Acid-suppressive drugs: A systematic review and network meta-analysis of their nocturnal acid-inhibitory effect
Abstract
Abstract Background and Aims Acid‐suppressive drugs (ASDs) are widely used in many gastric acid‐associated diseases. Nocturnal acid breakthrough has been a common problem of many ASDs, such as proton‐pump inhibitors (PPIs) and H 2 ‐receptor antagonists (H2RAs). Potassium‐competitive acid blockers (P‐CABs) are expected to solve this continuing conundrum. This article examined major ASDs and compared them with placebo in terms of nocturnal acid‐inhibitory effects, using a network meta‐analysis of randomized controlled trials (RCTs). Methods To compare the effectiveness of major ASDs, a Bayesian network meta‐analysis (NMA) was applied to process data extracted from RCTs. The plausible ranking for each regimen and some subgroups were assessed by surface under the cumulative ranking curves (SUCRA). Results Fifty‐five RCTs were conducted with 2015 participants. In terms of nocturnal acid‐inhibitory effects, the overall results showed that tegoprazan (SUCRA 91.8%) and vonoprazan (SUCRA 91.0%) had the best performance, followed by new PPIs (including tenatoprazole and ilaprazole) (SUCRA 76.6%), additional H2RAs once at bedtime (AHB) (SUCRA 61.3%), isomer PPIs (including esomeprazole and dexlansoprazole) (SUCRA 38.6%), revaprazan (SUCRA 34.7%), traditional PPIs (including omeprazole, rabeprazole, pantoprazole, lansoprazole) (SUCRA 32.6%), H2RAs (SUCRA 23.1%), and placebo (SUCRA 0.3%). In some subgroups, the nocturnal acid‐inhibitory effect of vonoprazan or tegoprazan was better than…
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