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Rebamipide Helps Defend Against Nonsteroidal Anti-Inflammatory Drugs Induced Gastroenteropathy: A Systematic Review and Meta-Analysis

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Abstract

Background

Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs (NSAIDs) has been perplexing most clinicians and users of NSAIDs. Rebamipide is increasingly advocated as a candidate option for the prevention of NSAIDs induced gastrointestinal mucosal injury.

Aims

To assess the efficacy and the safety of rebamipide for the prevention and treatment of NSAID-induced gastroenteropathy.

Methods

PubMed, Embase, Web of Science, Google Scholar, the Cochrane Library, Japan Science and Technology Information Aggregator, and China Biology Medicine Disc were searched up to December 2011. Randomized controlled trials (RCTs) recruiting subjects with co-prescriptions of NSAIDs and rebamipide were eligible. Efficacy and safety of rebamipide were reevaluated, and dichotomous data were pooled to obtain relative risk (RR) with a 95 % confidence interval. Heterogeneity and publication bias were assessed by the inconsistency index statistic and funnel plot analysis, respectively.

Results

The search identified 338 citations, and 15 RCTs including 965 individuals were eligible. In general, rebamipide acted better than placebo against short-term NSAID-induced gastroduodenal injury. Separate studies showed rebamipide was equal to or not superior to traditional strategies (including PPIs, H2RA and misoprostol treatment). Especially, rebamipide showed a beneficial effect against the small bowel damage (total RR = 2.70, 95 % confidence interval = 1.02–7.16, P = 0.045) when compared with placebo group. The average incidence of adverse events was about 36.1 % (0–70.0 %) but no serious event was recorded.

Conclusions

Current evidences show rebamipide is effective and safe for defending against NSAID-induced gastroduodenal and lower-gastrointestinal injuries. However, more well-designed trials should be conducted to fully confirm the practical value of rebamipide.

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Acknowledgments

Supported by National Natural Science Foundation of China (81070291), Program for New Century Excellent Talents in University (NCET-10-0091), and Guangdong Provincial Science and Technology Projects (2010B031600243).

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None.

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Authors and Affiliations

  1. Guangdong Provincial Key Laboratory of Gastroenterology, Department of Gastroenterology, Nanfang Hospital, Southern Medical University, No. 1838 Guangzhou North Avenue, Baiyun District, Guangzhou, 510515, China

    Shaoheng Zhang, Yang Bai, Wei Zhu, Yali Zhang & Ye Chen

  2. Department of Gastroenterology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yanjiang Xilu, Guangzhou, 510120, China

    Qing Qing & Qikui Chen

  3. Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, 253 Industrial Road, Guangzhou, 510282, China

    Hua Mao

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  1. Shaoheng Zhang
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  5. Wei Zhu
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Correspondence to Ye Chen.

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S. H. Zhang and Q. Qing contributed equally to this research and are co-first authors.

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Zhang, S., Qing, Q., Bai, Y. et al. Rebamipide Helps Defend Against Nonsteroidal Anti-Inflammatory Drugs Induced Gastroenteropathy: A Systematic Review and Meta-Analysis. Dig Dis Sci 58, 1991–2000 (2013). https://doi.org/10.1007/s10620-013-2606-0

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