Comparative effects of pharmacological interventions for the prevention of acute mountain sickness: A systematic review and Bayesian network meta-analysis

IF 6.3 3区医学 Q1 INFECTIOUS DISEASES

Travel Medicine and Infectious Disease Pub Date : 2025-05-16 DOI:10.1016/j.tmaid.2025.102868

Junyan Wang , Nan Lian , Kuo Tang , Yan Deng , Tao Li

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Abstract

Background

Acute Mountain Sickness (AMS), the most prevalent high-altitude illness, necessitates effective preventive measures due to rising sudden high-altitude exposure from tourism and occupational activities. Current Pharmacological prophylaxis lack robust comparisons, dose optimization, and confounder-adjusted analysis.

Methods

This network meta-analysis (NMA) included 28 randomized controlled trials (RCTs), evaluated healthy individuals with a rapid ascent to >2500 m, compared 13 drugs for AMS incidence, severe AMS (SAMS) incidence, Lake Louise Score (LLS), peripheral oxygen saturation (SpO2), and pulmonary artery pressure (PAP). Quality was evaluated using Cochrane Risk of Bias tools and CINeMA (Confidence in Network Meta-Analysis) for evidence grading. Network meta-regression adjusted for ascent altitude and exposure duration to identify “time” windows or “height” windows.

Results

250 mg BID acetazolamide (OR = 0.31, 95 %CI: 0.20–0.47) demonstrated a 5-day preventive efficacy window, while 375 mg BID acetazolamide (OR = 0.31, 95 %CI: 0.18–0.54) showed a shorter 3-day window. 4 mg BID dexamethasone (OR = 0.29, 95 %CI: 0.16–0.54) and 600 mg TID ibuprofen (OR = 0.44, 95 %CI: 0.3–0.64) also significantly reduced AMS incidence. No pharmacological interventions reduced SAMS incidence. After altitude adjustment, sildenafil (40 mg TID; MD = −1.11, 95 %CI: 2.01–0.25) attenuated altitude-induced PAP elevation.

Conclusion

Moderate-dose acetazolamide (125–250 mg BID) effectively prevents AMS with a longer prophylactic window compared to high-dose regimens (375 mg BID). There is no pharmacological intervention to prevent SAMS and no high-quality evidence to prevent high-altitude-induced PAP elevation. Our findings delineate the efficacy duration of acetazolamide across doses, while underscoring the imperative for robust clinical trials to advance the evidence base.

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药物干预预防急性高原病的比较效果：系统综述和贝叶斯网络荟萃分析

摘要急性高山病（acute Mountain Sickness， AMS）是最常见的高原疾病，由于旅游和职业活动导致突发性高原暴露增加，需要采取有效的预防措施。目前的药理学预防缺乏可靠的比较、剂量优化和混杂因素调整分析。方法本网络荟萃分析（NMA）纳入28项随机对照试验（rct），评估快速上升至2500米的健康个体，比较13种药物对AMS发病率、重度AMS发病率、Lake Louise评分（LLS）、外周氧饱和度（SpO2）和肺动脉压（PAP）的影响。使用Cochrane偏倚风险工具和CINeMA（网络元分析的置信度）进行证据分级。网络元回归调整了上升高度和暴露时间，以确定“时间”窗口或“高度”窗口。结果250 mg BID乙酰唑胺（OR = 0.31, 95% CI: 0.20 ~ 0.47）具有5天的预防窗口期，而375 mg BID乙酰唑胺（OR = 0.31, 95% CI: 0.18 ~ 0.54）具有较短的3天窗口期。4 mg BID地塞米松（OR = 0.29, 95% CI: 0.16-0.54）和600 mg TID布洛芬（OR = 0.44, 95% CI: 0.3-0.64）也可显著降低AMS的发生率。没有药物干预降低SAMS的发生率。海拔调整后，西地那非(40mg TID；MD =−1.11,95% CI: 2.01-0.25)衰减高度诱导的PAP升高。结论与高剂量方案（375 mg BID）相比，中剂量乙酰唑胺（125 ~ 250 mg BID）可有效预防AMS，且预防窗口期更长。没有药物干预来预防SAMS，也没有高质量的证据来预防高海拔诱发的PAP升高。我们的研究结果描述了不同剂量乙酰唑胺的疗效持续时间，同时强调了进行强有力的临床试验以推进证据基础的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Travel Medicine and Infectious Disease PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-INFECTIOUS DISEASES

CiteScore

19.40

自引率

1.70%

发文量

211

审稿时长

49 days

期刊介绍： Travel Medicine and Infectious Disease Publication Scope: Publishes original papers, reviews, and consensus papers Primary theme: infectious disease in the context of travel medicine Focus Areas: Epidemiology and surveillance of travel-related illness Prevention and treatment of travel-associated infections Malaria prevention and treatment Travellers' diarrhoea Infections associated with mass gatherings Migration-related infections Vaccines and vaccine-preventable disease Global policy/regulations for disease prevention and control Practical clinical issues for travel and tropical medicine practitioners Coverage: Addresses areas of controversy and debate in travel medicine Aims to inform guidelines and policy pertinent to travel medicine and the prevention of infectious disease Publication Features: Offers a fast peer-review process Provides early online publication of accepted manuscripts Aims to publish cutting-edge papers