右兰索拉唑与埃索美拉唑治疗胃食管反流病的疗效比较

Comparative Efficacy of Dexlansoprazole and Esomeprazole in the Treatment of Gastro-esophageal Reflux Disease

目的比较右兰索拉唑与埃索美拉唑对腐蚀性食管炎（EO）的治疗及维持治疗以及对非腐蚀性反流病（NERD）的治疗疗效。方法对比兰索拉唑或埃索美拉唑与安慰剂或另一种质子泵抑制剂的随机对照试验（RCT）进行系统性回顾,使用随机效应荟萃分析和经调整的间接比较方法,比较右兰索拉唑与埃索美拉唑的疗效,计算相对危险性（RR）和95%可信区间（CI）。结果间接比较结果显示,右兰索拉唑组与埃索美拉唑组NERD患者在4周时烧心症状存在显著性差异。右兰索拉唑30 mg剂量与埃索美拉唑20 mg或40 mg剂量相比,具有显著优势（RR：2.01,95%CI：1.15～3.51;RR：2.17,95%CI：1.39～3.38）。而对EO的治疗及维持治疗,2种药物无显著差异。结论对NERD患者烧心症状的控制,右兰索拉唑与埃索美拉唑相比具有更好的疗效,但对于EO的治疗疗效两者无显著性差异。本研究结果有待更大样本进一步研究证实。

OBJECTIVE To compare the efficacy of dexlansoprazole with esomeprazole in healing erosive oesophagitis（EO）, the maintenance of healed EO and the treatment of non-erosive reflux disease（NERD）. METHODS Randomised controlled trials（RCTs） comparing dexlansoprazole or esomeprazole with either placebo or another PPI were systematically reviewed. Random-effect Meta-analyses and adjusted indirect comparisons were conducted to compare the treatment effect of dexlansoprazole and esomeprazole using a common comparator. The relative risk（RR） and 95% confidence interval（CI） were calculated. RESULTS The indirect comparisons revealed significant differences in symptom control of heartburn in patients with NERD at 4 weeks between two drugs： dexlansoprazole 30 mg was more effective than esomeprazole 20 mg or 40 mg（RR： 2.01, 95% CI： 1.15–3.51; RR： 2.17, 95% CI： 1.39–3.38）. However, there were no statistically significant differences between the two drugs in EO healing and maintenance of healed EO. CONCLUSION It suggestes significantly better treatment effect in symptom control of heartburn in patients with NERD for dexlansoprazole against esomeprazole. No statistically significant differences are found in other EO outcomes. It is looking forward to have more high quality clinical randomized controlled trials to confirm the findings.