Department of Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Medical Information Research Institute, Sun Yat-sen University, Guangzhou, China .
Am J Gastroenterol. 2024 May 1;119(5):803-813. doi: 10.14309/ajg.0000000000002714. Epub 2024 Feb 12.
Los Angeles grade C/D esophagitis is a severe manifestation of gastroesophageal reflux disease that require active treatment and close follow-up. Potassium competitive acid blockers (P-CAB) are promising alternatives to proton pump inhibitors (PPI). We aimed to compare the efficacy and safety of P-CAB and PPI in healing grade C/D esophagitis to aid clinical decision-making.
A systematic literature search was performed using PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials were eligible for inclusion if efficacy of P-CAB and PPI in healing grade C/D esophagitis was reported. Pooled risk ratios and risk difference with 95% credible intervals were used to summarize estimated effect of each comparison. The benefit of treatments was ranked using the surface under the cumulative probability ranking score.
Of 5,876 articles identified in the database, 24 studies were eligible. Studies included incorporated 3 P-CAB (vonoprazan, tegoprazan, and keverprazan) and 6 PPI (lansoprazole, esomeprazole, omeprazole, rabeprazole extended-release (ER), pantoprazole, and dexlansoprazole). Based on the failure to achieve mucosal healing, 20 mg of vonoprazan q.d. ranked the first among PPI in initial and maintained healing of grade C/D esophagitis (surface under the cumulative probability ranking score = 0.89 and 0.87, respectively). Vonoprazan had similar risk of incurring adverse events, severe adverse events, and withdrawal to drug when compared with PPI. For those who attempted lower maintenance treatment dose, 10 mg of vonoprazan q.d. was a reasonable choice, considering its moderate efficacy and safety.
Vonoprazan has considerable efficacy in initial and maintained healing of grade C/D esophagitis compared with PPI, with moderate short-term and long-term safety.
洛杉矶 C/D 级食管炎是一种严重的胃食管反流病表现，需要积极治疗和密切随访。钾竞争性酸阻滞剂（P-CAB）是质子泵抑制剂（PPI）的有前途的替代品。我们旨在比较 P-CAB 和 PPI 在治疗 C/D 级食管炎方面的疗效和安全性，以帮助临床决策。
使用 PubMed、MEDLINE 和 Cochrane 对照试验中心注册库进行系统文献检索。如果报告了 P-CAB 和 PPI 治疗 C/D 级食管炎的疗效，则有资格纳入随机对照试验。使用汇总风险比和风险差异（95%可信区间）来总结每个比较的估计效果。使用累积概率排序评分的下面积来对治疗效果进行排名。
在数据库中识别出的 5876 篇文章中，有 24 项研究符合条件。这些研究纳入了 3 种 P-CAB（沃诺拉赞、替戈拉赞和凯维拉唑）和 6 种 PPI（兰索拉唑、艾司奥美拉唑、奥美拉唑、雷贝拉唑延长释放剂、泮托拉唑和度兰索拉唑）。基于未能实现黏膜愈合，每日 20mg 沃诺拉赞在 C/D 级食管炎的初始和维持愈合方面在 PPI 中排名第一（累积概率排序评分下面积分别为 0.89 和 0.87）。与 PPI 相比，沃诺拉赞在发生不良事件、严重不良事件和停药方面的风险相似。对于那些尝试较低维持治疗剂量的患者，考虑到其中等疗效和安全性，每日 10mg 沃诺拉赞是一个合理的选择。
与 PPI 相比，沃诺拉赞在 C/D 级食管炎的初始和维持愈合方面具有相当的疗效，且具有中等的短期和长期安全性。
