Table_4_Efficacy and safety of vonoprazan versus proton pump inhibitors in the treatment of peptic ulcer disease: a systematic review and network meta-analysis for randomized controlled trails.docx

Background and aimsVonoprazan, a novel acid suppressant, has been employed in the treatment of peptic ulcer disease in recent years. However, the efficacy and safety of vonoprazan versus proton-pump inhibitors remains controversial. To address this gap, a systematic review and network meta-analysis were conducted to evaluate the efficacy and safety of vonoprazan in comparison with various proton-pump inhibitors.
MethodsRandomized controlled trials that met selection criteria in PubMed (Medline), EMBASE and the Cochrane Library were searched up to July 15, 2024. The primary outcome was ulcer healing rate. Secondary outcomes were treatment-emergent adverse events and drug-related adverse events. Effect size on outcomes is presented as odds ratios with 95% confidence intervals.
ResultsThirty-five randomized controlled trials containing 9,544 participants were included. In terms of the healing rate at 2 weeks, lansoprazole 30 mg ranked first, followed by vonoprazan 20 mg and ilaprazole 10 mg. In terms of the healing rate at 4 weeks, pantoprazole 40 mg ranked first, with rabeprazole 10 mg and lansoprazole 30 mg ranking second and third, respectively. Regarding the healing rate at 8 weeks, lansoprazole 30 mg is demonstrated to be the most efficacious regimen. Moreover, subgroup analysis indicated that lansoprazole 30 mg is the optimal regimen in the treatment of artificial gastric ulcer at 4 and 8 weeks. Importantly, lansoprazole 30 mg has fewer adverse reactions and higher safety.
ConclusionThe optimal regimen for the treatment of peptic ulcer disease may be lansoprazole 30 mg at 2 and 8 weeks, while pantoprazole 40 mg has demonstrated superior performance at the 4-week when compared to vonoprazan 20 mg. Furthermore, lansoprazole 30 mg has shown to be superior in terms of safety outcomes. These findings, derived from a network meta-analysis, necessitate further research for validation.

背景与研究目的：沃诺拉赞（Vonoprazan）是一种新型抑酸剂，近年被应用于消化性溃疡病的治疗。然而，沃诺拉赞对比质子泵抑制剂（proton-pump inhibitors）的有效性与安全性仍存在争议。为填补这一研究空白，本研究开展系统评价与网状meta分析，以评估沃诺拉赞与各类质子泵抑制剂相比的有效性与安全性。
研究方法：检索截至2024年7月15日PubMed（Medline）、EMBASE及Cochrane图书馆中符合纳入标准的随机对照试验。本研究的主要结局指标为溃疡愈合率，次要结局指标为治疗突发不良事件与药物相关不良事件。结局指标的效应量以比值比（odds ratios）联合95%置信区间（confidence intervals）进行呈现。
研究结果：共纳入35项随机对照试验，涉及9544名受试者。在2周溃疡愈合率方面，30mg兰索拉唑（lansoprazole）位列首位，其次为20mg沃诺拉赞与10mg艾普拉唑（ilaprazole）；在4周溃疡愈合率方面，40mg泮托拉唑（pantoprazole）位居首位，10mg雷贝拉唑（rabeprazole）与30mg兰索拉唑分别位列第二、第三位；在8周溃疡愈合率方面，30mg兰索拉唑被证实为疗效最佳的给药方案。亚组分析显示，在4周及8周人工胃溃疡治疗中，30mg兰索拉唑为最优给药方案。值得关注的是，30mg兰索拉唑的不良事件发生率更低，安全性更高。
研究结论：治疗消化性溃疡病的最优方案或许为2周及8周疗程的30mg兰索拉唑，对比20mg沃诺拉赞，40mg泮托拉唑在4周疗程中展现出更优的疗效。此外，30mg兰索拉唑在安全性结局方面表现更优。本研究基于网状meta分析所得的结论，尚需开展进一步研究予以验证。