Carvedilol Versus Other Nonselective Beta Blockers for Variceal Bleeding Prophylaxis and Death: A Network Meta-analysis  

作　　者：Ka-Shing Cheung Chiu-Hang Mok Lok-Ka Lam Xian-Hua Mao Lung-Yi Mak Wai-Kay Seto Man-Fung Yuen 

机构地区：[1]Department of Medicine,School of Clinical Medicine,The University of Hong Kong,Queen Mary Hospital,Hong Kong,China [2]Department of Medicine,The University of Hong Kong-Shenzhen Hospital,Shenzhen,Guangdong,China [3]School of Clinical Medicine,The University of Hong Kong,Hong Kong,China [4]State Key Laboratory of Liver Research,The University of Hong Kong,Hong Kong,China

出　　处：《Journal of Clinical and Translational Hepatology》2023年第5期1143-1149,共7页临床与转化肝病杂志（英文版）

摘　　要：Background and Aims:We aimed to perform a network meta-analysis(NWM)to examine comparative effectiveness of non-selective beta blockers(NSBBs)on prophylaxis of gastroesophageal variceal bleeding(GVB)and mortality benefit.Methods:MEDLINE(OVID)and EMBASE databases were searched for eligible randomized clinical trials(RCTs)from inception to July 3,2021.Outcomes of interest included primary/secondary prophylaxis of GVB,failure to achieve hepatic venous pressure gradient(HVPG)decremental response,liver-related and all-cause mortality.A Bayesian NWM was performed to derive relative risk(RR)with 95%credible intervals(CrIs).The ranking probability of each NSBB was assessed by surface under cumulative ranking curve(SUCRA).Results:Thirty-three RCTs including 3,188 cirrhosis patients with gastroesophageal varices were included.Compared with placebo,nadolol ranked first for reducing variceal bleeding[RR:0.25,(95%CrI:0.11–0.51);SUCRA:0.898],followed by carvedilol[RR:0.33,(95%CrI:0.11–0.88);SUCRA:0.692]and propranolol[RR:0.52,(95%CrI:0.37–0.75);SUCRA:0.405].Carvedilol was more effective than propranolol in achieving HVPG decremental response[RR:0.43,(95%CrI:0.26–0.69)].Carvedilol ranked first for reducing all-cause mortality[RR:0.32,(95%CrI:0.17–0.57);SUCRA:0.963],followed by nadolol[RR:0.48,(95%CI:0.29–0.77);SUCRA:0.688],and propranolol[RR:0.77,(95%CI:0.58–1.02);SUCRA:0.337].Similar findings were observed for liver-related mortality.Carvedilol ranked the safest.The RR of adverse events was 4.38,(95%CrI:0.33–161.4);SUCRA:0.530,followed by propranolol[RR:7.54,(95%CrI:1.90–47.89);SUCRA:0.360],and nadolol[RR:18.24,(95%CrI:91.51–390.90);SUCRA:0.158].Conclusions:Carvedilol is the preferred NSBB with better survival benefit and lower occurrence of adverse events among patients with gastroesophageal varices.

关 键 词：NSBB CARVEDILOL NADOLOL PROPRANOLOL VARICES CIRRHOSIS CPSH 

分 类 号：R575.2[医药卫生—消化系统]