Racecadotril for childhood gastroenteritis: an individual patient data meta-analysis.

Abstract

BACKGROUND:

Racecadotril is an antidiarrhoeal drug with intestinal antisecretory mechanism of action.

AIM:

To assess racecadotril efficacy as an adjunct to oral rehydration solution, against oral rehydration solution alone or with placebo in childhood acute gastroenteritis.

METHODS:

Individual patient data meta-analysis following multilevel mixed models testing the significance of the treatment effect adjusted for baseline covariates.

RESULTS:

Nine randomised clinical trials (n=1384) were identified with raw data. Baseline dehydration level and Rotavirus were found as two essential predictors influencing the outcomes. The proportion of recovered patients was higher in racecadotril groups compared with placebo, Hazard Ratio HR=2.04, 95% CI (1.85; 2.32), p<0.001. For inpatient studies, the ratio of mean stool output racecadotril/placebo was 0.59 (0.51; 0.74), p<0.001. For outpatient studies, the ratio of the mean number of diarrhoeic stools racecadotril/placebo was 0.63 (0.51; 0.74), p<0.001.

CONCLUSION:

Dehydration level and Rotavirus at baseline are essential adjustments to compare treatments. As an adjunct to oral rehydration solution, racecadotril has a clinically relevant effect in reducing diarrhoea (duration, stool output and stool number), irrespective of baseline conditions (dehydration, Rotavirus or age), treatment conditions (inpatient or outpatient studies) or cultural environment.

• Authors: Philippe Lehert, Gérard Chéron, Guillermo Alvarez Calatayud, Jean-Pierre Cézard, Pedro Gutierrez Castrellón, José-Manuel Meléndez Garcia, Mar Santos, M R Savitha
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 43 Issue 9 Pg. 707-13 (Sep 2011) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 21514257 (Publication Type: Comparative Study, Journal Article, Meta-Analysis)
• Copyright: Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Antidiarrheals
• Rehydration Solutions
• racecadotril
• Thiorphan

Topics

• Adolescent
• Adult
• Antidiarrheals (therapeutic use)
• Child
• Combined Modality Therapy
• Dehydration (etiology)
• Diarrhea (drug therapy, etiology, therapy)
• Feces (virology)
• Female
• Gastroenteritis (complications, drug therapy)
• Humans
• Male
• Randomized Controlled Trials as Topic
• Rehydration Solutions (administration & dosage, therapeutic use)
• Rotavirus (isolation & purification)
• Thiorphan (analogs & derivatives, therapeutic use)
• Young Adult