Meta-analysis of the effectiveness of esomeprazole in gastroesophageal reflux disease and Helicobacter pylori infection

Summary What is known and objective Proton pump inhibitors (PPIs) are one of the most widely used classes of drugs. However, the quantum clinical benefit of newer and more expensive PPIs over the older generation PPIs remains uncertain. This meta‐analysis sought to assess the clinical and safety pro...

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Bibliographic Details
Published in:Journal of clinical pharmacy and therapeutics 2015-08, Vol.40 (4), p.368-375
Main Authors: Teng, M., Khoo, A. L., Zhao, Y. J., Lin, L., Lim, B. P., Wu, T. S., Dan, Y. Y.
Format: Article
Language:English
Subjects:
esomeprazole
Esomeprazole - adverse effects
Esomeprazole - pharmacology
Esomeprazole - therapeutic use
gastroesophageal reflux
Gastroesophageal Reflux - drug therapy
Gastroesophageal Reflux - microbiology
Helicobacter Infections - drug therapy
Helicobacter Infections - microbiology
Helicobacter pylori
Helicobacter pylori - isolation & purification
Humans
meta-analysis
omeprazole
Omeprazole - adverse effects
Omeprazole - therapeutic use
Proton Pump Inhibitors - adverse effects
Proton Pump Inhibitors - pharmacology
Proton Pump Inhibitors - therapeutic use
Randomized Controlled Trials as Topic
systematic review
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Summary:Summary What is known and objective Proton pump inhibitors (PPIs) are one of the most widely used classes of drugs. However, the quantum clinical benefit of newer and more expensive PPIs over the older generation PPIs remains uncertain. This meta‐analysis sought to assess the clinical and safety profiles of esomeprazole versus omeprazole at pharmacologically equivalent doses in healing gastroesophageal reflux disease (GERD), peptic ulcer disease and eradicating Helicobacter pylori (H. pylori) infection. Methods PubMed and the Cochrane Library were searched for randomized controlled trials comparing esomeprazole with omeprazole at all doses up to February 2015. Trials were assessed by two reviewers for eligibility according to predefined study inclusion criteria. Meta‐analysis was conducted using a random effects model, and heterogeneity in the estimated effects was investigated using meta‐regression. Sensitivity analysis was performed to test the robustness of the findings. Results and Discussion Fifteen trials were included and none of which compared esomeprazole with omeprazole in peptic ulcer disease. The included studies had not evaluated esomeprazole 20 mg versus omeprazole 40 mg. In GERD, esomeprazole 40 mg (relative risk (RR) = 1·07; 95% confidence interval (CI) 1·02 to 1·12) and 20 mg (RR=1·04; 95% CI 1·01 to 1·08) significantly improved esophagitis healing when compared with omeprazole 20 mg at week 8. The corresponding numbers needed to treat were 17 and 30, respectively. No significant difference was observed between esomeprazole 20 mg and omeprazole 20 mg at week 4. In H. pylori eradication, there was no difference in the treatment effects between esomeprazole 20 mg and omeprazole 20 mg (RR = 1·01;95% CI 0·96 to 1·05). Their safety profiles were comparable. What is new and conclusion Esomeprazole demonstrated better esophagitis healing rate in patients with GERD than omeprazole at week 8. However, this clinical advantage diminished when both drugs were given at the same doses at week 4. Superiority of esomeprazole was not observed in the H. pylori eradication rates. This review determined the quantum clinical benefit of esomeprazole over omeprazole in specific acid‐related disease groups. Additionally, their safety profiles were compared through a pooled analysis.
ISSN:0269-4727
1365-2710
DOI:10.1111/jcpt.12277