Vonoprazan versus proton‐pump inhibitors for healing gastroesophageal reflux disease: A systematic review
Background and Aim Gastroesophageal reflux disease (GERD) is a common disease caused by reflux of gastric contents to the esophagus. Proton‐pump inhibitors (PPIs) are recommended as a first‐line therapy to treat GERD. Recently, a new potassium‐competitive acid blocker, vonoprazan, was launched in Ja...
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Veröffentlicht in: | Journal of gastroenterology and hepatology 2019-08, Vol.34 (8), p.1316-1328 |
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creator | Miyazaki, Hirota Igarashi, Ataru Takeuchi, Toshihisa Teng, Lida Uda, Akihito Deguchi, Hisato Higuchi, Kazuhide Tango, Toshiro |
description | Background and Aim
Gastroesophageal reflux disease (GERD) is a common disease caused by reflux of gastric contents to the esophagus. Proton‐pump inhibitors (PPIs) are recommended as a first‐line therapy to treat GERD. Recently, a new potassium‐competitive acid blocker, vonoprazan, was launched in Japan. We aimed to evaluate the comparative efficacy of vonoprazan and other PPIs in healing GERD.
Methods
We used MEDLINE and the Cochrane Central Register of Controlled Trials to search the literature. Double‐blind randomized controlled trials for PPIs and/or vonoprazan that were published in English or Japanese and assessed healing effects in adult GERD patients were included. To estimate the comparative efficacy of treatments, we performed a Bayesian network meta‐analysis to assess the consistency assumption.
Results
Of 4001 articles identified in the database, 42 studies were eligible. One study was hand‐searched and added to the analysis. For the main analysis of healing effects at 8 weeks, odds ratios (ORs) of vonoprazan (20 mg daily) to esomeprazole (20 mg), rabeprazole (20 mg), lansoprazole (30 mg), and omeprazole (20 mg) were 2.29 (95% credible interval, 0.79–7.06), 3.94 (1.15–14.03), 2.40 (0.90–6.77), and 2.71 (0.98–7.90), respectively. Subgroup analysis for patients with severe esophagitis at baseline showed significantly higher ORs for vonoprazan versus most of the comparator PPIs.
Conclusions
This analysis shows that the GERD healing effect of vonoprazan is higher than that of rabeprazole (20 mg) but not higher than other PPIs. Subgroup analysis indicated that vonoprazan is more effective than most PPIs for patients with severe erosive esophagitis. |
doi_str_mv | 10.1111/jgh.14664 |
format | Article |
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Gastroesophageal reflux disease (GERD) is a common disease caused by reflux of gastric contents to the esophagus. Proton‐pump inhibitors (PPIs) are recommended as a first‐line therapy to treat GERD. Recently, a new potassium‐competitive acid blocker, vonoprazan, was launched in Japan. We aimed to evaluate the comparative efficacy of vonoprazan and other PPIs in healing GERD.
Methods
We used MEDLINE and the Cochrane Central Register of Controlled Trials to search the literature. Double‐blind randomized controlled trials for PPIs and/or vonoprazan that were published in English or Japanese and assessed healing effects in adult GERD patients were included. To estimate the comparative efficacy of treatments, we performed a Bayesian network meta‐analysis to assess the consistency assumption.
Results
Of 4001 articles identified in the database, 42 studies were eligible. One study was hand‐searched and added to the analysis. For the main analysis of healing effects at 8 weeks, odds ratios (ORs) of vonoprazan (20 mg daily) to esomeprazole (20 mg), rabeprazole (20 mg), lansoprazole (30 mg), and omeprazole (20 mg) were 2.29 (95% credible interval, 0.79–7.06), 3.94 (1.15–14.03), 2.40 (0.90–6.77), and 2.71 (0.98–7.90), respectively. Subgroup analysis for patients with severe esophagitis at baseline showed significantly higher ORs for vonoprazan versus most of the comparator PPIs.
