Meta-analysis: comparing the efficacy of proton pump inhibitors in short-term use.
BACKGROUND
Proton pump inhibitors have a prominent role in the management of acid-related diseases. Controlling expenses on proton pump inhibitors would yield great economic benefits for Dutch health care.


OBJECTIVE
To investigate whether clinical differences in proton pump inhibitors exist.


METHODS
We searched Medline, EMBASE and the Cochrane Library. We identified papers in English, German, French or Dutch in which two or more proton pump inhibitors were compared under the same clinical conditions in gastro-oesophageal reflux disease, peptic ulcer disease or Helicobacter pylori eradication. The pooled relative risks were calculated using the Mantel-Haenszel method.


RESULTS
Two significant differences were found in the proton pump inhibitors compared. In gastro-oesophageal reflux disease, esomeprazole 40 mg was superior to omeprazole 20 mg (relative risk, 1.18; 95% confidence interval, 1.14-1.23). In peptic ulcer disease, pantoprazole 40 mg was superior to omeprazole 20 mg (relative risk, 1.07; 95% confidence interval, 1.02-1.13). In Helicobacter pylori eradication, no significant differences were found.


CONCLUSIONS
Both significant differences found were in favour of the highest dose of proton pump inhibitor on a milligram basis. This indicates that the difference may be dose dependent and not proton pump inhibitor specific. Therefore, when prescribing proton pump inhibitors, arguments other than clinical efficacy, such as those related to pharmaco-economics, may be considered.
Klok
R M
RM
Groningen University Institute for Drug Exploration/University of Groningen Research Institute of Pharmacy, Department of Social Pharmacy, Pharmaco-epidemiology and Pharmacotherapy, Groningen, The Netherlands.
Postma
M J
MJ
van Hout
B A
BA
Brouwers
J R B J
JR
D000284:Administration, Oral; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D054328:Proton Pump Inhibitors; D016032:Randomized Controlled Trials as Topic
D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors