web of Science (January 1, 1966 to December 15, 2006) for randomized controlled trials of 5-HT3 antagonists in IBS reporting clinical end points of the IBS symptom complex and safety parameters. Study characteristics, markers of methodologic quality, and outcomes for the intention-to-treat population for each randomized controlled trial were extracted independently. Results: We found 14 eligible randomized controlled trials of alosetron (n = 3024) or cilansetron (n = 1116) versus placebo (n = 3043) or mebeverine (n = 304). Random-effects meta-analyses found 5-HT3 antagonists more effective than the comparators in achieving global improvement in IBS symptoms (pooled relative risk, 1.60; 95% confidence interval [0], 1.49-1.72; I-2 = 0%) and relief of abdominal pain and discomfort (pooled relative risk, 1.30; 95% CI, 1.22-1.39; 12 = 22%). Benefit was apparent for both agents, in patients of either sex. These agents were more likely to cause constipation (pooled relative risk, 4.28; 95% CI, 3.28-5.60, 12 = 65%); there was less constipation with 5-HT3 antagonists in D-IBS patients than in mixed populations (NC-IBS and D-IBS; relative risk ratio, 0.65; 95% CI, 0.41-0.99). Nine patients (0.2%) using 5-HT3 antagonists had possible ischemic colitis versus none in control groups. Conclusions: 5-HT3 antagonists significantly improve symptoms of NC-IBS or D-IBS in men and women. There is an increased risk of constipation with 5-HT3 antagonists, although the risk is lower in those with D-IBS.