ACETAZOLAMIDE FOR THE TREATMENT OF CHRONIC MOUNTAIN SICKNESS (MONGE DISEASE): A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

SESSION TITLE: Occupational and Environmental Lung Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Chronic mountain sickness is a clinical syndrome that occurs in high altitude dwellers (>2500 m) characterized by excessive erythrocytosis and severe hypoxemia. It is frequently associated with moderate to severe pulmonary hypertension, which might evolve into Cor pulmonale. Leon-Velarde et al. estimated that 5 - 10% of the 140 million living above 2500 meters are at risk of developing this disease. Qinghai Score is used to assess the severity of the disease based on the presence or absence of erythrocytosis and specific sets of signs and symptoms. Acetazolamide has been suggested as a treatment option in reducing hematocrit and erythropoietin levels. We conducted a systematic review and meta-analysis to determine if Acetazolamide provides any significant benefit over placebo for the treatment of Monge's disease. METHODS: We conducted a systematic search of the PubMed, EMBASE, and Cochrane databases from inception through January-2020 for studies comparing daily 250 mg of Acetazolamide and placebo in the treatment of Monge's disease using terms “ Acetazolamide,” “ Chronic Mountain Sickness,” and “ Monge's disease.” Relevant data were extracted and analyzed using Comprehensive Meta-Analysis software. The size of overall intervention effect was estimated by calculating the weighted average of the differences in means (DM) between the groups in each study. The random-effects model was used for all variables, and publication bias was assessed using Egger's test. RESULTS: Three randomized controlled trials published between 2005 and 2017, examining a total of 116 patients, were included in our analysis. We found Acetazolamide to be effective in reducing hematocrit DM=1.05 (0.48-1.616) (I²= 43.86%) and increasing arterial oxygen pressure (Po2 ) DM=0.91(0.51-1.31) (I²=0.00%) compared to placebo. Also, we found acetazolamide to be superior to placebo in decreasing both arterial carbon dioxide pressure (Pco2) DM=1.05 (0.65-1.46) (I²= 0.00%) and bicarbonate concentration (HCO3) DM=1.05 (0.48 -1.62) (I²= 44.21%). No significant difference in the improvement of the Qinghai Score was found between the two groups DM=-0.33 (-1.68-1.02) (I²= 90.36%). CONCLUSIONS: Our results suggest that Acetazolamide is effective in reducing erythrocytosis and improving oxygenation in patients with Monge's disease, probably by reducing hypoxic pulmonary vascular constriction (Swenson 2006) , although, no significant difference in the improvement of Qinghai Score was noticed between the two groups. CLINICAL IMPLICATIONS: Acetazolamide might be an effective treatment for chronic mountain sickness (Monge's disease). DISCLOSURES: Consultant relationship with Medtronics/Covidien Please note: $1-$1000 Added 03/28/2020 by Wael El Minaoui, source=Web Response, value=Consulting fee No relevant relationships by Ibrahim Haddad, source=Web Response No relevant relationships by Sajin Karakattu, source=Web Response No relevant relationships by Rasheed Musa, source=Web Response No relevant relationships by Todd Pearson, source=Web Response