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Meta-analysis: esomeprazole or rabeprazole vs. first-generation pump... » Isaúde
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Alimentary Pharmacology and Therapeutics
2012-07-16 01:33:01

Meta-analysis: esomeprazole or rabeprazole vs. first-generation pump inhibitors in the treatment of Helicobacter pylori infection

Descrição: BackgroundThe decreasing efficacy of H. pylori eradication treatments over time makes the search for better regimens and adjuvant medications a priority.AimTo 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.MethodsSelection of Studies: Randomised clinical trials comparing esomeprazole or rabeprazole with first-generation PPIs (omeprazole-lansoprazole-pantoprazole) or with each other.ResultsThe 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(1.01-1.73); NNT?=?21. Rabeprazole also showed better results than first-generation PPIs: 80.5% vs. 76.2%; OR?=?1.21(1.02-1.42); 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(1.07-4.82); 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(0.70-1.17). CYP2C19 sub-analysis: Genotype did not significantly affect eradication either in first [OR?=?1.76(0.99-3.12)] or new generation [OR?=?1.19(0.73-1.95)] PPIs. However, sub-analysis considering only extensive metaboliser patients showed higher eradication with new-generation PPIs [OR?=?1.37(1.02-1.84)].ConclusionsEsomeprazole 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.

Editorial: John Wiley & Sons, Inc.
Seção: Meta-analysis
Volume: 0
Página: n/a a n/a


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