Effectiveness and Tolerability of Different Recommended Doses of PPIs and H2RAs in GERD: Network Meta-Analysis and GRADE system

Proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H 2 RAs) are used for gastro-esophageal reflux disease (GERD); however, the clinical evidence for treatment is poor. We evaluated the effectiveness and tolerability of different doses of PPIs, H 2 RAs and placebo in adults with GERD...

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Published in:Scientific reports 2017-01, Vol.7 (1), p.41021-41021, Article 41021
Main Authors: Zhang, Chao, Kwong, Joey S. W., Yuan, Rui-Xia, Chen, Hao, Xu, Chang, Wang, Yi-Pin, Yang, Gong-Li, Yan, Jin-Zhu, Peng, Le, Zeng, Xian-Tao, Weng, Hong, Luo, Jie, Niu, Yu-Ming
Format: Article
Language:English
Subjects:
692/4020/1503/1501
692/699/1503/197/1546
Bayesian analysis
Bias
Clinical trials
Drug dosages
Drug therapy
Endoscopy
Esophagus
Evidence-based medicine
Gastroesophageal reflux
Histamine
Hospitals
Humanities and Social Sciences
Medicine
Meta-analysis
Motivation
multidisciplinary
Omeprazole
Pharmaceutical industry
Proton pump inhibitors
Science
Science (multidisciplinary)
Sensitivity analysis
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Summary:Proton pump inhibitors (PPIs) and histamine-2-receptor antagonists (H 2 RAs) are used for gastro-esophageal reflux disease (GERD); however, the clinical evidence for treatment is poor. We evaluated the effectiveness and tolerability of different doses of PPIs, H 2 RAs and placebo in adults with GERD. Six online databases were searched through September 1, 2016. All related articles were included and combined with a Bayesian network meta-analysis from randomized controlled trials (RCTs). The GRADE systems were employed to assess the main outcome. Ninety-eight RCTs were identified, which included 45,964 participants. Our analysis indicated that the full/standard dose of esomeprazole at 40 mg per day was the most efficient in healing among nine different dosages of PPIs and H 2 RAs. The main efficacy outcome did not change after adjustments for the area, age, level of disease from endoscopy, year of publication, pharmaceutical industry sponsorship, Intention-to-treat (ITT)/per-protocol (PP), withdrawal rate, pre-set select design bias, single blinded and unblinded studies, study origination in China, study arms that included zero events, inconsistency node or discontinued drug were accounted for in the meta-regressions and sensitivity analyses. This research suggests that the full/standard doses (40 mg per day) of esomeprazole should be recommended as first-line treatments for GERD in adults for short-term therapy.
ISSN:2045-2322
2045-2322
DOI:10.1038/srep41021