Systematic Review with Meta-Analyses of Randomized Trials on Isosorbide-Mononitrate Alone or With Beta-Blockers or Endoscopic Therapy for Esophageal Varices

Lise Lotte Gluud (1) , Ebbe Langholz (2) , Aleksander Krag (1)

1 Department of Internal Medicine
2 Department of Internal Medicine

BACKGROUND The evidence concerning the use of Isosorbide-Mononitrate (IsMn) for esophageal varices is equivocal. METHODS Systematic review with meta-analyses of randomized trials on IsMn alone or with beta-blockers or endoscopic therapy for esophageal varices. Electronic and manual searches were combined. Randomized trials on primary and secondary prevention were included. The primary outcome measure was mortality. Intention-to-treat random effects meta-analyses were performed. The robustness of the results were assessed in trial sequential analyses. RESULTS Ten randomized trials on primary and 17 on secondary prevention were included. Evidence of bias was identified. No apparent effect of IsMn on mortality compared with placebo or beta-blockers or IsMn plus beta-blockers versus beta-blockers was identified. Compared with endoscopic therapy, IsMn plus beta-blockers had no apparent effect on bleeding, but did seem to reduce mortality in secondary (RR 0.73, 95% CI 0.59-0.89), but not in primary prevention. The effect of IsMn plus beta-blockers on mortality in secondary prevention was not confirmed in trial sequential analysis. CONCLUSIONS IsMn alone or combined with beta blockers does not reduce bleeding in the prevention of esophageal varices. Compared to endoscopic therapy, there may be a survival advantage to IsMn and beta-blockers, but additional trials are needed to verify this finding.

Mots clés: Medicine

Lise Lotte Gluud, Ebbe Langholz, Aleksander Krag. Systematic Review with Meta-Analyses of Randomized Trials on Isosorbide-Mononitrate Alone or With Beta-Blockers or Endoscopic Therapy for Esophageal Varices. Alimentary Pharmacology and Therapeutics, 2010, 32 (7), pp.859. ⟨10.1111/j.1365-2036.2010.04418.x⟩. ⟨hal-00565916⟩