Standard-Dose Proton Pump Inhibitors in the Initial Non-eradication Treatment of Duodenal Ulcer: Systematic Review, Network Meta-Analysis, and Cost-Effectiveness Analysis

Abstract

Background: Short-term use of standard-dose proton pump inhibitors (PPIs) is the first-line initial non-eradication treatment for duodenal ulcer (DU), but the choice on individual PPI drug is still controversial. The purpose of this study is to compare the efficacy, safety, and cost-effectiveness of standard-dose PPI medications in the initial non-eradication treatment of DU.Methods: We searched PubMed, Embase, Cochrane Library, Clinicaltrials.gov, China National Knowledge Infrastructure, VIP database, and the Wanfang database from their earliest records to September 2017. Randomized controlled trials (RCTs) evaluating omeprazole (20 mg/day), pantoprazole (40 mg/day), lansoprazole (30 mg/day), rabeprazole (20 mg/day), ilaprazole (10 mg/day), ranitidine (300 mg/day), famotidine (40 mg/day), or placebo for DU were included. The outcomes were 4-week ulcer healing rate (4-UHR) and the incidence of adverse events (AEs). A network meta-analysis (NMA) using a Bayesian random effects model was conducted, and a cost-effectiveness analysis using a decision tree was performed from the payer’s perspective over 1 year.Results: A total of 62 RCTs involving 10,339 participants (eight interventions) were included. The NMA showed that all the PPIs significantly increased the 4-UHR compared to H2 receptor antagonists (H2RA) and placebo, while there was no significant difference for 4-UHR among PPIs. As to the incidence of AEs, no significant difference was observed among PPIs, H2RA, and placebo during 4-week follow-up. Based on the costs of both PPIs and management of AEs in China, the incremental cost-effectiveness ratio per quality-adjusted life year (in US dollars) for pantoprazole, lansoprazole, rabeprazole, and ilaprazole compared to omeprazole corresponded to $5134.67, $17801.67, $25488.31, and $44572.22, respectively.Conclusion: Although the efficacy and tolerance of different PPIs are similar in the initial non-eradication treatment of DU, pantoprazole (40 mg/day) seems to be the most cost-effective option in China.

RETRACTED: Antiulcerogenic Activity of Li‐Zhong Decoction on Duodenal Ulcers Induced by Indomethacin in Rats: Involvement of TLR‐2/MyD88 Signaling Pathway

“…e occurrence and recurrence of DU seriously affects the quality of human life [23]. Currently, the prevention and treatment of DU mainly include clinical use of antacids, proton pump inhibitors, and H 2 receptor antagonists [24,25]. Nevertheless, long-term use of these drugs may result in undesirable side effects such as abdominal pain, nausea, sleep deprivation, diarrhea, headache, pneumonia, and osteoporosis-related fracture [26].…”

CYP2C19 Gene Profiling as a Tool for Personalized Stress Ulcer Prophylaxis With Proton Pump Inhibitors in Critically Ill Patients - Recommendations Proposal

“…Based on the information in the individual summaries of product characteristics, pantoprazole bears the lowest risk of common adverse effects (incidence ≥1/100 to < 1/10), followed by omeprazole and esomeprazole, lansoprazole, and rabeprazole with the highest number and variety of adverse drug reactions. Pantoprazole and omeprazole can also be considered preferred PPIs in terms of costs per daily dose and, with respect to safety profiles and clinical evidence, could be the drugs of choice among PPIs ( 57 , 58 ).…”

Efficacy and safety of proton pump inhibitors versus vonoprazan in treatment of erosive esophagitis: A PRISMA-compliant systematic review and network meta-analysis

“…[ 18 ] The efficacy and safety of them were ranked by using the surface under the cumulative ranking curve (SUCRA). [ 19 , 20 ] For the same outcome, the larger SUCRA and the higher the rank probability, the better efficacy and safety of the treatment regimen. Funnel plot was used to assess publication bias.…”