A systematic review with meta-analysis: Efficacy and safety of potassium-competitive acid blocker compared with proton pump inhibitor in the maintenance of healed erosive esophagitis

IF 1.7 Q3 GASTROENTEROLOGY & HEPATOLOGY

JGH Open Pub Date : 2024-03-22 DOI:10.1002/jgh3.13053

Daniel M Simadibrata, Elvira Lesmana, Muhammad I A Pratama, Adrianus J Sugiharta, Afiah S Winarizal, Yeong Y Lee, Ari F Syam

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Abstract

Introduction

Proton pump inhibitor (PPI) is the mainstay therapy for the maintenance of healed erosive esophagitis (EE). It is unknown whether potassium-competitive acid blockers (PCABs) are more efficacious and safer than PPIs.

Methods

Only randomized controlled trials (RCTs) comparing PCABs to PPIs in the maintenance of healing rates of endoscopically proven healed EE and indexed in MEDLINE, EMBASE, and CENTRAL until 3 February 2024, were included. A fixed-effects model meta-analysis was performed to pool primary efficacy outcome (maintenance of healing rates at week 24) and safety data (any treatment-emergent adverse event or TEAE). The risk of bias was assessed using Cochrane's Risk of Bias 2 (RoB2) tool.

Results

Four RCTs with a total of 2554 patients were eligible for inclusion. All trials were of low risk of bias. Compared to lansoprazole 15 mg, the maintenance rates of healed EE at week 24 were significantly higher with vonoprazan 10 mg (RR 1.13; 95% CI 1.07–1.19) and vonoprazan 20 mg (RR 1.15; 95% CI 1.10–1.21). Likewise, compared to lansoprazole 15 mg, any TEAEs were significantly greater with vonoprazan 20 mg (RR 1.10; 95% CI 1.01–1.20) but not vonoprazan 10 mg.

Conclusion

Vonoprazan 10 and 20 mg were superior to lansoprazole 15 mg in the maintenance of the healing of EE. Any TEAEs were greater with vonoprazan 20 mg.

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系统回顾与荟萃分析：钾竞争性酸阻滞剂与质子泵抑制剂在维持侵蚀性食管炎痊愈中的疗效和安全性比较

导言质子泵抑制剂（PPI）是维持侵蚀性食管炎（EE）痊愈的主要疗法。目前尚不清楚钾竞争性酸阻滞剂（PCAB）是否比 PPI 更有效、更安全。方法仅纳入 2024 年 2 月 3 日前在 MEDLINE、EMBASE 和 CENTRAL 索引中收录的、比较 PCAB 与 PPI 在维持内镜证实痊愈的 EE 愈合率方面效果的随机对照试验（RCT）。采用固定效应模型进行荟萃分析，以汇总主要疗效结果（第 24 周的愈合率维持率）和安全性数据（任何治疗突发不良事件或 TEAE）。偏倚风险采用 Cochrane 的偏倚风险 2 (RoB2) 工具进行评估。结果共纳入了四项 RCT，共 2554 名患者。所有试验的偏倚风险均较低。与兰索拉唑15毫克相比，冯诺普拉赞10毫克（RR为1.13；95% CI为1.07-1.19）和冯诺普拉赞20毫克（RR为1.15；95% CI为1.10-1.21）在第24周时的EE痊愈维持率明显更高。同样，与兰索拉唑 15 毫克相比，沃诺普拉赞 20 毫克（RR 1.10；95% CI 1.01-1.20）的 TEAEs 明显高于沃诺普拉赞 10 毫克（RR 1.10；95% CI 1.01-1.20）。结论在维持 EE 愈合方面，沃诺普拉赞 10 毫克和 20 毫克优于兰索拉唑 15 毫克。沃诺普拉赞 20 毫克的 TEAEs 更多。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JGH Open GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

3.40

自引率

0.00%

发文量

143

审稿时长

7 weeks