Acid-suppressive drugs: A systematic review and network meta-analysis of their nocturnal acid-inhibitory effect.

Publisher: Wiley-Blackwell Country of Publication: United States NLM ID: 8111305 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1875-9114 (Electronic) Linking ISSN: 02770008 NLM ISO Abbreviation: Pharmacotherapy

Publication: 2012- : Malden, MA : Wiley-Blackwell
Original Publication: [Carlisle, MA : Pharmacotherapy Publications, c1981-

Proton Pump Inhibitors*/administration & dosage ; Proton Pump Inhibitors*/pharmacology ; Randomized Controlled Trials as Topic* ; Bayes Theorem* ; Network Meta-Analysis* ; Gastric Acid*/metabolism; Humans ; Histamine H2 Antagonists/pharmacology ; Histamine H2 Antagonists/administration & dosage ; Gastroesophageal Reflux/drug therapy

Background and Aims: Acid-suppressive drugs (ASDs) are widely used in many gastric acid-associated diseases. Nocturnal acid breakthrough has been a common problem of many ASDs, such as proton-pump inhibitors (PPIs) and H 2 -receptor antagonists (H2RAs). Potassium-competitive acid blockers (P-CABs) are expected to solve this continuing conundrum. This article examined major ASDs and compared them with placebo in terms of nocturnal acid-inhibitory effects, using a network meta-analysis of randomized controlled trials (RCTs).
Methods: To compare the effectiveness of major ASDs, a Bayesian network meta-analysis (NMA) was applied to process data extracted from RCTs. The plausible ranking for each regimen and some subgroups were assessed by surface under the cumulative ranking curves (SUCRA).
Results: Fifty-five RCTs were conducted with 2015 participants. In terms of nocturnal acid-inhibitory effects, the overall results showed that tegoprazan (SUCRA 91.8%) and vonoprazan (SUCRA 91.0%) had the best performance, followed by new PPIs (including tenatoprazole and ilaprazole) (SUCRA 76.6%), additional H2RAs once at bedtime (AHB) (SUCRA 61.3%), isomer PPIs (including esomeprazole and dexlansoprazole) (SUCRA 38.6%), revaprazan (SUCRA 34.7%), traditional PPIs (including omeprazole, rabeprazole, pantoprazole, lansoprazole) (SUCRA 32.6%), H2RAs (SUCRA 23.1%), and placebo (SUCRA 0.3%). In some subgroups, the nocturnal acid-inhibitory effect of vonoprazan or tegoprazan was better than most of the other regimens, even new PPIs and AHB.
Conclusions: This is the first study to compare the effect of ASDs on inhibiting nocturnal acid breakthrough. Overall, in terms of nocturnal acid-inhibitory effect, vonoprazan and tegoprazan had an advantage against other regimens including H2RAs, isomer PPIs, traditional PPIs, AHB, and new PPIs. Even in some subgroups, such as language classification (English), types of study design (crossover-RCT), age (≤40 years), BMI (18.5-24.9 kg/m ² ), continent (Asia and North America), disease status (health), the duration of therapy (2 weeks), and time of administration (at daytime or at night-time), the nocturnal acid-inhibitory effect of vonoprazan or tegoprazan were better than most regimens, even AHB and new PPIs.
(© 2023 Pharmacotherapy Publications, Inc.)

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Keywords: network meta-analysis; nocturnal acid breakthrough; potassium-competitive acid blockers; proton-pump inhibitors

0 (Proton Pump Inhibitors)
0 (Histamine H2 Antagonists)

Date Created: 20231204 Date Completed: 20240807 Latest Revision: 20240918

20240919

10.1002/phar.2899

38049205