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摘要
Background: This study compared the effectiveness and acceptability of all Food and Drug Administration (FDA)-recommended dose proton pump inhibitors (PPIs) in erosive esophagitis (EE): Dexlansoprazole 60mg, Esomeprazole 40mg, Esomeprazole 20mg, Pantoprazole 40mg, Lansoprazole 30mg, Rabeprazole 20mg, Omeprazole 20mg. @@@ Methods: A systematic literature search was performed using PubMed, Embase, and Cochrane Library. Totally, 25 randomized controlled trials (RCTs) met study selection criteria and were incorporated in this network meta-analysis (NMA) study. @@@ Results: For the NMA, eligible RCTs of adults with EE verified by endoscopic examination were randomly assigned to the licensed PPIs at least 4 weeks of continuous therapy. The primary efficacy outcome was the endoscopic healing rates at 4 and 8 weeks. Heartburn relief rates were a secondary efficacy outcome. The rates of withdrawal were analyzed as a safety outcome. In comparison to the common comparator omeprazole 20mg, esomeprazole 40mg provided significantly healing rates at 4 weeks [odds ratio (OR), 1.46 (95% confidence interval, 95% CI, 1.24-1.71)] and 8 weeks [1.58 (1.29-1.92)], and improved the heartburn relief rates [1.29 (1.07-1.56)]. In comparison to lansoprazole 30mg, esomeprazole 40mg provided significantly healing rates at 4 weeks [1.30 (1.10-1.53)] and 8 weeks [1.37 (1.13-1.67)], and improved the heartburn relief rates [1.29 (1.03-1.62)]. In terms of acceptability, only dexlansoprazole 60mg had significantly more all-cause discontinuation than omeprazole 20mg [1.54 (1.03-2.29)], pantoprazole 40 mg [1.68 (1.08-2.63)], and lansoprazole 30mg [1.38 (1.02-1.88)]. @@@ Conclusion: The standard-dose esomeprazole 40mg had more superiority in mucosal erosion healing and heartburn relief. Esomeprazole 40mg, pantoprazole 40mg, esomeprazole 20mg, and lansoprazole 30mg showed more benefits in effectiveness and acceptability than other interventions.
