TY - JOUR
T1 - Esomeprazole Versus Other Proton Pump Inhibitors in Erosive Esophagitis
T2 - A Meta-Analysis of Randomized Clinical Trials
AU - Gralnek, Ian M.
AU - Dulai, Gareth S.
AU - Fennerty, M. Brian
AU - Spiegel, Brennan M.R.
N1 - Funding Information:
Supported by VA HSR&D Advanced Research Career Development Award and VA HSR&D IIR 01-191-1 (I.M.G.); supported by VA HSR&D Research Career Development Award RCD 03-179-2 and by the CURE Digestive Diseases Research Center (NIH 2P30 DK 041301-17) (B.M.R.S.); and by a grant from EBMed with funding for the grant obtained from AstraZeneca.
PY - 2006/12
Y1 - 2006/12
N2 - Background & Aims: There are limited data comparing the effectiveness of available proton pump inhibitors (PPIs) in erosive esophagitis (EE). We performed a meta-analysis to calculate the pooled effect of esomeprazole on healing rates, symptom relief, and adverse events versus competing PPIs in EE. Methods: We performed a structured electronic search of MEDLINE and EMBASE and reviewed published abstracts to identify English-language, randomized clinical trials from 1995-2005, comparing rates of endoscopic healing, symptom relief, and adverse events with esomeprazole versus alternative PPIs in the treatment of gastroesophageal reflux disease (GERD)/EE. We then performed meta-analysis to compare the relative risk (RR) of EE healing, symptom relief, and adverse events between study arms and calculated the absolute risk reduction and number needed to treat (NNT) for each outcome. Results: Meta-analysis was performed on 10 studies (n = 15,316). At 8 weeks, there was a 5% (RR, 1.05; 95% confidence interval, 1.02-1.08) relative increase in the probability of healing of EE with esomeprazole, yielding an absolute risk reduction of 4% and NNT of 25. The calculated NNTs by Los Angeles grade of EE (grades A-D) were 50, 33, 14, and 8, respectively. Last, esomeprazole conferred an 8% (RR, 1.08; 95% confidence interval, 1.05-1.11) relative increase in the probability of GERD symptom relief at 4 weeks. Conclusions: As compared with other PPIs, esomeprazole confers a statistically significant improvement, yet, clinically, only a modest overall benefit in 8-week healing and symptom relief in all-comers with EE. The clinical benefit of esomeprazole appears negligible in less severe erosive disease but might be important in more severe disease.
AB - Background & Aims: There are limited data comparing the effectiveness of available proton pump inhibitors (PPIs) in erosive esophagitis (EE). We performed a meta-analysis to calculate the pooled effect of esomeprazole on healing rates, symptom relief, and adverse events versus competing PPIs in EE. Methods: We performed a structured electronic search of MEDLINE and EMBASE and reviewed published abstracts to identify English-language, randomized clinical trials from 1995-2005, comparing rates of endoscopic healing, symptom relief, and adverse events with esomeprazole versus alternative PPIs in the treatment of gastroesophageal reflux disease (GERD)/EE. We then performed meta-analysis to compare the relative risk (RR) of EE healing, symptom relief, and adverse events between study arms and calculated the absolute risk reduction and number needed to treat (NNT) for each outcome. Results: Meta-analysis was performed on 10 studies (n = 15,316). At 8 weeks, there was a 5% (RR, 1.05; 95% confidence interval, 1.02-1.08) relative increase in the probability of healing of EE with esomeprazole, yielding an absolute risk reduction of 4% and NNT of 25. The calculated NNTs by Los Angeles grade of EE (grades A-D) were 50, 33, 14, and 8, respectively. Last, esomeprazole conferred an 8% (RR, 1.08; 95% confidence interval, 1.05-1.11) relative increase in the probability of GERD symptom relief at 4 weeks. Conclusions: As compared with other PPIs, esomeprazole confers a statistically significant improvement, yet, clinically, only a modest overall benefit in 8-week healing and symptom relief in all-comers with EE. The clinical benefit of esomeprazole appears negligible in less severe erosive disease but might be important in more severe disease.
UR - http://www.scopus.com/inward/record.url?scp=33845383409&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33845383409&partnerID=8YFLogxK
U2 - 10.1016/j.cgh.2006.09.013
DO - 10.1016/j.cgh.2006.09.013
M3 - Article
C2 - 17162239
AN - SCOPUS:33845383409
SN - 1542-3565
VL - 4
SP - 1452
EP - 1458
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 12
ER -