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Thématique :
- Œsophage/Estomac
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
 
 
Gastroenterology
  2016/07  
 
  2016 Jul;151(1):87-96.e6  
  doi: 10.1053/j.gastro.2016.03.038  
 
  Relamorelin Reduces Vomiting Frequency and Severity and Accelerates Gastric Emptying in Adults With Diabetic Gastroparesis  
 
  Lembo A, Camilleri M, McCallum R, Sastre R, Breton C, Spence S, White J, Currie M, Gottesdiener K, Stoner E; RM-131-004 Trial Group  
  https://www.ncbi.nlm.nih.gov/pubmed/27055601  
 
 

BACKGROUND & AIMS:
Gastroparesis is an important complication of diabetes. We investigated the effects of relamorelin (a pentapeptide-selective agonist of the ghrelin receptor that speeds gastric emptying in patients with diabetes) in patients with diabetic gastroparesis.

METHODS:
We performed a double-blind trial of 204 patients (78% Caucasian; 67% female; mean age, 55 y; 88% with type 2 diabetes) with diabetic gastroparesis with moderate to severe symptoms and delayed gastric emptying at 27 clinical centers, from June 2012 until August 2013. Patients were assigned randomly (1:1:1) to groups given placebo or subcutaneous relamorelin 10 μg once or twice daily. The primary end point was the half-time of gastric emptying. Secondary end points included nausea, abdominal pain, bloating, early satiety, as well as the composite score of these 4 subjective symptoms and vomiting frequency and severity.

RESULTS:
Twice-daily relamorelin significantly accelerated gastric emptying (P < .03) and reduced vomiting frequency (by ∼60%) and severity vs placebo (P ≤ .033). Compared with placebo, relamorelin did not improve other gastrointestinal symptoms, such as abdominal pain and satiety. In the 119 patients (58.3%) with baseline vomiting, twice-daily relamorelin significantly reduced the half-time of gastric emptying and vomiting, as well as nausea, abdominal pain, bloating, and early satiety compared with placebo (composite score, P = .043). No overall safety concerns were identified.

CONCLUSIONS:
In a clinical trial of patients with diabetic gastroparesis, relamorelin (10 μg twice daily) significantly accelerated gastric emptying and significantly reduced vomiting, compared with placebo. Among patients with baseline vomiting, relamorelin had prokinetic effects and significantly reduced vomiting and also improved other symptoms of diabetic gastroparesis compared with placebo. ClincialTrials.gov number: NCT01571297.

Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

 
Question posée
 
Un agoniste des récepteurs de la ghréline, la relamoreline, a-t-il un effet sur la vidange gastrique et les symptômes digestifs en cas de gastroparésie diabétique ?
 
Question posée
 
Dans cette étude de phase 2 randomisée en double aveugle effectuée chez 204 patients ayant une gastroparésie diabétique symptomatique, l’injection sous-cutanée de relamoreline (10μg matin et soir) pendant 4 semaines accélère significativement la vidange gastrique et diminue significativement la fréquence et la sévérité des vomissements, avec une bonne tolérance.
 
Commentaires

Un traitement médicamenteux prometteur de la gastroparésie diabétique, dont l’efficacité doit être confirmée dans d’autres études.

 
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