Systematic review: standard- and double-dose proton pump inhibitors for the healing of severe erosive oesophagitis -- a mixed treatment comparison of randomized controlled trials.
BACKGROUND
No randomized controlled trial (RCT) has compared all European-licensed standard- and double-dose PPIs for the healing of severe erosive oesophagitis.


OBJECTIVE
To compare the effectiveness of licensed doses of PPIs for healing severe erosive oesophagitis (i.e. esomeprazole 40 mg, lansoprazole 30 mg, omeprazole 20 mg and 40 mg, pantoprazole 40 mg and rabeprazole 20 mg).


METHODS
Systematic review of CENTRAL, EMBASE and MEDLINE for RCTs in patients with erosive oesophagitis (completed October 2008). Endoscopically verified healing rates at 4 and 8 weeks were extracted and re-calculated if not analysed by intention-to-treat. A mixed treatment comparison was used to combine direct treatment comparisons with indirect trial evidence while maintaining randomization. Odds ratios (OR) are reported compared to omeprazole 20 mg.


RESULTS
A total of 3021 papers were identified in the literature search; 12 were of sufficient quality to be included in the analysis. Insufficient data were available to included rabeprazole. Esomeprazole 40 mg was found to provide significantly higher healing rates at 4 weeks [OR 1.84, 95% Credible Interval (95% CrI): 1.50 to 2.22] and 8 weeks (OR 1.91, 95% CrI: 1.13 to 2.88). No other PPI investigated had significantly higher healing rates than omeprazole 20 mg.


CONCLUSIONS
Esomeprazole 40 mg consistently demonstrates higher healing rates compared with licensed standard- and double-dose PPIs.
Edwards
S J
SJ
Outcomes Research, AstraZeneca UK Ltd, Luton, UK. .j.edwards@astrazeneca.com
Lind
T
T
Lundell
L
L
DAS
R
R
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D064098:Esomeprazole; D004941:Esophagitis / Q000188:drug therapy*; D006801:Humans; D064747:Lansoprazole; D009853:Omeprazole / Q000008:administration & dosage; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D064750:Rabeprazole; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D064750:Rabeprazole; D009853:Omeprazole; D064098:Esomeprazole