Conclusions
This analysis shows that the GERD healing effect of vonoprazan is higher than that of rabeprazole (20 mg) but not higher than other PPIs. Subgroup analysis indicated that vonoprazan is more effective than most PPIs for patients with severe erosive esophagitis.</description><identifier>ISSN: 0815-9319</identifier><identifier>EISSN: 1440-1746</identifier><identifier>DOI: 10.1111/jgh.14664</identifier><identifier>PMID: 30883868</identifier><language>eng</language><publisher>Australia: Wiley Subscription Services, Inc</publisher><subject>Bayes Theorem ; Bayesian analysis ; Clinical trials ; Esophagitis ; Esophagitis, Peptic - diagnosis ; Esophagitis, Peptic - drug therapy ; Esophagitis, Peptic - physiopathology ; Esophagus ; gastric secretion ; Gastroesophageal reflux ; Gastroesophageal Reflux - diagnosis ; Gastroesophageal Reflux - drug therapy ; Gastroesophageal Reflux - physiopathology ; gastroesophagus reflux disease ; Humans ; Network Meta-Analysis ; Omeprazole ; Patient Selection ; Proton pump inhibitors ; Proton Pump Inhibitors - adverse effects ; Proton Pump Inhibitors - therapeutic use ; Pyrroles - adverse effects ; Pyrroles - therapeutic use ; Randomized Controlled Trials as Topic ; Remission Induction ; Severity of Illness Index ; Sulfonamides - adverse effects ; Sulfonamides - therapeutic use ; Time Factors ; Treatment Outcome ; Wound Healing - drug effects</subject><ispartof>Journal of gastroenterology and hepatology, 2019-08, Vol.34 (8), p.1316-1328</ispartof><rights>2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd</rights><rights>2019 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5034-2050c998a88310720916d865e7eed51100514b43eb79c065ae75dc7c45ccb41b3</citedby><cites>FETCH-LOGICAL-c5034-2050c998a88310720916d865e7eed51100514b43eb79c065ae75dc7c45ccb41b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjgh.14664$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjgh.14664$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30883868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Miyazaki, Hirota</creatorcontrib><creatorcontrib>Igarashi, Ataru</creatorcontrib><creatorcontrib>Takeuchi, Toshihisa</creatorcontrib><creatorcontrib>Teng, Lida</creatorcontrib><creatorcontrib>Uda, Akihito</creatorcontrib><creatorcontrib>Deguchi, Hisato</creatorcontrib><creatorcontrib>Higuchi, Kazuhide</creatorcontrib><creatorcontrib>Tango, Toshiro</creatorcontrib><title>Vonoprazan versus proton‐pump inhibitors for healing gastroesophageal reflux disease: A systematic review</title><title>Journal of gastroenterology and hepatology</title><addtitle>J Gastroenterol Hepatol</addtitle><description>Background and Aim
Gastroesophageal reflux disease (GERD) is a common disease caused by reflux of gastric contents to the esophagus. Proton‐pump inhibitors (PPIs) are recommended as a first‐line therapy to treat GERD. Recently, a new potassium‐competitive acid blocker, vonoprazan, was launched in Japan. We aimed to evaluate the comparative efficacy of vonoprazan and other PPIs in healing GERD.
Methods
We used MEDLINE and the Cochrane Central Register of Controlled Trials to search the literature. Double‐blind randomized controlled trials for PPIs and/or vonoprazan that were published in English or Japanese and assessed healing effects in adult GERD patients were included. To estimate the comparative efficacy of treatments, we performed a Bayesian network meta‐analysis to assess the consistency assumption.
Results
Of 4001 articles identified in the database, 42 studies were eligible. One study was hand‐searched and added to the analysis. For the main analysis of healing effects at 8 weeks, odds ratios (ORs) of vonoprazan (20 mg daily) to esomeprazole (20 mg), rabeprazole (20 mg), lansoprazole (30 mg), and omeprazole (20 mg) were 2.29 (95% credible interval, 0.79–7.06), 3.94 (1.15–14.03), 2.40 (0.90–6.77), and 2.71 (0.98–7.90), respectively. Subgroup analysis for patients with severe esophagitis at baseline showed significantly higher ORs for vonoprazan versus most of the comparator PPIs.
