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Efficacy of Drugs Used in Gastro-Oesophageal Reflux: Network Meta-Analysis

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DOI: 10.4236/pp.2013.42028    3,634 Downloads   5,944 Views   Citations

ABSTRACT

Introduction: It is important to rank the clinical efficacy of different anti-reflux agents to promote their rational use. Objective: To combine the results of randomized clinical trials that have compared the incidence of symptoms related to gastro-oesophageal reflux (GER) with/without endoscopic evidence of oesophagitis in a network meta-analysis and thus rank the main anti-reflux therapies according to the magnitude of their clinical efficacy. Method: Inclusion criteria: 1) randomized controlled trials that compare anti-reflux agents (alginates (ALG), proton-pump inhibitors (PPI), H2 histamine receptor antagonists (H2RA), antacids (AA), gastrokinetics (GK)) in open designs as compared to placebo or in comparative designs (head-to-head); 2) outcome of interest measured in some scale representing the significant improvement of reflux symptoms; 3) GER diagnosis with/without oesophagitis endoscopic evidence. We collected available clinical trials for each one of the direct comparisons. The Odds Ratio (OR) was used additionally to calculating lnOR and its Standard Error (SE[lnOR]) to measure effects in a network meta-analysis. Results: Network meta-analysis has placebo as a reference intervention. Initial treatments with PPI or ALG are the two interventions that significantly differ from the others: H2RA, AA and GK. At the same time, the latter are significantly different from the placebo. In contrast to placebo, ORs for ALG, PPI, H2RA, AA and GK were 4.72 (95% CI: 3.39, 6.57), 4.00 (95% CI: 3.30, 4.85), 1.73 (95% CI: 1.54, 1.95), 1.41 (95% CI: 1.12, 1.76), and 1.86 (95% CI: 1.32, 2.63), respectively. Conclusion: ALG or PPI seem to be the two most effective alternatives in short-time management of GER with or without oesophagitis.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

R. Bolaños-Díaz, H. Velarde-Criado and E. Cóndor-Mori, "Efficacy of Drugs Used in Gastro-Oesophageal Reflux: Network Meta-Analysis," Pharmacology & Pharmacy, Vol. 4 No. 2, 2013, pp. 201-208. doi: 10.4236/pp.2013.42028.

References

[1] T. Oscanoa, “Seguridad de los Inhibidores de la Bomba de Protones,” Revista de Gastroenterología del Perú, Vol. 31, No. 1, 2011, pp. 49-55.
[2] D. Gillen, A. A. Wirz, J. E. Ardill, et al., “Rebound Hypersecretion after Omeprazole and Its Relation to On- Treatment Acid Suppression and Helicobacter pylori Status,” Gastroenterology, Vol. 116, No. 2, 1999, pp. 239-247. doi:10.1016/S0016-5085(99)70118-6
[3] M. Broeren, E. Geerdink, H. Vader and A. Warmold, “Hypomagnesemia Induced by Several Proton-Pump Inhibitors,” Annals of Internal Medicine, Vol. 151, 2009, pp. 755-756.
[4] “El uso Prolongado y Regular de Inhibidores de la Bomba de Protones (PPI) Puede Reducir el Nivel de Magnesio,” Boletín Farmacos, Vol. 14, No. 2, 2011, pp. http://www.saludyfarmacos.org/boletin-farmacos/
[5] C. Kapadia and V. Mane, “Raft-Forming Agents: Anti- Reflux Formulations,” Drug Development and Industrial Pharmacy, Vol. 33, No. 12, 2007, pp. 1350-1361. doi:10.1080/03639040701385691
[6] K. G. Mandel, B. P. Daggy, D. A. Brodie and H. I. Jacoby, “Review Article: Alginate-Raft Formulations in the Treatment of Heartburn and Acid Reflux,” Alimentary Pharmacology & Therapeutics, Vol. 14, No. 6, 2000, pp. 669-690. doi:10.1046/j.1365-2036.2000.00759.x
[7] N. Vakil, T. Rydén-Bergsten and K. Bergenheim, “Systematic Review: Patient-Centred Endpoints in Economic Evaluations of Gastro-Oesophageal Reflux Disease,” Alimentary Pharmacology & Therapeutics, Vol. 16, No. 8, 2002, pp. 1469-1480. doi:10.1046/j.1365-2036.2002.01303.x
[8] I. Mason and N. J. Marchant, “Management of Acid- Related Dispepsia in General Practice,” Clinical Drug Investigation, Vol. 18, No. 2, 1999, pp. 117-124. doi:10.2165/00044011-199918020-00004
[9] A. Briggs, R. Goeree, G. Blackhouse and B. O’Brien, “Probabilistic Analysis of Cost-Effectiveness Models: Choosing between Treatment Strategies for Gastroesophageal Reflux Disease,” Medical Decision Making, Vol. 22, 2002, pp. 290-308.
