ASYMMETRICALLY DOSED 1L PEG+ASC DEMONSTRATES HIGH-QUALITY CLEANSING EFFICACY COMPARED WITH COMPARATOR SOLUTIONS ACROSS CLINICAL TRIALS

Aims High-quality (HQ) cleansing may be associated with more favourable colonoscopy outcomes, such as improvement in adenoma detection rate, than adequate level cleansing. In randomised trials, 1L polyethylene glycol and ascorbate (asymmetrically dosed PEG+ASC, or ner1006) showed additional efficacy in achieving HQ cleansing compared with 2L PEG+ASC, trisulphate or sodium picosulphate (1,2). The aim of this study was to indirectly compare the HQ cleansing efficacy of 1L PEG+ASC with comparators including 4L, 2L and lower volume preparations.

Methods We conducted a systematic literature search for all reported data on HQ cleansing efficacy of 1L PEG+ASC and comparator solutions. HQ cleansing success was defined as stool-free cleansing of the overall colon using a validated cleansing scale assessed (as in clinical practice) by on-site colonoscopists. Included were the Harefield Cleansing Scale, the Boston Bowel Preparation Scale and the 5-point Aronchick scale. Mixed treatment comparison (MTC) analyses were conducted in a Bayesian framework (with the Just Another Gibbs sampling algorithm), pooling both direct and indirect evidence from randomised controlled trials. Binary outcomes were analysed as odds ratios using a fixed effects model performed using the surface under the cumulative ranking curve.

Results Final MTC analysis included 20 randomised controlled trials, involving 6450 patients. 1L PEG+ASC as morning-only or split dosing achieved HQ cleansing more frequently than 2L PEG+bisacodyl ([Table 1]).

Table 1

1L PEG+ASC vs comparators	Median odds ratio	95% confidence interval
1L PEG+ASC 1D vs. 2L PEG+bisacodyl	8.403	4.558	15.568
1L PEG+ASC 1D vs. sodium phosphate	3.053	1.706	5.478
1L PEG+ASC 2D vs. 2L PEG+bisacodyl	10.622	6.129	18.536
1L PEG+ASC 2D vs. sodium phosphate	3.864	2.259	6.618

Conclusions 1L PEG+ASC consistently, and reproducibly, achieved HQ cleansing across multiple clinical trials.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2022

• References

• 1 Repici A, et al. Dig Liver Dis. 2019;51(12):1671–1677.
• 2 Repici A, et al. Gastrointest Endosc. 2021;94(4):823–831.e9.