Labenz J, Armstrong D, Leodolter A, Baldycheva I
Medical Department, Diakonie Klinikum Jung-Stilling, Siegen, Germany.
Division of Gastroenterology, McMaster University, Hamilton, ON, Canada.
Int J Clin Pract. 2015 Jul;69(7):796-801. doi: 10.1111/ijcp.12623. Epub 2015 Feb 27.
Proton pump inhibitors (PPIs) are the treatment of choice for reflux esophagitis (RE). The effectiveness of PPIs throughout RE management, from healing to maintenance, has not been fully studied.
To compare esomeprazole with lansoprazole or pantoprazole for RE management using a management model.
Data from six studies comparing esomeprazole with lansoprazole or pantoprazole for healing (4-8 weeks) or maintenance of healing (6 months) of RE were incorporated into hypothetical management models to determine the proportion of patients in endoscopic remission after sequential healing and maintenance therapy, assuming that patients received the same PPI throughout. The number needed to treat (NNT) to achieve one more patient in remission with esomeprazole vs. other PPIs was estimated. The hypothetical model was validated using results from the EXPO study, which compared esomeprazole with pantoprazole for RE healing and maintenance.
Overall, esomeprazole 40 mg produced higher rates of healing (life-table estimates) than lansoprazole 30 mg (82.4-92.6% vs. 77.5-88.8%; p < 0.01) or pantoprazole 40 mg (95.5% vs. 92.0%; p < 0.001) and higher rates of endoscopic and symptomatic remission at 6 months than lansoprazole (83.0-84.8% vs. 74.0-75.9%; p < 0.001; life-table estimates) or pantoprazole (70.9% vs. 59.6%; p < 0.0001; observed rates). In the hypothetical management model, the NNT for esomeprazole was 9 vs. lansoprazole and 8 vs. pantoprazole. The actual NNT for esomeprazole vs. pantoprazole in the EXPO study was 9 (95% confidence interval: 6; 16).
In this management model, esomeprazole was more effective than either lansoprazole or pantoprazole for maintaining remission after sequential healing and 6 months' maintenance therapy for RE.
质子泵抑制剂（PPIs）是反流性食管炎（RE）的首选治疗药物。PPIs在RE整个治疗过程中，从愈合到维持阶段的有效性尚未得到充分研究。
使用一种治疗模型比较埃索美拉唑与兰索拉唑或泮托拉唑在RE治疗中的效果。
将六项比较埃索美拉唑与兰索拉唑或泮托拉唑用于RE愈合（4 - 8周）或愈合维持（6个月）的研究数据纳入假设的治疗模型，以确定在序贯愈合和维持治疗后达到内镜缓解的患者比例，假设患者在整个过程中接受相同的PPI。估计使用埃索美拉唑相较于其他PPIs使一名患者达到缓解所需治疗的患者数（NNT）。使用EXPO研究的结果对该假设模型进行验证，该研究比较了埃索美拉唑与泮托拉唑用于RE愈合和维持的效果。
总体而言，40mg埃索美拉唑的愈合率（寿命表估计值）高于30mg兰索拉唑（82.4 - 92.6%对77.5 - 88.8%；p < 0.01）或40mg泮托拉唑（95.5%对92.0%；p < 0.001），且在6个月时的内镜缓解率和症状缓解率高于兰索拉唑（83.0 - 84.8%对74.0 - 75.9%；p < 0.001；寿命表估计值）或泮托拉唑（70.9%对59.6%；p < 0.0001；观察到的比率）。在假设的治疗模型中，埃索美拉唑相对于兰索拉唑的NNT为9，相对于泮托拉唑的NNT为8。在EXPO研究中，埃索美拉唑相对于泮托拉唑的实际NNT为9（95%置信区间：6；16）。
在此治疗模型中，对于RE序贯愈合和6个月维持治疗后维持缓解，埃索美拉唑比兰索拉唑或泮托拉唑更有效。
