The advantages of penehyclidine hydrochloride over atropine in acute organophosphorus pesticide poisoning: A meta-analysis

Siyao Zeng; Lei Ma; Lishan Yang; Xiaodong Hu; Cheng Wang; Xinxin Guo; Yi Li; Yi Gou; Yao Zhang; Shengming Li; Shaotong Zhang; Xiaoxuan Wu; Meihong Li; Jing Lei; Bingqian Li; Chengfei Bi; Like Ma; Qingpeng Luo

doi:10.1016/j.jointm.2022.07.006

The advantages of penehyclidine hydrochloride over atropine in acute organophosphorus pesticide poisoning: A meta-analysis

J Intensive Med. 2022 Oct 15;3(2):171-184. doi: 10.1016/j.jointm.2022.07.006. eCollection 2023 Apr 30.

Authors

Siyao Zeng¹, Lei Ma², Lishan Yang², Xiaodong Hu², Cheng Wang¹, Xinxin Guo¹, Yi Li¹, Yi Gou¹, Yao Zhang¹, Shengming Li¹, Shaotong Zhang¹, Xiaoxuan Wu¹, Meihong Li¹, Jing Lei¹, Bingqian Li¹, Chengfei Bi¹, Like Ma¹, Qingpeng Luo¹

Affiliations

¹ School of Clinical Medicine, Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, China.
² Department of Emergency Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia Hui Autonomous Region 750004, China.

Abstract

Background: Penehyclidine hydrochloride (PHC) has been used for many years as an anticholinergic drug for the treatment of acute organophosphorus pesticide poisoning (AOPP). The purpose of this meta-analysis was to explore whether PHC has advantages over atropine in the use of anticholinergic drugs in AOPP.

Methods: We searched Scopus, Embase, Cochrane, PubMed, ProQuest, Ovid, Web of Science, China Science and Technology Journal Database (VIP), Duxiu, Chinese Biomedical literature (CBM), WanFang, and Chinese National Knowledge Infrastructure (CNKI), from inception to March 2022. After all qualified randomized controlled trials (RCTs) were included, we conducted quality evaluation, data extraction, and statistical analysis. Statistics using risk ratios (RR), weighted mean difference (WMD), and standard mean difference (SMD).

Results: Our meta-analysis included 20,797 subjects from 240 studies across 242 different hospitals in China. Compared with the atropine group, the PHC group showed decreased mortality rate (RR=0.20, 95% confidence intervals [CI]: 0.16-0.25, P <0.001), hospitalization time (WMD=-3.89, 95% CI: -4.37 to -3.41, P <0.001), overall incidence rate of complications (RR=0.35, 95% CI: 0.28-0.43, P <0.001), overall incidence of adverse reactions (RR=0.19, 95% CI: 0.17-0.22, P <0.001), total symptom disappearance time (SMD=-2.13, 95% CI: -2.35 to -1.90, P <0.001), time for cholinesterase activity to return to normal value 50-60% (SMD=-1.87, 95% CI: -2.03 to -1.70, P <0.001), coma time (WMD=-5.57, 95% CI: -7.20 to -3.95, P <0.001), and mechanical ventilation time (WMD=-2.16, 95% CI: -2.79 to -1.53, P <0.001).

Conclusion: PHC has several advantages over atropine as an anticholinergic drug in AOPP.

Keywords: Acute organophosphorus pesticide poisoning; Anticholinergic drug; Atropine; Meta-analysis; Penehyclidine hydrochloride.