[10] C. Donnellan, C. Preston, P. Moayyedi and N. Sharma, “Medical Treatments for the Maintenance Therapy of Reflux Oesophagitis and Endoscopic Negative Reflux Disease,” Cochrane Database of Systematic Reviews. The Cochrane Library, No. 6, 2009, Article ID: CD003245. doi:10.1002/14651858.CD003245.pub2
[11] P. Moayyedi, J. Santana, M. Khan, C. Preston and C. Donnellan, “Medical Treatments in the Short Term Management of Reflux Oesophagitis,” Cochrane Database of Systematic Reviews. The Cochrane Library, No. 6, 2009, Article ID: CD003244. doi:10.1002/14651858.CD003244.pub2
[12] B. van Pinxteren, K. E. Sigterman, P. Bonis, J. Lau and M. E. Numans, “Short-Term Treatment with Proton Pump Inhibitors, H2-Receptor Antagonists and Prokinetics for Gastro-Oesophageal Reflux Disease-Like Symptoms and Endoscopy Negative Reflux Disease,” Cochrane Database of Systematic Reviews. The Cochrane Library, No. 6, 2006, Article ID: CD002095. doi:10.1002/14651858.CD002095.pub2
[13] A. Jadad, D. Moher, G. Nichol, M. Penman, P. Tugwell and S. Walsh, “Assessing the Quality of Randomized Controlled Trials: An Annotated Bibliography of Scales and Checklists,” Controlled Clinical Trials, Vol. 16, No. 1, 1995, pp. 62-73. doi:10.1016/0197-2456(94)00031-W
[14] Multiple Treatments Meta-Analysis, “A Framework for Evaluating and Ranking Multiple Healthcare Technologies.” http://www.mtm.uoi.gr/
[15] D. Armstrong, P. Paré, D. Pericak, M. Pyzyk and The Canadian Pantoprazole GER Study Group, “Symptom Relief in Gastroesophageal Reflux Disease: A Randomized, Controlled Comparison of Pantoprazol and Nizatidine in a Mixed Patient Population with Erosive Esophagitis or Endoscopy-Negative Reflux Disease,” The American Journal of Gastroenterology, Vol. 96, 2001, pp. 2849-2857.
