Comparative Efficacy of P-CAB vs Proton Pump Inhibitors for Grade C/D Esophagitis: A Systematic Review and Network Meta-analysis

被引:16
作者
Zhuang, Qianjun [1 ]
Chen, Songfeng [1 ]
Zhou, Xuyu [2 ]
Jia, Xingyu [1 ]
Zhang, Mengyu [1 ]
Tan, Niandi [1 ]
Chen, Fangfei [1 ]
Zhang, Zhanye [1 ]
Hu, Junnan [1 ]
Xiao, Yinglian [1 ]
机构
[1] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Gastroenterol & Hepatol, Guangzhou, Peoples R China
[2] Sun Yat Sen Univ, Med Informat Res Inst, Guangzhou, Peoples R China
基金
中国国家自然科学基金;
关键词
gastroesophageal reflux disease; erosive esophagitis; P-CAB; network meta-analysis; ESOMEPRAZOLE; 40; MG; HEALED EROSIVE ESOPHAGITIS; RANDOMIZED CLINICAL-TRIAL; GASTROESOPHAGEAL-REFLUX SYMPTOMS; COMPETITIVE ACID BLOCKER; 8-WEEK COMPARATIVE TRIAL; PANTOPRAZOLE; 20; LANSOPRAZOLE; 30; VS; DOUBLE-BLIND;
D O I
10.14309/ajg.0000000000002714
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
INTRODUCTION: Los Angeles grade C/D esophagitis is a severe manifestation of gastroesophageal reflux disease that require active treatment and close follow-up. Potassium competitive acid blockers (P-CAB) are promising alternatives to proton pump inhibitors (PPI). We aimed to compare the efficacy and safety of P-CAB and PPI in healing grade C/D esophagitis to aid clinical decision-making. METHODS: A systematic literature search was performed using PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials were eligible for inclusion if efficacy of P-CAB and PPI in healing grade C/D esophagitis was reported. Pooled risk ratios and risk difference with 95% credible intervals were used to summarize estimated effect of each comparison. The benefit of treatments was ranked using the surface under the cumulative probability ranking score. RESULTS: Of 5,876 articles identified in the database, 24 studies were eligible. Studies included incorporated 3 P-CAB (vonoprazan, tegoprazan, and keverprazan) and 6 PPI (lansoprazole, esomeprazole, omeprazole, rabeprazole extended-release (ER), pantoprazole, and dexlansoprazole). Based on the failure to achieve mucosal healing, 20 mg of vonoprazan q.d. ranked the first among PPI in initial and maintained healing of grade C/D esophagitis (surface under the cumulative probability ranking score = 0.89 and 0.87, respectively). Vonoprazan had similar risk of incurring adverse events, severe adverse events, and withdrawal to drug when compared with PPI. For those who attempted lower maintenance treatment dose, 10 mg of vonoprazan q.d. was a reasonable choice, considering its moderate efficacy and safety. DISCUSSION: Vonoprazan has considerable efficacy in initial and maintained healing of grade C/D esophagitis compared with PPI, with moderate short-term and long-term safety.
引用
收藏
页码:803 / 813
页数:11
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