Objective To investigate the effect of intravesical infusion with different drugs in the treatment of non-muscular invasive bladder cancer (NMIBC).Methods Randomized controlled trials (RCTs) on NMIBC with different drugs were searched in PubMed, SpringerLink, The Cochrane Library, OVID, CNKI, Wanfang and VIP databases. The search period was from January 1, 2000 to March 1, 2022, and the literature language was limited to Chinese and English only. A network Metaanalysis was performed on tumor recurrence rate, bladder irritation symptoms, and hematuria after different interventions for NMIBC, and the stability of the findings was evaluated by sensitivity analysis.Results A total of 26 RCTs were included, including 4 403 patients, involving 6 interventions: bacille calmette guérin(BCG), epirubicin (EPI), gemcitabine(GEM), pirubicin (THP), mitomycin C (MMC), and hydroxycamptothecin (HCPT). The results of mesh Metaanalysis showed that the 1-year recurrence rate of BCG users was significantly lower than that of EPI and MMC users, with statistical significance (all P<0.05). The surface under the cumulative ranking (SUCRA) of 1-year recurrence rate were BCG, THP, GEM, EPI, MMC and HCPT. The 2-year recurrence rate of BCG patients was lower than that of GEM, EPI, THP, HCPT and MMC patients, while that of GEM patients was lower than that of HCPT patients, the differences were statistically significant (all P<0.05). The SUCRAs with 2-year recurrence rate were BCG, GEM, EPI, THP, MMC and HCPT. The incidence of bladder irritation after treatment in GEM patients was lower than that in EPI and MMC patients, while the incidence of bladder irritation after treatment in BCG patients was higher than that in GEM, EPI, THP and HCPT patients, with statistical significance (all P<0.05). The SUCRA of bladder irritation were GEM, HCPT, THP, EPI, MMC and BCG. There was no significant difference in the incidence of hematuria caused by six different drugs for NMIBC (all P>0.05).Conclusions BCG treatment can reduce the recurrence rate of NMIBC patients after 1 year or 2 years, but can not reduce the occurrence of bladder irritation and hematuria. GEM treatment is second only to BCG in reducing the recurrence rate in 1 year or 2 years, but can effectively prevent bladder irritation and hematuria.
