Meta-analysis: esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection
Meta-analysis: esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection
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DOI：
10.1111/j.1365-2036.2012.05211.x
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发表时间：
2012-09-01
影响因子：
7.6
通讯作者：
Gisbert, J. P.
中科院分区：
文献类型：
--
作者：
McNicholl, A. G.;Linares, P. M.;Gisbert, J. P.
背景H.随着时间的推移，幽门螺杆菌根除治疗使得寻找更好的方案和辅助药物成为优先事项。目的对雷贝拉唑或埃索美拉唑与其他质子泵抑制剂（PPI）或两者之间治疗H.幽门螺杆菌根除治疗。研究方法选择：比较埃索美拉唑或雷贝拉唑与第一代PPI（奥美拉唑-兰索拉唑-泮托拉唑）或相互比较的随机临床试验。结果荟萃分析（35项研究，5998例患者）显示，埃索美拉唑的根除率高于第一代PPI：82.3% vs. 77.6%; OR = 1.32（1.011.73）; NNT = 21。Rabbidine的结果也优于第一代PPI：80.5% vs. 76.2%; OR = 1.21（1.021.42）; NNT = 23。PPI剂量子分析：仅埃索美拉唑40 mg b.d.结果改善[83.5%埃索美拉唑vs. 72.4%第一代; OR = 2.27（1.074.82）; NNT = 9]。而雷贝拉唑10和20 mg b.d.保持结果，埃索美拉唑20 mg b.d.获得了较低的功效。埃索美拉唑与雷贝拉唑亚组分析（5项研究）：未发现显著差异：78.7%与76.7%; OR = 0.90（0.701.17）。CYP 2C 19子分析：基因型对第一代PPI [OR = 1.76（0.993.12）]或新一代PPI [OR = 1.19（0.731.95）]的根除无显著影响。然而，仅考虑快代谢型患者的子分析显示，新一代PPI的根除率更高[OR = 1.37（1.021.84）]。结论埃索美拉唑和雷贝拉唑的总体H。幽门螺杆菌根除率高于第一代PPI。埃索美拉唑40 mg b.d.的临床获益更为明显。养生法在CYP 2C 19快代谢者中，新一代PPI比第一代PPI对H.根除幽门然而，在所有情况下使用新一代PPI的一般建议仍不清楚。
Background The decreasing efficacy of H. pylori eradication treatments over time makes the search for better regimens and adjuvant medications a priority. Aim To conduct a meta-analysis of studies comparing rabeprazole or esomeprazole with other proton pump inhibitors (PPI) or with each other in H. pylori eradication treatment. Methods Selection of Studies: Randomised clinical trials comparing esomeprazole or rabeprazole with first-generation PPIs (omeprazole-lansoprazole-pantoprazole) or with each other. Results The meta-analysis (35 studies, 5998 patients) showed higher eradication rates for esomeprazole than for first-generation PPIs: 82.3% vs. 77.6%; OR = 1.32(1.011.73); NNT = 21. Rabeprazole also showed better results than first-generation PPIs: 80.5% vs. 76.2%; OR = 1.21(1.021.42); NNT = 23. PPI dosage sub-analysis: only esomeprazole 40 mg b.d. improved results [83.5% esomeprazole vs. 72.4% first generation; OR = 2.27(1.074.82); NNT = 9]. Whereas rabeprazole 10 and 20 mg b.d. maintained results, esomeprazole 20 mg b.d. obtained lower efficacy. Esomeprazole vs. rabeprazole sub-analysis (five studies): no significant differences were found: 78.7% vs. 76.7%; OR = 0.90(0.701.17). CYP2C19 sub-analysis: Genotype did not significantly affect eradication either in first [OR = 1.76(0.993.12)] or new generation [OR = 1.19(0.731.95)] PPIs. However, sub-analysis considering only extensive metaboliser patients showed higher eradication with new-generation PPIs [OR = 1.37(1.021.84)]. Conclusions Esomeprazole and rabeprazole show better overall H. pylori eradication rates than first-generation PPIs. This clinical benefit is more pronounced in esomeprazole 40 mg b.d. regimens. In CYP2C19 extensive metabolisers, new-generation PPIs are more effective than first-generation PPIs for H. pylori eradication. However, a general recommendation of using new-generation PPIs in all scenarios remains unclear.