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Meta-Analysis
. 2017 Sep;96(39):e8120.
doi: 10.1097/MD.0000000000008120.

Comparative Effectiveness and Acceptability of the FDA-licensed Proton Pump Inhibitors for Erosive Esophagitis: A PRISMA-compliant Network Meta-Analysis

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Free PMC article
Meta-Analysis

Comparative Effectiveness and Acceptability of the FDA-licensed Proton Pump Inhibitors for Erosive Esophagitis: A PRISMA-compliant Network Meta-Analysis

Mei-Juan Li et al. Medicine (Baltimore). .
Free PMC article

Abstract

Background: This study compared the effectiveness and acceptability of all Food and Drug Administration (FDA)-recommended dose proton pump inhibitors (PPIs) in erosive esophagitis (EE): Dexlansoprazole 60 mg, Esomeprazole 40 mg, Esomeprazole 20 mg, Pantoprazole 40 mg, Lansoprazole 30 mg, Rabeprazole 20 mg, Omeprazole 20 mg.

Methods: A systematic literature search was performed using PubMed, Embase, and Cochrane Library. Totally, 25 randomized controlled trials (RCTs) met study selection criteria and were incorporated in this network meta-analysis (NMA) study.

Results: For the NMA, eligible RCTs of adults with EE verified by endoscopic examination were randomly assigned to the licensed PPIs at least 4 weeks of continuous therapy. The primary efficacy outcome was the endoscopic healing rates at 4 and 8 weeks. Heartburn relief rates were a secondary efficacy outcome. The rates of withdrawal were analyzed as a safety outcome. In comparison to the common comparator omeprazole 20 mg, esomeprazole 40 mg provided significantly healing rates at 4 weeks [odds ratio (OR), 1.46 (95% confidence interval, 95% CI, 1.24-1.71)] and 8 weeks [1.58 (1.29-1.92)], and improved the heartburn relief rates [1.29 (1.07-1.56)]. In comparison to lansoprazole 30 mg, esomeprazole 40 mg provided significantly healing rates at 4 weeks [1.30 (1.10-1.53)] and 8 weeks [1.37 (1.13-1.67)], and improved the heartburn relief rates [1.29 (1.03-1.62)]. In terms of acceptability, only dexlansoprazole 60 mg had significantly more all-cause discontinuation than omeprazole 20 mg [1.54 (1.03-2.29)], pantoprazole 40 mg [1.68 (1.08-2.63)], and lansoprazole 30 mg [1.38 (1.02-1.88)].

Conclusion: The standard-dose esomeprazole 40 mg had more superiority in mucosal erosion healing and heartburn relief. Esomeprazole 40 mg, pantoprazole 40 mg, esomeprazole 20 mg, and lansoprazole 30 mg showed more benefits in effectiveness and acceptability than other interventions.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Network plots for the primary efficacy outcome healing rates at 4 and 8 weeks (A and B), secondary efficacy outcome heartburn relief rates (C), and primary safety outcome (D). Nodes show interventions being compared, surface areas of circles represent the number of patients included studies, and edges indicate head-to-head comparisons in the eligible RCTs.
Figure 3
Figure 3
Inconsistency plots for primary efficacy outcome healing rates at 4 and 8 weeks (A and B), secondary efficacy outcome heartburn relief rates (C), and the safety outcome acceptability (D). Forest plots present the RoRs with their 95% CI. DEX60 = dexlansoprazole 60 mg, ESO20 = esomeprazole 20 mg, ESO40 = esomeprazole 40 mg, LAN30 = lansoprazole 30 mg, OME20 = omeprazole 20 mg, PAN40 = pantoprazole 40 mg, RAB20 = rabeprazole 20 mg.
Figure 4
Figure 4
Funnel plots for primary efficacy outcome healing rates at 4 and 8 weeks (A and B), secondary efficacy outcome heartburn relief rates (C), and the safety outcome acceptability (D). Different colors represent different comparisons.
Figure 5
Figure 5
Network meta-analysis results: healing rates at 4 weeks.
Figure 6
Figure 6
Network meta-analysis results: healing rates at 8 weeks.
Figure 7
Figure 7
Network meta-analysis results: heartburn relief rates.
Figure 8
Figure 8
Network meta-analysis results: acceptability.
Figure 9
Figure 9
Clustered ranking plot representing simultaneously the primary outcomes: healing rates at 8 weeks (x axis) and acceptability (y axis) of the 8 therapeutic agents. The same color represents 1 cluster of treatments.

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References

    1. Richard H, David A, Peter K, Mary A. World Gastroenterology Organisation Global Guidelines. Global Perspective on Gastroesophageal Reflux Disease. 2015. Available at: http://www.worldgastroenterology.org/guidelines/global-guidelines/gastroesophageal-reflux-disease. Accessed October 1, 2015.
    1. Vakil N, van Zanten SV, Kahrilas P, et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006;101:1900–20. quiz 1943. - PubMed
    1. El-Serag HB, Sweet S, Winchester CC, et al. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014;63:871–80. - PMC - PubMed
    1. Hung LJ, Hsu PI, Yang CY, et al. Prevalence of gastroesophageal reflux disease in a general population in Taiwan. J Gastroenterol Hepatol 2011;26:1164–8. - PubMed
    1. Kumar S, Sharma S, Norboo T, et al. Population based study to assess prevalence and risk factors of gastroesophageal reflux disease in a high altitude area. Indian J Gastroenterol 2011;30:135–43. - PubMed

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