Key Specialty of Clinical Pharmacy, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China.
Medicine (Baltimore). 2022 Nov 25;101(47):e31807. doi: 10.1097/MD.0000000000031807.
Proton-pump inhibitors (PPIs) and vonoprazan are recommended as first-line therapies for erosive esophagitis (EE). However, it is uncertain how the magnitude of efficacy and safety of first-line therapy, the choice of individual PPIs or vonoprazan in the treatment of EE remains controversial. This study aimed to evaluate the efficacy and safety of vonoprazan and PPIs in healing esophageal mucosal injury in patients with EE.
Relevant databases were searched to collect randomized controlled trials of proton pump inhibitors and vonoprazan in the treatment of reflux esophagitis up to December 2021. Studies on standard-dose PPIs or vonoprazan that were published in Chinese or English and assessed healing effects in EE were included in the analysis. Stata16.0 was used to conduct a network Meta-analysis to evaluate the efficacy and safety of the treatment.
A total of 41 literatures were included with 11,592 enrolled patients. For the endoscopic cure rate, all the PPIs and vonoprazan significantly improve compared to Placebo; Based on the surface under the cumulative ranking curve, Ilaprazole ranked first, followed by esomeprazole, vonoprazan, pantoprazole, lansoprazole, omeprazole, rabeprazole and placebo therapy ranked the last. For the rate of adverse events, there was no significant difference among all the PPIs, vonoprazan, and placebo.
Ilaprazole, esomeprazole and vonoprazan have more advantages in mucosal erosion healing, there was no significant difference in the comparative safety among all interventions.
质子泵抑制剂（PPIs）和沃诺拉赞被推荐为糜烂性食管炎（EE）的一线治疗药物。然而，对于 EE 一线治疗的疗效和安全性的大小，以及个体 PPI 或沃诺拉赞在 EE 治疗中的选择，仍存在争议。本研究旨在评估沃诺拉赞和 PPIs 在治疗 EE 患者食管黏膜损伤方面的疗效和安全性。
检索相关数据库，收集截至 2021 年 12 月质子泵抑制剂和沃诺拉赞治疗反流性食管炎的随机对照试验。纳入分析的研究为标准剂量 PPIs 或沃诺拉赞的中文或英文随机对照试验，并评估 EE 的愈合效果。采用 Stata16.0 进行网络荟萃分析，评估治疗的疗效和安全性。
共纳入 41 篇文献，共纳入 11592 例患者。对于内镜治愈率，所有 PPI 和沃诺拉赞均显著优于安慰剂；基于累积排序曲线下面积，艾普拉唑排名第一，其次是埃索美拉唑、沃诺拉赞、泮托拉唑、兰索拉唑、奥美拉唑、雷贝拉唑和安慰剂治疗排名最后。对于不良事件发生率，所有 PPI、沃诺拉赞和安慰剂之间无显著差异。
艾普拉唑、埃索美拉唑和沃诺拉赞在黏膜糜烂愈合方面具有更多优势，所有干预措施之间的安全性无显著差异。
