Increased levels of substance P in patients taking beta‐blockers are linked with a protective effect on oropharyngeal dysphagia

Miarons, Marta; Tomsen, Noemí; Nascimento, Weslania Viviane; Espín, Acosta; López-Faixó, D.; Clavé, Père; Rofes, Laia

doi:10.1111/nmo.13397

Cited by 16 publications

(17 citation statements)

References 54 publications

(62 reference statements)

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“…Ye et al [41] China Comparison of two bedside evaluation methods of dysphagia in patients with acute stroke. Miarons et al [42] Spain Increased levels of substance P in patients taking beta-blockers are linked with a protective effect on oropharyngeal dysphagia. 0 (low risk) 4 Westmark et al [43] Denmark The cost of dysphagia in geriatric patients.…”

Section: Quality Of Studies In the Srmentioning

confidence: 99%

A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia

Riera

Marín

Serra‐Prat

et al. 2021

Foods

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(1) Background: The volume-viscosity swallow test (V-VST) is a clinical tool for screening and diagnosis of oropharyngeal dysphagia (OD). Our aims were to examine the clinical utility of the V-VST against videofluoroscopy (VFS) or fiberoptic endoscopic evaluation of swallow (FEES) and to map the V-VST usage with patients at risk of OD across the years since it was described for the first time, carrying a systematic and a scoping review. (2) Methods: We performed both a systematic review (SR) including studies that look at the diagnostic test accuracy, and a scoping review (ScR) with articles published from September 2008 to May 2020. Searches were done in different databases, including PubMed and EMBASE from September 2008 until May 2020, and no language restrictions were applied. A meta-analysis was done in the SR to assess the psychometric properties of the V-VST. Quality of studies was assessed by Dutch Cochrane, QUADAS, GRADE (SR), and STROBE (ScR) criteria. The SR protocol was registered on PROSPERO (registration: CRD42020136252). (3) Results: For the diagnostic accuracy SR: four studies were included. V-VST had a diagnostic sensitivity for OD of 93.17%, 81.39% specificity, and an inter-rater reliability Kappa = 0.77. Likelihood ratios (LHR) for OD were 0.08 (LHR–) and 5.01 (LHR+), and the diagnostic odds ratio for OD was 51.18. Quality of studies in SR was graded as high with low risk of bias. In the ScR: 34 studies were retrieved. They indicated that V-VST has been used internationally to assess OD’s prevalence and complications. (4) Conclusions: The V-VST has strong psychometric properties and valid endpoints for OD in different phenotypes of patients. Our results support its utility in the screening and clinical diagnosis and management of OD.

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Section: Quality Of Studies In the Srmentioning

confidence: 99%

A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia

Riera

Marín

Serra‐Prat

et al. 2021

Foods

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“…ACEi and Dipeptidyl-Peptidase IV Inhibitors (DPP-4i) have been reported to improve the swallowing reflex (Cunningham and O'Connor, 1997;Nakayama et al, 1998). Beta-blockers were found to be associated with lower dysphagia prevalence in the elderly patients (Miarons et al, 2018). Nevertheless, none of the studies clarified the mechanisms underlying the potential positive effects of these drugs on dysphagia, although a weak role of substance P (SP), a neuropeptide that enhances swallowing and cough reflexes, was hypothesized (Jin et al, 1994;Imoto et al, 2011;Canning et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

On the potential of drug repurposing in dysphagia treatment: New insights from a real-world pharmacovigilance study and a systematic review

Battini

Rocca²,

Guarnieri³

et al. 2023

Front. Pharmacol.

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Background: Polypharmacy is common in patients with dysphagia. Routinely used drugs may influence swallowing function either improving or worsening it. We aimed to explore the potential effects of three commonly used drug classes on dysphagia and aspiration pneumonia through a systematic review and a real-world data analysis to probe the possibility of drug repurposing for dysphagia treatment.Material and Methods: Five electronic databases were searched. Studies on adults at risk for dysphagia, treated with Dipeptidyl-Peptidase IV Inhibitors (DPP-4i), Adrenergic Beta-Antagonists (beta-blockers), or Angiotensin-Converting Enzyme Inhibitors (ACEi), and reporting outcomes on dysphagia or aspiration pneumonia were included. A nested case/non-case study was performed on adverse events recorded in the FDA Adverse Event Reporting System (FAERS) on patients >64 years. Cases (dysphagia or aspiration pneumonia) were compared between patients only treated with Levodopa and patients who were concomitantly treated with the drugs of interest.Results: Twenty studies were included in the review (17 on ACEi, 2 on beta-blockers, and 1 on DPP-4i). Contrasting findings on the effects of ACEi were found, with a protective effect mainly reported in Asian studies on neurological patients. Beta-blockers were associated with a reduced dysphagia rate. The study on DPP-4i suggested no effect on dysphagia and an increased risk of aspiration pneumonia. The FAERS analysis showed a reduction of the risk for dysphagia/aspiration pneumonia with ACEi, beta-blockers, and DPP-4i.Conclusion: Our study explores the potential drug repurposing of ACEi, beta-blockers and DPP-4i in neurological patients with dysphagia to improve swallowing function and reduce aspiration pneumonia risk. Future randomized controlled studies should confirm these results and clarify the underlying mechanisms of action.