[16] C. M. Bate, S. M. Griffin, P. W. Keeling, A. T. Axon, M. W. Dronfield, et al., “Reflux Symptom Relief with Omeprazole in Patients without Unequivocal Oesophagitis,” Alimentary Pharmacology & Therapeutics, Vol. 10, No. 4, 1996, pp. 547-555. doi:10.1046/j.1365-2036.1996.44186000.x
[17] C. M. Bate, J. R. Green, A. T. Axon, F. E. Murray, G. Tildesley, et al., “Omeprazol Is More Effective than Cimetidine for the Relief of All Grades of Gastro-Oesophageal Reflux Disease-Associated Heartburn, Irrespective of the Presence or Absence of Endoscopic Oesophagitis,” Alimentary Pharmacology & Therapeutics, Vol. 11,No. 4, 1997, pp. 755-763. doi:10.1046/j.1365-2036.1997.00198.x
[18] M. Beeley and J. Warner, “Medical Treatment of Symptomatic Hiatus Hernia with Low-Density Compounds,” Current Medical Research and Opinion, Vol. 1, No. 2, 1972, pp. 63-69. doi:10.1185/03007997209111146
[19] R. Carlsson, J. Dent, R. Watts, S. Riley, R. Sheikh, et al., “Gastro-Oesophageal Reflux Disease in Primary Care: An International Study of Different Treatment Strategies with Omeprazole,” European Journal of Gastroenterology & Hepatology, Vol. 10, No. 2, 1998, pp. 119-124. doi:10.1097/00042737-199802000-00004
[20] S. Chatfield, “A Comparison of the Efficacy of the Alginate Preparation, Gaviscon Advance, with Placebo in the Treatment of Gastro-Oesophageal Reflux Disease,” Current Medical Research and Opinion, Vol. 15, No. 3, 1999, pp. 152-159. doi:10.1185/03007999909114086
[21] A. Ciociola, K. Pappa and M. Sirgo, “Nonprescription Doses of Ranitidine Are Effective in the Relief of Episodic Heartburn,” American Journal of Therapeutics, Vol. 8, No. 6, 2001, pp. 399-408. doi:10.1097/00045391-200111000-00004
[22] C. A. Eriksen, W. G. Cheadle, C. A. Cranford and A. Cuschieri, “Combined Cimetidine-Alginate Antacid Therapy versus Single Agent Treatment for Reflux Oesophagitis,” Annales Chirugiae et Gynaecologiae, Vol. 77, 1988, pp. 133-137.
[23] J. P. Galmiche, G. Shi, B. Simon, F. Casset-Semanasanaz and A. Slama, “On-Demand Treatment of Gastro-Oesophageal Reflux Symptoms: A Comparison of Ranitidine 75 mg with Cimetidine 200 mg or Placebo,” Alimentary Pharmacology & Therapeutics, Vol. 12, No. 9, 1998, pp. 909-917. doi:10.1046/j.1365-2036.1998.00384.x
[24] E. Giannini, P. Zentilin, P. Dulbecco, R. Iritano, C. Bilardi, et al., “A Comparison between Sodium Alginate and Magaldrate Anhydrous in the Treatment of Patients with Gastroesophageal Reflux Symptoms,” Digestive Diseases and Sciences, Vol. 51, No. 11, 2006, pp. 1904- 1909. doi:10.1007/s10620-006-9284-0
[25] W. Holtmeier, G. Holtmann, W. Caspary and U. Weingartner, “On-Demand Treatment of Acute Heartburn with the Antacid Hydrotalcite Compared with Famotidine and Placebo,” Journal of Clinical Gastroenterology, Vol. 41, No. 6, 2007, pp. 564-570. doi:10.1097/MCG.0b013e31802e7efb
[26] F. L. Lanza, V. Smith, J. A. Page-Castell and D. O. Castell, “Effectiveness of Foaming Antacid in Relieving Induced Heartburn,” Southern Medical Journal, Vol. 79, No. 3, 1986, pp. 327-330. doi:10.1097/00007611-198603000-00017
[27] T. Lind, T. Havelund, R. Carlsson, O. Anker-Hansen and H. Glise, “Heartburn without Oesophagitis: Efficacy of Omeprazole Therapy and Features Determining Therapeutic Response,” Scandinavian Journal of Gastroenterology, Vol. 32, No. 10, 1997, pp. 974-979. doi:10.3109/00365529709011212
[28] P. Miner, W. Orr, J. Filippone, L. Jokubaitis and S. Sloan, “Rabeprazole in Norerosive Gastroesophageal Reflux Disease: A Randomized Placebo-Controlled Trial,” The American Journal of Gastroenterology, Vol. 97, 2002, pp. 1332-1339. doi:10.1111/j.1572-0241.2002.05769.x
[29] K. A. Pappa, W. M. Gooch, K. Buaron, J. E. Payne, E. E. Giefer, et al., “Low-Dose Ranitidine Fir the Relief of Heartburn,” Alimentary Pharmacology & Therapeutics, Vol. 13, No. 4, 1999, pp. 459-465. doi:10.1046/j.1365-2036.1999.00507.x
[30] J. Richter, D. Peura, S. Benjamin, B. Joelsson and J. Whipple, “Efficacy of Omeprazole for the Treatment of Symptomatic Acid Reflux Disease without Esophagitis,” Archives of Internal Medicine, Vol. 160, No. 12, 2000, pp. 1810-1816. doi:10.1001/archinte.160.12.1810
[31] J. F. Riemann and W. H?bel, “Cimetidine Suspension in Patients with Stage 0 Gastro-Oesophageal Reflux Disease,” Alimentary Pharmacology & Therapeutics, Vol. 5, No. 2, 1991, pp. 191-197. doi:10.1111/j.1365-2036.1991.tb00020.x
[32] I.-R. Lai, M.-S. Wu and J.-T. Lin, “Prospective, Randomized, and Active Controlled Study of the Efficacy of Alginic Acid and Antacid in the Treatment of Patients with Endoscopy-Negative Reflux Disease,” World Journal of Gastroenterology, Vol. 12, 2006, pp. 747-754.