Conclusions
This analysis shows that the GERD healing effect of vonoprazan is higher than that of rabeprazole (20 mg) but not higher than other PPIs. Subgroup analysis indicated that vonoprazan is more effective than most PPIs for patients with severe erosive esophagitis.</description><subject>Bayes Theorem</subject><subject>Bayesian analysis</subject><subject>Clinical trials</subject><subject>Esophagitis</subject><subject>Esophagitis, Peptic - diagnosis</subject><subject>Esophagitis, Peptic - drug therapy</subject><subject>Esophagitis, Peptic - physiopathology</subject><subject>Esophagus</subject><subject>gastric secretion</subject><subject>Gastroesophageal reflux</subject><subject>Gastroesophageal Reflux - diagnosis</subject><subject>Gastroesophageal Reflux - drug therapy</subject><subject>Gastroesophageal Reflux - physiopathology</subject><subject>gastroesophagus reflux disease</subject><subject>Humans</subject><subject>Network Meta-Analysis</subject><subject>Omeprazole</subject><subject>Patient Selection</subject><subject>Proton pump inhibitors</subject><subject>Proton Pump Inhibitors - adverse effects</subject><subject>Proton Pump Inhibitors - therapeutic use</subject><subject>Pyrroles - adverse effects</subject><subject>Pyrroles - therapeutic use</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Remission Induction</subject><subject>Severity of Illness Index</subject><subject>Sulfonamides - adverse effects</subject><subject>Sulfonamides - therapeutic use</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Wound Healing - drug effects</subject><issn>0815-9319</issn><issn>1440-1746</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kcFu1DAQhi0EapfSAy-ALHEph7TjxE4cblVVWlAlLsDVcpzZXS9JnHqStsupj9Bn5EkwbOkBibmMNPPp1_zzM_ZawLFIdbJZrY-FLEv5jC2ElJCJSpbP2QK0UFldiHqfvSTaAICESu2x_QK0LnSpF-z7tzCEMdofduA3GGkmPsYwheHn_cM49yP3w9o3fgqR-DJEvkbb-WHFV5amGJDCuLarNOMRl918x1tPaAnf81NOW5qwt5N3aXnj8fYVe7G0HeHhYz9gXz-cfzm7zK4-X3w8O73KnIJCZjkocHWtbbpRQJVDLcpWlworxFYJAaCEbGSBTVU7KJXFSrWuclI510jRFAfsaKebnFzPSJPpPTnsOjtgmMnkopZC5VrkCX37D7oJcxzSdSbPNWipa6US9W5HuRiIklMzRt_buDUCzO8ETErA_EkgsW8eFeemx_aJ_PvyBJzsgFvf4fb_SubTxeVO8heUUpE9</recordid><startdate>201908</startdate><enddate>201908</enddate><creator>Miyazaki, Hirota</creator><creator>Igarashi, Ataru</creator><creator>Takeuchi, Toshihisa</creator><creator>Teng, Lida</creator><creator>Uda, Akihito</creator><creator>Deguchi, Hisato</creator><creator>Higuchi, Kazuhide</creator><creator>Tango, Toshiro</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>7X8</scope></search><sort><creationdate>201908</creationdate><title>Vonoprazan versus proton‐pump inhibitors for healing gastroesophageal reflux disease: A systematic review</title><author>Miyazaki, Hirota ; Igarashi, Ataru ; Takeuchi, Toshihisa ; Teng, Lida ; Uda, Akihito ; Deguchi, Hisato ; Higuchi, Kazuhide ; Tango, Toshiro</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5034-2050c998a88310720916d865e7eed51100514b43eb79c065ae75dc7c45ccb41b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Bayes Theorem</topic><topic>Bayesian analysis</topic><topic>Clinical trials</topic><topic>Esophagitis</topic><topic>Esophagitis, Peptic - diagnosis</topic><topic>Esophagitis, Peptic - drug therapy</topic><topic>Esophagitis, Peptic - physiopathology</topic><topic>Esophagus</topic><topic>gastric secretion</topic><topic>Gastroesophageal reflux</topic><topic>Gastroesophageal Reflux - diagnosis</topic><topic>Gastroesophageal Reflux - drug therapy</topic><topic>Gastroesophageal Reflux - physiopathology</topic><topic>gastroesophagus reflux disease</topic><topic>Humans</topic><topic>Network Meta-Analysis</topic><topic>Omeprazole</topic><topic>Patient Selection</topic><topic>Proton pump inhibitors</topic><topic>Proton Pump Inhibitors - adverse effects</topic><topic>Proton Pump Inhibitors - therapeutic use</topic><topic>Pyrroles - adverse effects</topic><topic>Pyrroles - therapeutic use</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Remission Induction</topic><topic>Severity of Illness Index</topic><topic>Sulfonamides - adverse effects</topic><topic>Sulfonamides - therapeutic