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“…These agents either stimulate swallowing-related neural pathways in the peripheral or central nervous systems or directly modifying muscular function. 13 To date, the drug classes that have been studied in the area of swallowing and oropharyngeal dysphagia include transient receptor potential vanilloid 1 (TRPV1) agonists, [14][15][16][17][18][19][20] transient receptor potential ankyrin 1 (TRPA1) agonists, 21 transient receptor potential melastatin 8 (TRPM8) agonists, 22 levodopa, [23][24][25] other dopaminergic agents, 26 calcium blocking agents, 27,28 dopamine D2 receptor antagonists, 29 angiotensin-converting enzyme (ACE) inhibitors, 30 beta blockers, 31 nitric oxide donors 32 and acetylcholinesterase inhibitors. 33 Studies have suggested that these drugs may improve the swallowing reflex or reduce incidence of aspiration pneumonia in dysphagic patients.…”

Section: Introductionmentioning

confidence: 99%

“…One mechanism is stimulation of afferent neural pathways for swallowing, for example receptors (TRPV1, TRPA1 and TRPM8) located in the oropharynx, 34 through TRP channel agonists 14‐22 . Another mechanism involves increasing the level of or decreasing degradation of substance P, which is a neuropeptide known to enhance the swallow reflex, 35 through capsaicin, ACE inhibitors or beta blockers 17,30,31,36 . Levodopa and dopaminergic agents may improve swallowing through improving dopamine metabolism 23‐26 .…”

Section: Introductionmentioning

confidence: 99%

“… 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 Another mechanism involves increasing the level of or decreasing degradation of substance P, which is a neuropeptide known to enhance the swallow reflex, 35 through capsaicin, ACE inhibitors or beta blockers. 17 , 30 , 31 , 36 Levodopa and dopaminergic agents may improve swallowing through improving dopamine metabolism. 23 , 24 , 25 , 26 Some studies have also suggested that treating coexisting esophageal dysphagia or facilitating stroke recovery may result in overall improvement in swallowing function.…”

Section: Introductionmentioning

confidence: 99%

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Effects of pharmacological agents for neurogenic oropharyngeal dysphagia: A systematic review and meta‐analysis

Cheng

Sasegbon

Hamdy

2021

Neurogastroenterology Motil

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Background: This systematic review and meta-analysis aimed to evaluate the effects of pharmacological agents for neurogenic oropharyngeal dysphagia based on evidence from randomized controlled trials (RCTs). Methods: Electronic databases were systematically searched between January 1970 and March 2021. Two reviewers independently extracted and synthesized the data. The outcome measure was changed in (any) relevant clinical swallowing-related characteristics. Key results: Data from 2186 dysphagic patients were collected from 14 RCT studies across a range of pharmacotherapies. The pooled effect size of transient receptor potential (TRP) channel agonists was large compared to placebo interventions (SMD[95%CI] =1.27[0.74,1.80], p < 0.001; I 2 = 79%). Data were limited for other pharmacological agents and the overall pooled effect size of these agents was nonsignificant (SMD [95% CI] =0.25 [−0.24, 0.73]; p = 0.31; I 2 = 85%). When analyzed separately, large effect sizes were observed with Nifedipine (SMD[95%CI] =1.13[0.09,2.18]; p = 0.03) and Metoclopramide (SMD[95%CI] =1.68[1.08,2.27]; p < 0.001). By contrast, the effects of angiotensin-converting enzyme (ACE) inhibitors (SMD[95%CI] = −0.67 [−2.32,0.99]; p = 0.43; I 2 = 61%), Physostigmine (SMD[95%CI] = −0.05[−1.03,0.93]; p = 0.92) and Glyceryl Trinitrate (GTN) (SMD [95% CI] = −0.01 [−0.11, 0.08]; p = 0.78) were non-significant. Within stroke patients, subgroup analysis showed that TRP channel agonists had a moderate pooled effect size (SMD[95%CI] =0.74[0.10,1.39]; p = 0.02; I 2 = 82%) whereas the effects of other agents were non-significant (SMD[95%CI] =0.40[−0.04,0.84]; p = 0.07; I 2 = 87%).Conclusions & Inferences: Our results showed that TRP channel agonists, Nifedipine and Metoclopromide may be beneficial for neurogenic dysphagic patients. Large scale, multicenter clinical trials are warranted to fully explore their therapeutic effects on swallowing.

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Increased levels of substance P in patients taking beta‐blockers are linked with a protective effect on oropharyngeal dysphagia

Abstract: We have found that serum and saliva SP levels are greater in patients TBB. This increase in SP levels could be the action mechanism by which beta-blockers protect patients from OD.

Cited by 16 publications

References 54 publications

A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia

A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia

On the potential of drug repurposing in dysphagia treatment: New insights from a real-world pharmacovigilance study and a systematic review

Effects of pharmacological agents for neurogenic oropharyngeal dysphagia: A systematic review and meta‐analysis

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