Inhibition of Aspirin-Induced Gastrointestinal Injury: Systematic Review and Network Meta-Analysis

Wan-Tong Zhang; Miao-Ran Wang; Guo-Dong Hua; Qiu-Yan Li; Xu-Jie Wang; Rui Lang; Wei-Liang Weng; Chun-Miao Xue; Bao-Chen Zhu

doi:10.3389/fphar.2021.730681

Inhibition of Aspirin-Induced Gastrointestinal Injury: Systematic Review and Network Meta-Analysis

Front Pharmacol. 2021 Aug 12:12:730681. doi: 10.3389/fphar.2021.730681. eCollection 2021.

Authors

Wan-Tong Zhang¹, Miao-Ran Wang², Guo-Dong Hua³, Qiu-Yan Li⁴, Xu-Jie Wang¹, Rui Lang⁵, Wei-Liang Weng^{1

4}, Chun-Miao Xue³, Bao-Chen Zhu³

Affiliations

¹ Institute of Clinical Pharmacology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
² Department of Endocrinology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
³ Department of Pharmacy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
⁴ National Clinical Research Center for Chinese Medicine Cardiology, Beijing, China.
⁵ Department of Nephrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.

Abstract

Background: Administration of aspirin has the potential for significant side effects of gastrointestinal (GI) injury mainly caused by gastric acid stimulation, especially in long-term users or users with original gastrointestinal diseases. The debate on the optimal treatment of aspirin-induced gastrointestinal injury is ongoing. We aimed to compare and rank the different treatments for aspirin-induced gastrointestinal injury based on current evidence. Methods: We searched PubMed, EMBASE, Cochrane Library (Cochrane Central Register of Controlled Trials), and Chinese databases for published randomized controlled trials (RCTs) of different treatments for aspirin-induced gastrointestinal injury from inception to 1 May 2021. All of the direct and indirect evidence included was rated by network meta-analysis under a Bayesian framework. Results: A total of 10 RCTs, which comprised 503 participants, were included in the analysis. The overall quality of evidence was rated as moderate to high. Eleven different treatments, including omeprazole, lansoprazole, rabeprazole, famotidine, geranylgeranylacetone, misoprostol, ranitidine bismuth citrate, chili, phosphatidylcholine complex, omeprazole plus rebamipide, and placebo, were evaluated in terms of preventing gastrointestinal injury. It was suggested that omeprazole plus rebamipide outperformed other treatments, whereas geranylgeranylacetone and placebo were among the least treatments. Conclusion: This is the first systematic review and network meta-analysis of different treatments for aspirin-induced gastrointestinal injury. Our study suggested that omeprazole plus rebamipide might be considered the best option to treat aspirin-induced gastrointestinal injury. More multicenter, high quality, large sample size randomized controlled trials will confirm the advantages of these medicines in the treatment of aspirin-induced gastrointestinal injury in the future.

Keywords: aspirin; gastrointestinal injury; healthy subject; network meta-analysis; randomized controlled trials.