The advantages of penehyclidine hydrochloride over atropine in acute organophosphorus pesticide poisoning: A meta-analysis

BACKGROUND: Penehyclidine hydrochloride (PHC) has been used for many years as an anticholinergic drug for the treatment of acute organophosphorus pesticide poisoning (AOPP). The purpose of this meta-analysis was to explore whether PHC has advantages over atropine in the use of anticholinergic drugs in AOPP. METHODS: We searched Scopus, Embase, Cochrane, PubMed, ProQuest, Ovid, Web of Science, China Science and Technology Journal Database (VIP), Duxiu, Chinese Biomedical literature (CBM), WanFang, and Chinese National Knowledge Infrastructure (CNKI), from inception to March 2022. After all qualified randomized controlled trials (RCTs) were included, we conducted quality evaluation, data extraction, and statistical analysis. Statistics using risk ratios (RR), weighted mean difference (WMD), and standard mean difference (SMD). RESULTS: Our meta-analysis included 20,797 subjects from 240 studies across 242 different hospitals in China. Compared with the atropine group, the PHC group showed decreased mortality rate (RR=0.20, 95% confidence intervals [CI]: 0.16–0.25, P <0.001), hospitalization time (WMD=−3.89, 95% CI: −4.37 to −3.41, P <0.001), overall incidence rate of complications (RR=0.35, 95% CI: 0.28–0.43, P <0.001), overall incidence of adverse reactions (RR=0.19, 95% CI: 0.17–0.22, P <0.001), total symptom disappearance time (SMD=−2.13, 95% CI: −2.35 to −1.90, P <0.001), time for cholinesterase activity to return to normal value 50–60% (SMD=−1.87, 95% CI: −2.03 to −1.70, P <0.001), coma time (WMD=−5.57, 95% CI: −7.20 to −3.95, P <0.001), and mechanical ventilation time (WMD=−2.16, 95% CI: −2.79 to −1.53, P <0.001). CONCLUSION: PHC has several advantages over atropine as an anticholinergic drug in AOPP.