Efficacy And Safety Of A-Lipoic Acid Combined With Prokinetic Agents In The Treatment Of Diabetic Gastroparesis: A Meta-Analysis

Objective: Results of previous randomized trials have shown that interventions of Alpha-lipoic acid (ALA) combined with prokinetic agents can significantly reduce the gastric dyskinesia of Diabetic Gastroparesis (DGP) in a wide range of individuals. However, each separate trial has limited power to assess particular outcomes. The aims of this study were mainly to systematically review the effects and safety of ALA combined with prokinetic agents in treating DGP. Methods: PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, CBM, VIP, WanFang, and clinicaltrials.gov were searched. Randomized controlled trials (RCTs) of ALA combined with prokinetic agents (experimental group) and prokinetic agents only (control group) in treating DGP were included. Data were searched from their inception untill February 11th 2019, using Stata 12.0 for Meta-analysis. Results: Thirteen RCTs were finally included with 1064 patients. Meta-analysis results showed that ALA combined with prokinetic agents can significantly improve the efficacy rate (P<0.001), regardless of the type of prokinetic agents (domperidone or clebopride or mosapride or itopride) combined with ALA or the length of treatment (<4 weeks or >= 4 weeks). Furthermore, the experimental group was able to significantly improve gastric emptying rate (P<0.001), serum motilin and gastrin level (P<0.001). No remarkable difference between the experimental group and control group in the incidence of adverse reactions was found (P=0.868). Conclusions: ALA combined with prokinetic agents can significantly improve the efficacy rate and gastric emptying rate with few adverse reactions, and reduce serum motilin and gastrin levels in DGP.