PDF(Pubmed)
Abstract：
Novel potassium-competitive acid blockers (P-CABs) have emerged as effective acid-suppressive drugs in recent years, replacing proton pump inhibitors (PPIs). We aim to compare the efficacy and safety of P-CABs versus PPIs in the treatment of peptic ulcers with or without Helicobacter pylori (H. pylori) infection. We searched in PubMed, Embase, WOS, Cochrane Library, ClinicalTrials.gov, CNKI, and Wanfang databases (all years up to January 2024). Efficacy and safety outcomes were evaluated using odds ratio (OR) and 95% confidence intervals (CI). The Surface Under the Cumulative Ranking (SUCRA) probabilities were used to rank each intervention. Among 14,056 studies screened, 56 studies involving 9792 participants were analyzed. Vonoprazan demonstrated the best efficacy in ulcer healing rate and H. pylori eradication rate (SUCRA = 86.4% and 90.7%, respectively). Keverprazan ranked second in ulcer healing rates (SUCRA = 76.0%) and was more effective in pain remission rates (SUCRA = 91.7%). The risk of adverse events was low for keverprazan (SUCRA = 11.8%) and tegoprazan (SUCRA = 12.9%), and moderate risk for vonoprazan (SUCRA = 44.3%) was demonstrated. Compared to lansoprazole, vonoprazan exhibited a higher risk of drug-related adverse events (OR: 2.15; 95% CI: 1.60-2.89) and serious adverse events (OR: 2.22; 95% CI: 1.11-4.42). Subgroup analysis on patients with H. pylori-positive peptic ulcers showed that vonoprazan was at the top of the SUCRA rankings, followed by keverprazan. Vonoprazan showed superior performance in peptic ulcers, especially for patients with H. pylori-positive peptic ulcers. However, the risk of adverse events associated with vonoprazan should be noted. Keverprazan has also shown good therapeutic outcomes and has performed better in terms of safety.
摘要：
近年来，新型钾竞争性酸阻滞剂（P-CABs）已成为有效的抑酸药。替代质子泵抑制剂（PPI）。我们的目的是比较P-CABs与PPI治疗有或没有幽门螺杆菌的消化性溃疡的疗效和安全性（H.幽门螺杆菌)感染。我们在PubMed搜索,Embase,WOS,科克伦图书馆,ClinicalTrials.gov,CNKI,和万方数据库（截至2024年1月的所有年份）。使用比值比（OR）和95％置信区间（CI）评估疗效和安全性结果。使用累积排名下的表面(SUCRA)概率对每个干预进行排名。在筛选的14056项研究中，对涉及9792名参与者的56项研究进行了分析。Vonoprazan在溃疡愈合率和幽门螺杆菌根除率方面表现出最佳疗效（SUCRA=86.4％和90.7％，分别)。Keverprazan在溃疡愈合率方面排名第二（SUCRA=76.0％），在疼痛缓解率方面更有效（SUCRA=91.7％）。Keverprazan（SUCRA=11.8％）和tegoprazan（SUCRA=12.9％）的不良事件风险较低，并证明了vonoprazan的中度风险（SUCRA=44.3％）。与兰索拉唑相比,vonoprazan表现出更高的药物相关不良事件（OR：2.15;95％CI：1.60-2.89）和严重不良事件（OR：2.22;95％CI：1.11-4.42）的风险。对幽门螺杆菌阳性消化性溃疡患者的亚组分析显示，vonoprazan在SUCRA排名中名列前茅，其次是Keverprazan.Vonoprazan在消化性溃疡中表现优异，特别是幽门螺杆菌阳性消化性溃疡患者。然而,应注意与vonoprazan相关的不良事件风险.Keverprazan也显示出良好的治疗效果，并且在安全性方面表现更好。
