抑酸药物:夜间抑酸效果的系统回顾和网络荟萃分析。

IF 2.9 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Pharmacotherapy Pub Date : 2024-02-01 Epub Date: 2023-12-12 DOI:10.1002/phar.2899
Shupeng Zou, Mengling Ouyang, Qian Cheng, Xuan Shi, Minghui Sun
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引用次数: 0

摘要

背景与目的:抑酸药物广泛应用于胃酸相关疾病。夜间酸突破是许多自闭症患者的常见问题,如质子泵抑制剂(PPIs)和H2受体拮抗剂(H2RAs)。钾竞争性酸阻滞剂(p - cab)有望解决这一持续的难题。本文通过随机对照试验(rct)的网络荟萃分析,研究了主要的asd,并将其与安慰剂在夜间抑酸作用方面进行了比较。方法:采用贝叶斯网络元分析(NMA)对随机对照试验数据进行处理,比较主要asd的疗效。采用累积排名曲线(SUCRA)下的曲面法评估各方案和部分亚组的合理排名。结果:55项随机对照试验共纳入2015名受试者。在夜间抑酸效果方面,整体结果显示替戈拉赞(SUCRA 91.8%)和伏诺帕赞(SUCRA 91.0%)表现最佳,其次为新型PPIs(包括泰那托拉唑和伊拉唑)(SUCRA 76.6%)、睡前一次添加H2RAs (AHB) (SUCRA 61.3%)、异构体PPIs(包括埃索美拉唑和右兰索拉唑)(SUCRA 38.6%)、雷帕拉赞(SUCRA 34.7%)、传统PPIs(包括奥美拉唑、雷贝拉唑、泮托拉唑、兰索拉唑)(SUCRA 32.6%)、H2RAs (supra 23.1%)和安慰剂(supra 0.3%)。在一些亚组中,伏诺哌赞或替戈拉赞的夜间抑酸效果优于大多数其他方案,甚至优于新PPIs和AHB。结论:这是第一个比较asd对抑制夜间酸突破作用的研究。总体而言,就夜间抑酸效果而言,vonoprazan和替戈拉赞比其他方案具有优势,包括H2RAs、异构体ppi、传统ppi、AHB和新型ppi。即使在一些亚组中,如语言分类(英语)、研究设计类型(交叉rct)、年龄(≤40岁)、BMI (18.5-24.9 kg/m2)、大洲(亚洲和北美)、疾病状态(健康)、治疗持续时间(2周)和给药时间(白天或夜间),vonoprazan或替格拉嗪的夜间抑酸效果也优于大多数方案,甚至优于AHB和新PPIs。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acid-suppressive drugs: A systematic review and network meta-analysis of their nocturnal acid-inhibitory effect.

Background and aims: Acid-suppressive drugs (ASDs) are widely used in many gastric acid-associated diseases. Nocturnal acid breakthrough has been a common problem of many ASDs, such as proton-pump inhibitors (PPIs) and H2 -receptor antagonists (H2RAs). Potassium-competitive acid blockers (P-CABs) are expected to solve this continuing conundrum. This article examined major ASDs and compared them with placebo in terms of nocturnal acid-inhibitory effects, using a network meta-analysis of randomized controlled trials (RCTs).

Methods: To compare the effectiveness of major ASDs, a Bayesian network meta-analysis (NMA) was applied to process data extracted from RCTs. The plausible ranking for each regimen and some subgroups were assessed by surface under the cumulative ranking curves (SUCRA).

Results: Fifty-five RCTs were conducted with 2015 participants. In terms of nocturnal acid-inhibitory effects, the overall results showed that tegoprazan (SUCRA 91.8%) and vonoprazan (SUCRA 91.0%) had the best performance, followed by new PPIs (including tenatoprazole and ilaprazole) (SUCRA 76.6%), additional H2RAs once at bedtime (AHB) (SUCRA 61.3%), isomer PPIs (including esomeprazole and dexlansoprazole) (SUCRA 38.6%), revaprazan (SUCRA 34.7%), traditional PPIs (including omeprazole, rabeprazole, pantoprazole, lansoprazole) (SUCRA 32.6%), H2RAs (SUCRA 23.1%), and placebo (SUCRA 0.3%). In some subgroups, the nocturnal acid-inhibitory effect of vonoprazan or tegoprazan was better than most of the other regimens, even new PPIs and AHB.

Conclusions: This is the first study to compare the effect of ASDs on inhibiting nocturnal acid breakthrough. Overall, in terms of nocturnal acid-inhibitory effect, vonoprazan and tegoprazan had an advantage against other regimens including H2RAs, isomer PPIs, traditional PPIs, AHB, and new PPIs. Even in some subgroups, such as language classification (English), types of study design (crossover-RCT), age (≤40 years), BMI (18.5-24.9 kg/m2 ), continent (Asia and North America), disease status (health), the duration of therapy (2 weeks), and time of administration (at daytime or at night-time), the nocturnal acid-inhibitory effect of vonoprazan or tegoprazan were better than most regimens, even AHB and new PPIs.

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来源期刊
Pharmacotherapy
Pharmacotherapy 医学-药学
CiteScore
7.80
自引率
2.40%
发文量
93
审稿时长
4-8 weeks
期刊介绍: Pharmacotherapy is devoted to publication of original research articles on all aspects of human pharmacology and review articles on drugs and drug therapy. The Editors and Editorial Board invite original research reports on pharmacokinetic, bioavailability, and drug interaction studies, clinical trials, investigations of specific pharmacological properties of drugs, and related topics.
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