Efectos de la midodrina en pacientes con ascitis Debido a cirrosis: revisión sistemática con metanálisis.

AIM:

Midodrine was found to improve systemic and renal hemodynamics in patients with cirrhotic ascites. Recently, this discovery has received research interest. Clinical trials on midodrine for this indication have demonstrated conflicting results. The aim of this study is to evaluate the effects of midodrine on cirrhotic ascites through a meta-analysis and systematic review.

METHODS:

We searched PubMed (January 1966 to December 2014), EMBASE (January 1966- December 2014), the Cochrane Library (Issue 11, 2014), ScienceDirect (January 1966- December 2014), and the China National Knowledge Infrastructure (January 1979- December 2014) using the search terms "midodrine", "cirrhosis", "ascites" and "paracentesis" and searched for all relevant randomized controlled trials using midodrine for treatment of cirrhotic ascites.

RESULTS:

Ten trials with a total of 462 patients were included. As a novel therapy for cirrhotic ascites, midodrine was not found to improve survival (OR=0.81; 95%CI 0.23 to 2.91); on the other hand, it may improve response rates (OR=3.36; 95%CI 1.47 to 7.69) and reduce plasma renin activity (MD=-3.10; 95%CI -5.37 to -0.84). When midodrine was used as an alternative to albumin in large volume paracentesis, the mortality was higher for midodrine than for albumin (OR=10.76; 95%CI 1.35 to 85.97). However, midodrine and albumin were similarly associated with the development of paracentesis-induced circulatory dysfunction (OR=1.69; 95%CI 0.43 to 6.72).

CONCLUSIONS:

Based on the results of the meta-analysis, midodrine may have treatment effects on cirrhotic ascites. More adequately powered and well-designed trials are required to assess the extent of the efficacy of midodrine in specifically targeted patients. This article is protected by copyright. All rights reserved.