Still a dilemma! Are vonoprazan and esomeprazole attenuating the antiplatelet function of clopidogrel when taken concomitantly? A systematic review and meta-analysis
Abstract
Abstract Objective CYP2C19 metabolizes all three drugs—esomeprazole, vonoprazan, and clopidogrel—so it is mostly responsible for their drug interactions. Is this clinically true or just theoretical? This systematic review and meta-analysis aimed to investigate clopidogrel’s effectiveness when taken with one of these drugs concurrently. Methods PubMed, SCOPUS, Web of Science, and Cochrane CENTRAL were searched from inception to February 2023, and eligible randomized controlled trials (RCTs) were chosen. Using VerifyNow P2Y12 and light transmission aggregometry measuring, the inhibition of platelet aggregation (IPA%) was measured. IPA% was pooled in a random effect model. The Cochrane Risk of Bias 2.0 tool (ROB2) was used. Results Nine RCTs involving 550 patients were included, with only 222 healthy individuals and 96 coronary artery disease (CAD) patients randomly assigned to the intervention arm (esomeprazole or vonoprazan). The remaining participants were excluded as they were exposed to different PPIs. Among healthy subgroups, esomeprazole and vonoprazan showed a statistically significant reduction in the mean difference (MD) of IPA% compared to clopidogrel alone ((MD − 8.32; 95% confidence interval (CI) [− 14.13, − 2.51], I 2 = 54%, p-value = 0.005) and (− 21.28; CI [− 29.76, − 12.79], I 2 = 0%, p-value < 0.00001), respectively. However, the CAD subgroup of esomeprazole did not demonstrate statistical significance in IPA% (− 7.47, CI [− 19.98,5.04], I 2 = 86%, p-value =…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 550 participants or records.
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