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Different dose of new generation proton pump inhibitors for the treatment of Helicobacter pylori infection: A meta-analysis
International Journal of Immunopathology and Pharmacology ( IF 3.5 ) Pub Date : 2021-07-10 , DOI: 10.1177/20587384211030397
Wenwen Gao 1 , Xiang Zhang 1 , Yanhui Yin 1 , Shuwen Yu 2, 3, 4 , Lu Wang 1
Affiliation  

The evidence on whether high-dose new generation proton pump inhibitors (PPIs) including rabeprazole and esomeprazole achieve a higher eradication rate of Helicobacter pylori has not been assessed. The primary comparison was eradication and adverse events (AEs) rate of standard (esomeprazole 20 mg bid, rabeprazole 10 mg bid) versus high-dose (esomeprazole 40 mg bid, rabeprazole 20 mg bid) PPIs. Sub-analyses were performed to evaluate the eradication rate between Asians and Caucasians, clarithromycin-resistance (CAM-R) strains, and clarithromycin-sensitivity (CAM-S) strains of different dose PPIs. We conducted a literature search for randomized controlled trials comparing high-with standard-dose esomeprazole and rabeprazole for H. pylori eradication and AEs. A total of 12 trials with 2237 patients were included. The eradication rate of high-dose PPIs was not significantly superior to standard-dose PPIs regimens: 85.3% versus 84.2%, OR 1.09 (0.86–1.37), P = 0.47. The high dose induced more AEs than those of the standard dose, but didn’t reach statistical significance (OR 1.25, 95% CI: 0.99–1.56, P = 0.06). Subgroup analysis showed that the difference in eradication rate of PPIs between high- and standard-dose groups were not statistically significant both in Asians (OR 0.99, 95% CI 0.75–1.32, P = 0.97) and Caucasians (OR 1.27, 95% CI 0.84–1.92, P = 0.26). Furthermore, there were similar eradication rates in CAM-S (OR 1.2; 95% CI 0.58–2.5; P = 0.63) and CAM-R strains (OR 1.08; 95% CI 0.45–2.56; P = 0.87) between the standard-and high-dose groups. High and standard dosages of new generation of the PPIs showed similar H. pylori eradication rates and AEs as well as between Asian versus Caucasian populations, with or without clarithromycin-resistance. However, further studies are needed to confirm.



中文翻译:

不同剂量的新一代质子泵抑制剂治疗幽门螺杆菌感染的荟萃分析

尚未评估包括雷贝拉唑和埃索美拉唑在内的高剂量新一代质子泵抑制剂(PPI)是否能达到更高的幽门螺杆菌根除率的证据。主要比较标准(埃索美拉唑 20 mg bid,雷贝拉唑 10 mg bid)与高剂量(埃索美拉唑 40 mg bid,雷贝拉唑 20 mg bid)PPI 的根除率和不良事件 (AE) 率。进行子分析以评估不同剂量 PPI 的亚洲人和高加索人、克拉霉素耐药 (CAM-R) 菌株和克拉霉素敏感性 (CAM-S) 菌株之间的根除率。我们对比较高剂量与标准剂量埃索美拉唑和雷贝拉唑治疗幽门螺杆菌的随机对照试验进行了文献检索根除和 AE。共纳入 12 项试验,共 2237 名患者。大剂量 PPI 的根除率并未显着优于标准剂量 PPI 方案:85.3% 对 84.2%,OR 1.09(0.86-1.37),P  = 0.47。高剂量比标准剂量诱导更多的AEs,但未达到统计学意义(OR 1.25,95% CI:0.99-1.56,P  = 0.06)。亚组分析显示,高剂量组和标准剂量组 PPI 根除率的差异在亚洲人(OR 0.99, 95% CI 0.75-1.32, P  = 0.97)和白种人(OR 1.27, 95% CI)中均无统计学意义0.84–1.92,P  = 0.26)。此外,CAM-S 的根除率相似(OR 1.2;95% CI 0.58–2.5;P = 0.63)和 标准剂量组和高剂量组之间的CAM-R 菌株(OR 1.08;95% CI 0.45–2.56;P = 0.87)。新一代 PPI 的高剂量和标准剂量显示出相似的H. pylori根除率和 AE,以及在亚洲人群与高加索人群之间,有或没有克拉霉素耐药性。但是,还需要进一步的研究来证实。

更新日期:2021-07-12
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