Effects of pharmacological agents for neurogenic oropharyngeal dysphagia: A systematic review and meta-analysis
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Published on: March 1, 2015
Ivy Cheng1, Ayodele Sasegbon1, Shaheen Hamdy1
1Centre for Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M6 8HD, UK.
Background:
This systematic review and meta-analysis aimed to evaluate the effects of pharmacological agents for neurogenic oropharyngeal dysphagia based on evidence from randomized controlled trials (RCTs).
Methods:
Electronic databases were systematically searched between January 1970 and March 2021. Two reviewers independently extracted and synthesized the data. The outcome measure was changed in (any) relevant clinical swallowing-related characteristics.
Key Results:
Data from 2186 dysphagic patients were collected from 14 RCT studies across a range of pharmacotherapies. The pooled effect size of transient receptor potential (TRP) channel agonists was large compared to placebo interventions (SMD[95%CI] =1.27[0.74,1.80], p < 0.001; I2 = 79%). Data were limited for other pharmacological agents and the overall pooled effect size of these agents was non-significant (SMD [95% CI] =0.25 [-0.24, 0.73]; p = 0.31; I2 = 85%). When analyzed separately, large effect sizes were observed with Nifedipine (SMD[95%CI] =1.13[0.09,2.18]; p = 0.03) and Metoclopramide (SMD[95%CI] =1.68[1.08,2.27]; p < 0.001). By contrast, the effects of angiotensin-converting enzyme (ACE) inhibitors (SMD[95%CI] = -0.67[-2.32,0.99]; p = 0.43; I2 = 61%), Physostigmine (SMD[95%CI] = -0.05[-1.03,0.93]; p = 0.92) and Glyceryl Trinitrate (GTN) (SMD [95% CI] = -0.01 [-0.11, 0.08]; p = 0.78) were non-significant. Within stroke patients, subgroup analysis showed that TRP channel agonists had a moderate pooled effect size (SMD[95%CI] =0.74[0.10,1.39]; p = 0.02; I2 = 82%) whereas the effects of other agents were non-significant (SMD[95%CI] =0.40[-0.04,0.84]; p = 0.07; I2 = 87%).
Conclusions & Inferences:
Our results showed that TRP channel agonists, Nifedipine and Metoclopromide may be beneficial for neurogenic dysphagic patients. Large scale, multicenter clinical trials are warranted to fully explore their therapeutic effects on swallowing.
Insights
Pharmacological agents like TRP channel agonists, Nifedipine, and Metoclopramide show promise for treating neurogenic oropharyngeal dysphagia. Further large-scale trials are needed to confirm their effectiveness in improving swallowing function.
Area of Science:
- Pharmacology
- Neurology
- Gastroenterology
Background:
- Neurogenic oropharyngeal dysphagia presents a significant challenge in managing neurological conditions.
- Effective pharmacological interventions are crucial for improving swallowing function and patient outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of various pharmacological agents in treating neurogenic oropharyngeal dysphagia.
- To evaluate evidence from randomized controlled trials (RCTs) to determine the effectiveness of these treatments.
Main Methods:
- A comprehensive search of electronic databases was conducted from January 1970 to March 2021.
- Data from 14 RCTs involving 2186 patients were extracted and synthesized.
- The primary outcome measure was changes in relevant clinical swallowing-related characteristics.
Main Results:
- Transient receptor potential (TRP) channel agonists demonstrated a large pooled effect size (SMD = 1.27) compared to placebo.
- Nifedipine (SMD = 1.13) and Metoclopramide (SMD = 1.68) also showed significant large effect sizes.
- Other agents, including ACE inhibitors, Physostigmine, and Glyceryl Trinitrate (GTN), exhibited non-significant effects.
Conclusions:
- TRP channel agonists, Nifedipine, and Metoclopramide show potential therapeutic benefits for neurogenic dysphagia.
- Further large-scale, multicenter clinical trials are recommended to validate these findings.
- These agents may offer new avenues for managing swallowing difficulties in affected patients.
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