PPI Effectiveness Compared for Erosive Esophagitis Management

Endoscopic healing rates (at 4 and 8 weeks) were chosen as the primary efficacy outcome
Endoscopic healing rates (at 4 and 8 weeks) were chosen as the primary efficacy outcome

Esomeprazole 40mg was found to be superior for both mucosal erosion healing and heartburn relief in patients with erosive esophagitis when compared to other proton pump inhibitors (PPIs). Findings from this network meta-analysis study were published in the journal Medicine.

In order to compare PPI monotherapy outcomes in patients with erosive esophagitis, researchers performed an extensive literature search which identified 25 randomized controlled trials that met the study criteria: adults with erosive esophagitis verified by endoscopic examination who had taken PPIs continuously for at least 4 weeks.

The researchers chose endoscopic healing rates (at 4 and 8 weeks) as the primary efficacy outcome. In addition, they considered heartburn relief as a secondary outcome and withdrawal rate as a safety outcome.

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Compared to omeprazole 20mg, esomeprazole 40mg increased erosion healing by 46% at 4 weeks (odds ratio [OR] 1.46; 95% CI 1.24–1.71) and by 58% at 8 weeks (OR 1.58; 95% CI 1.29–1.92); heartburn relief rates were also superior with esomeprazole (OR 1.29; 95% CI 1.07–1.56).  Similarly, compared to lansoprazole 30mg, the rates of healing (4 weeks: OR 1.30; 95% CI 1.10–1.53; 8 weeks: OR 1.37; 95% CI 1.13–1.67) and heartburn relief (OR 1.29; 95% CI 1.03–1.62) were superior with esomeprazole 40mg.

With regards to the safety outcome, compared to omeprazole 20mg (OR 1.54; 95% 1.03–2.29), pantoprazole 40mg (OR 1.68; 95% CI 1.08–2.63), and lansoprazole 30mg (OR 1.38; 95% 1.02–1.88), only dexlansoprazole 60mg was associated with significantly more all-cause discontinuation (2.3%).

The researchers concluded that based on the analysis, esomeprazole 40mg proved to be superior for both healing and heartburn relief compared to other PPIs. In addition, “esomeprazole 40mg, pantoprazole 40mg, esomeprazole 20mg, and lansoprazole 30mg showed more benefits in effectiveness and acceptability than other interventions.”

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