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SYSTEMATIC REVIEW article

Front. Pharmacol.
Sec. Drugs Outcomes Research and Policies
Volume 15 - 2024 | doi: 10.3389/fphar.2024.1507616
This article is part of the Research Topic Clinical Pharmacist Service Promotes the Improvement of Medical Quality Volume II View all 34 articles

Comparative Efficacy and Safety of 20 Intravenous Pharmaceutical Intervention for Prevention of Etomidate-induced Myoclonus: A Systematic Review and Bayesian Network Meta-analysis

Provisionally accepted
Lu Chen Lu Chen 1,2Pengxiang Zhou Pengxiang Zhou 2,3Zhengqian Li Zhengqian Li 4Ziyang Wu Ziyang Wu 5Suodi Zhai Suodi Zhai 2,3*
  • 1 Department of Pharmacy, Yantai Yuhuangding Hospital, Yantai, China
  • 2 Department of Pharmacy, Peking University Third Hospital, Beijing, Beijing Municipality, China
  • 3 Institute for drug evaluation, Peking University Health Science Center, Beijing, China
  • 4 Department of Anesthesiology, Peking University Third Hospital, Beijing, China
  • 5 Department of Pharmacy, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China

The final, formatted version of the article will be published soon.

    Objective: To compare the efficacy and safety of pharmaceutical interventions to prevent etomidateinduced myoclonus (EIM), providing the optimal intervention for clinical practice.: PubMed, Embase, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, Chinese National Knowledge Infrastructure, WanFang database, and SinoMed database were searched from the inception to 6 th May 2024. We included randomized controlled trials (RCTs) comparing intravenous pharmaceutical interventions to prevent EIM with placebo, no intervention, or another pharmaceutical intervention. Results: Forty-eight RCTs involving 4,768 participants randomly assigned to 20 intravenous pharmaceutical interventions and normal saline were included. Granisetron (odds ratio [OR]: 0.01, 95%confidence interval [CI]: 0.00 to 0.06; one study, moderate certainty) and oxycodone (OR: 0.01, 95% CI: 0.00 to 0.05; three studies, low certainty) was found to be the most effective intervention in reducing the risk of EIM and ranked highest in terms of surface under the cumulative ranking values (94.4% and 89.7% probability), followed by sufentanil (76.5% probability) and remifentanil (74.8% probability). Further subgroup analysis of EIM at mild, moderate-to-severe levels highlighted granisetron and oxycodone as the favorable interventions for reducing EIM. For safety outcomes, the synthesized results indicated that opioids were associated with a higher risk of adverse events (AEs), while no severe AEs were observed.Moderate-to-low certainty evidence indicated that granisetron and oxycodone may represent the optimal intervention for reducing the risk of overall and moderate-to-severe EIM with a reasonable safety profile, providing the potential interventions for clinical practice.

    Keywords: Bayesian Analysis, Etomidate, Myoclonus, randomized controlled trials, network metaanalysis

    Received: 08 Oct 2024; Accepted: 27 Dec 2024.

    Copyright: © 2024 Chen, Zhou, Li, Wu and Zhai. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Suodi Zhai, Department of Pharmacy, Peking University Third Hospital, Beijing, 100191, Beijing Municipality, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.