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

TitleCarvedilol Versus Other Nonselective Beta Blockers for Variceal Bleeding Prophylaxis and Death: A Network Meta-analysis
Authors
KeywordsCarvedilol
Cirrhosis
CPSH
Nadolol
NSBB
Propranolol
Varices
Issue Date8-Jun-2023
PublisherXIA & HE Publishing Inc.
Citation
Journal of Clinical and Translational Hepatology, 2023, v. 11, n. 5, p. 1143-1149 How to Cite?
Abstract

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.

Keywords: CPSH; Carvedilol; Cirrhosis; NSBB; Nadolol; Propranolol; Varices.



Persistent Identifierhttp://hdl.handle.net/10722/331826
ISSN
2023 Impact Factor: 3.1
2023 SCImago Journal Rankings: 0.988
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorCheung, KS-
dc.contributor.authorMok, CH-
dc.contributor.authorLam, LK-
dc.contributor.authorMao, XH-
dc.contributor.authorMak, LY-
dc.contributor.authorSeto, WK-
dc.contributor.authorYuen, MF-
dc.date.accessioned2023-09-21T06:59:15Z-
dc.date.available2023-09-21T06:59:15Z-
dc.date.issued2023-06-08-
dc.identifier.citationJournal of Clinical and Translational Hepatology, 2023, v. 11, n. 5, p. 1143-1149-
dc.identifier.issn2225-0719-
dc.identifier.urihttp://hdl.handle.net/10722/331826-
dc.description.abstract<p><strong>Background and aims: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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].</p><p><strong>Conclusions: </strong>Carvedilol is the preferred NSBB with better survival benefit and lower occurrence of adverse events among patients with gastroesophageal varices.</p><p><strong>Keywords: </strong>CPSH; Carvedilol; Cirrhosis; NSBB; Nadolol; Propranolol; Varices.</p><p><br></p>-
dc.languageeng-
dc.publisherXIA & HE Publishing Inc.-
dc.relation.ispartofJournal of Clinical and Translational Hepatology-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjectCarvedilol-
dc.subjectCirrhosis-
dc.subjectCPSH-
dc.subjectNadolol-
dc.subjectNSBB-
dc.subjectPropranolol-
dc.subjectVarices-
dc.titleCarvedilol Versus Other Nonselective Beta Blockers for Variceal Bleeding Prophylaxis and Death: A Network Meta-analysis-
dc.typeArticle-
dc.identifier.doi10.14218/JCTH.2022.00130S-
dc.identifier.scopuseid_2-s2.0-85167674764-
dc.identifier.volume11-
dc.identifier.issue5-
dc.identifier.spage1143-
dc.identifier.epage1149-
dc.identifier.isiWOS:001012924700001-
dc.identifier.issnl2225-0719-

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