use</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Wound Healing - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Miyazaki, Hirota</creatorcontrib><creatorcontrib>Igarashi, Ataru</creatorcontrib><creatorcontrib>Takeuchi, Toshihisa</creatorcontrib><creatorcontrib>Teng, Lida</creatorcontrib><creatorcontrib>Uda, Akihito</creatorcontrib><creatorcontrib>Deguchi, Hisato</creatorcontrib><creatorcontrib>Higuchi, Kazuhide</creatorcontrib><creatorcontrib>Tango, Toshiro</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of gastroenterology and hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Miyazaki, Hirota</au><au>Igarashi, Ataru</au><au>Takeuchi, Toshihisa</au><au>Teng, Lida</au><au>Uda, Akihito</au><au>Deguchi, Hisato</au><au>Higuchi, Kazuhide</au><au>Tango, Toshiro</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Vonoprazan versus proton‐pump inhibitors for healing gastroesophageal reflux disease: A systematic review</atitle><jtitle>Journal of gastroenterology and hepatology</jtitle><addtitle>J Gastroenterol Hepatol</addtitle><date>2019-08</date><risdate>2019</risdate><volume>34</volume><issue>8</issue><spage>1316</spage><epage>1328</epage><pages>1316-1328</pages><issn>0815-9319</issn><eissn>1440-1746</eissn><abstract>Background and Aim
Gastroesophageal reflux disease (GERD) is a common disease caused by reflux of gastric contents to the esophagus. Proton‐pump inhibitors (PPIs) are recommended as a first‐line therapy to treat GERD. Recently, a new potassium‐competitive acid blocker, vonoprazan, was launched in Japan. We aimed to evaluate the comparative efficacy of vonoprazan and other PPIs in healing GERD.
Methods
We used MEDLINE and the Cochrane Central Register of Controlled Trials to search the literature. Double‐blind randomized controlled trials for PPIs and/or vonoprazan that were published in English or Japanese and assessed healing effects in adult GERD patients were included. To estimate the comparative efficacy of treatments, we performed a Bayesian network meta‐analysis to assess the consistency assumption.
Results
Of 4001 articles identified in the database, 42 studies were eligible. One study was hand‐searched and added to the analysis. For the main analysis of healing effects at 8 weeks, odds ratios (ORs) of vonoprazan (20 mg daily) to esomeprazole (20 mg), rabeprazole (20 mg), lansoprazole (30 mg), and omeprazole (20 mg) were 2.29 (95% credible interval, 0.79–7.06), 3.94 (1.15–14.03), 2.40 (0.90–6.77), and 2.71 (0.98–7.90), respectively. Subgroup analysis for patients with severe esophagitis at baseline showed significantly higher ORs for vonoprazan versus most of the comparator PPIs.
Conclusions
This analysis shows that the GERD healing effect of vonoprazan is higher than that of rabeprazole (20 mg) but not higher than other PPIs. Subgroup analysis indicated that vonoprazan is more effective than most PPIs for patients with severe erosive esophagitis.</abstract><cop>Australia</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30883868</pmid><doi>10.1111/jgh.14664</doi><tpages>13</tpages></addata></record> |
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subjects | Bayes Theorem Bayesian analysis Clinical trials Esophagitis Esophagitis, Peptic - diagnosis Esophagitis, Peptic - drug therapy Esophagitis, Peptic - physiopathology Esophagus gastric secretion Gastroesophageal reflux Gastroesophageal Reflux - diagnosis Gastroesophageal Reflux - drug therapy Gastroesophageal Reflux - physiopathology gastroesophagus reflux disease Humans Network Meta-Analysis Omeprazole Patient Selection Proton pump inhibitors Proton Pump Inhibitors - adverse effects Proton Pump Inhibitors - therapeutic use Pyrroles - adverse effects Pyrroles - therapeutic use Randomized Controlled Trials as Topic Remission Induction Severity of Illness Index Sulfonamides - adverse effects Sulfonamides - therapeutic use Time Factors Treatment Outcome Wound Healing - drug effects |
title | Vonoprazan versus proton‐pump inhibitors for healing gastroesophageal reflux disease: A systematic review |
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