The efficacy and safety of adamgammadex for reversing rocuronium-induced deep neuromuscular blockage. A systematic review and network meta-analysis

Abdallah  Abunamoos; Amr  Elrosasy; Nada Ibrahim  Hendi; Obai  Yousef; Ahmad  Alzawahreh; Thoria Ibrahim Essa  Ghanm; Zina  Otmani; Mohamed Abouzid; Yehia  Nabil

doi:10.20883/medical.e1172

Authors

Abdallah Abunamoos School of Medicine, University of Jordan, Amman, Jordan https://orcid.org/0000-0001-8147-4985
Amr Elrosasy Faculty of Medicine, Cairo University, Cairo, Egypt https://orcid.org/0000-0002-5592-3908
Nada Ibrahim Hendi Faculty of Medicine, Ain Shams University, Cairo, Egypt https://orcid.org/0000-0003-1201-0487
Obai Yousef Faculty of Medicine, Tartous University, Tartous, Syria https://orcid.org/0009-0001-5832-3780
Ahmad Alzawahreh Faculty of Medicine, The Hashemite University, Zarqa, Jordan https://orcid.org/0009-0007-7672-1073
Thoria Ibrahim Essa Ghanm Faculty of Medicine Mansoura University, Mansoura, Egypt
Zina Otmani Faculty of Medicine, Mouloud Mammeri University, Tizi Ouzou, Algeria https://orcid.org/0009-0005-4665-2500
Mohamed Abouzid Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Poland; Doctoral School, Poznan University of Medical Sciences, Poland https://orcid.org/0000-0002-8917-671X
Yehia Nabil Faculty of Medicine, Zagazig University, Zagazig, Egypt https://orcid.org/0000-0002-1349-2978

DOI:

https://doi.org/10.20883/medical.e1172

Keywords:

adamgammadex, sugammadex, neuromuscular block, NMB, rocuronium

Abstract

Aim. We aim to evaluate the efficacy and safety of adamgammadex, a new modified γ-cyclodextrin, in reversing rocuronium-induced neuromuscular blockade compared with sugammadex or placebo.

Material and methods. We comprehensively searched three electronic databases (PubMed, Scopus, and ScienceDirect) from inception until February 2024 to detect all randomised controlled trials comparing adamgammadex versus sugammadex or placebo. STATA software 17 and RevMan version 5.4 were used for network and pairwise meta-analyses, respectively. The study protocol was prospectively registered in PROSPERO (CRD42024516623).

Results. Five randomised controlled trials comprising 530 patients were included in our study. There was a statistically significant difference between adamgammadex and sugammadex compared to placebo in the recovery time of neuromuscular function. A dose-response relationship was observed except for adamgammadex 7 mg/kg, which ranked first. Sugammadex was found to be more effective than a similar dose of adamgammadex. There was a non-significant difference between adamgammadex and sugammadex compared to placebo in the incidence of adverse events.

Conclusions. Adamgammadex or sugammadex can be a safe and effective therapeutic option in reversing rocuronium-induced neuromuscular blockade. More clinical trials with larger sample sizes should be conducted to obtain better evidence regarding these two drugs' most effective and safe doses.

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