Original articleEsomeprazole Versus Other Proton Pump Inhibitors in Erosive Esophagitis: A Meta-Analysis of Randomized Clinical Trials
Section snippets
Search Strategy and Inclusion Criteria
We performed a structured electronic search of MEDLINE and EMBASE along with a review of published abstracts from 3 major subspecialty journals 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 GERD/EE. In addition, we manually searched the bibliographies of key review articles for references not captured by our search strategy and
Study Selection and Data Collection
We identified 84 titles, of which 11 were selected for final review (κ >0.8 for agreement) (Figure 1). Meta-analysis was performed on 10 studies that included n = 15,316 total subjects. These 10 studies included 8 peer-reviewed, full-text manuscripts, 1 published abstract, and 1 manufacturer package insert7, 8, 9, 17, 18, 19, 20, 21, 22, 23 (Table 3). In our methodologic assessment of the quality of selected clinical trials for meta-analysis, 7 of 8 published trials were “high quality” (Jadad
Discussion
This meta-analysis of randomized clinical trials comparing esomeprazole versus alternative PPIs in the treatment of EE found that in the healing of EE, there was a modest overall benefit of esomeprazole. Specifically, at 8 weeks of healing, we found an ARR of 4%, yielding an NNT of 25. However, when analyzing by specific LA grade of EE, we found that as the severity of EE grade increased, the NNT decreased. These data suggest that as compared with other available PPIs, esomeprazole provides
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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.
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M.B.F. is a consultant for TAP Pharmaceuticals, Santarus, AstraZeneca, Atlanta, and Axcan.