Tian Lidi, Xiang Dan, Yue Feili, Li Runjie, Zhou Youping
Department of Dermatology, Ya'an People's Hospital, Ya'an, China.
Department of Clinical Medicine, Ya'an People's Hospital, Ya'an, China.
Front Nutr. 2024 Sep 5;11:1436993. doi: 10.3389/fnut.2024.1436993. eCollection 2024.
Vonoprazan, a novel acid suppressant, has been employed in the treatment of peptic ulcer disease in recent years. However, the efficacy and safety of vonoprazan versus proton-pump inhibitors remains controversial. To address this gap, a systematic review and network meta-analysis were conducted to evaluate the efficacy and safety of vonoprazan in comparison with various proton-pump inhibitors.
Randomized controlled trials that met selection criteria in PubMed (Medline), EMBASE and the Cochrane Library were searched up to July 15, 2024. The primary outcome was ulcer healing rate. Secondary outcomes were treatment-emergent adverse events and drug-related adverse events. Effect size on outcomes is presented as odds ratios with 95% confidence intervals.
Thirty-five randomized controlled trials containing 9,544 participants were included. In terms of the healing rate at 2 weeks, lansoprazole 30 mg ranked first, followed by vonoprazan 20 mg and ilaprazole 10 mg. In terms of the healing rate at 4 weeks, pantoprazole 40 mg ranked first, with rabeprazole 10 mg and lansoprazole 30 mg ranking second and third, respectively. Regarding the healing rate at 8 weeks, lansoprazole 30 mg is demonstrated to be the most efficacious regimen. Moreover, subgroup analysis indicated that lansoprazole 30 mg is the optimal regimen in the treatment of artificial gastric ulcer at 4 and 8 weeks. Importantly, lansoprazole 30 mg has fewer adverse reactions and higher safety.
The optimal regimen for the treatment of peptic ulcer disease may be lansoprazole 30 mg at 2 and 8 weeks, while pantoprazole 40 mg has demonstrated superior performance at the 4-week when compared to vonoprazan 20 mg. Furthermore, lansoprazole 30 mg has shown to be superior in terms of safety outcomes. These findings, derived from a network meta-analysis, necessitate further research for validation.
沃克（富马酸伏诺拉生）是一种新型抑酸剂，近年来已用于治疗消化性溃疡疾病。然而，与质子泵抑制剂相比，沃克的疗效和安全性仍存在争议。为填补这一空白，我们进行了一项系统评价和网状Meta分析，以评估沃克与各种质子泵抑制剂相比的疗效和安全性。
检索截至2024年7月15日在PubMed（Medline）、EMBASE和Cochrane图书馆中符合入选标准的随机对照试验。主要结局是溃疡愈合率。次要结局是治疗中出现的不良事件和药物相关不良事件。结局的效应大小以比值比及其95%置信区间表示。
纳入了35项随机对照试验，共9544名参与者。在2周愈合率方面，兰索拉唑30mg排名第一，其次是沃克20mg和艾普拉唑10mg。在4周愈合率方面，泮托拉唑40mg排名第一，雷贝拉唑10mg和兰索拉唑30mg分别排名第二和第三。关于8周愈合率，兰索拉唑30mg被证明是最有效的治疗方案。此外，亚组分析表明，兰索拉唑30mg是治疗人工胃溃疡4周和8周时的最佳方案。重要的是，兰索拉唑30mg不良反应较少，安全性较高。
治疗消化性溃疡疾病的最佳方案可能是2周和8周时使用兰索拉唑30mg，而泮托拉唑40mg在4周时与沃克20mg相比表现更优。此外，兰索拉唑30mg在安全性结局方面表现更优。这些来自网状Meta分析的结果需要进一步研究验证。