[33] T. Simon, R. Berlin, A. Gardner, L. Stauffer, A. Lawrence, et al., “Self-Directed Treatment of Intermittent Heartburn: A Randomized, Multicenter, Double-Blind, Placebo-Controlled Evaluation of Antacid and Low Doses of an H2-Receptor Antagonist (Famotidine),” World Journal of Gastroenterology, Vol. 2, No. 5, 1995, pp. 304-313. doi:10.1097/00045391-199505000-00003
[34] C. Stanciu and J. Bennett, “Alginate/Antacid in the Reduction of Gastro-Oesophageal Reflux,” Lancet, Vol. 303, No. 7848, 1974, pp. 109-111. doi:10.1016/S0140-6736(74)92340-X
[35] T. L. Venables, R. D. Newland, A. C. Patel, J. Hole, C. Wilcock, et al., “Omeprazole 10 Milligrams Once Daily, Omeprazole 20 Milligrams Once Daily, or Ranitidine 150 Milligrams Twice Daily, Evaluated as Initial Therapy for the Relief of Symptoms of Gastro-Oesophageal Reflux Disease in General Practice,” Scandinavian Journal of Gastroenterology, Vol. 32, No. 10, 1997, pp. 965-973. doi:10.3109/00365529709011211
[36] R. Weberg and A. Berstad, “Symptomatic Effect of a Low-Dose Antacid Regimen in Reflux Oesophagitis,” Scandinavian Journal of Gastroenterology, Vol. 24, No. 4, 1989, pp. 401-406. doi:10.3109/00365528909093066
[37] D. Castell, D. Silvers, T. Littlejohn, W. Orr, J. Napolitano, et al., “Cisapride 20 mg b.d. for Preventing Symptoms of GER Induced by a Provocative Meal,” Alimentary Pharmacology & Therapeutics, Vol. 13, No. 6, 1999, pp. 787- 794. doi:10.1046/j.1365-2036.1999.00525.x
[38] C. S. Robertson, D. F. Evans, S. J. Ledingham and M. Atkinson, “Cisapride in the Treatment of Gastro-Oesophageal Reflux Disease,” Alimentary Pharmacology & Therapeutics, Vol. 7, No. 2, 1993, pp. 181-190. doi:10.1111/j.1365-2036.1993.tb00088.x
[39] T. Poynard, B. Vernisse and H. Agostini, “Randomized, Multicenntre Comparison of Sodium Alginate and Cisapride in the Symptomatic Treatment of Uncomplicated Gastrooesophageal Reflux,” Alimentary Pharmacology & Therapeutics, Vol. 12, No. 2, 1998, pp. 159-165. doi:10.1046/j.1365-2036.1998.00283.x
[40] C. Arvanitakis, A. Nikopoulus, A. Theoharidis, E. Gianooulis, I. Vagios, et al., “Cisapride and Ranitidine in the Treatment of Gastro-Oesophageal Reflux Disease—A Comparative Randomized Double-Blind Trial,” Alimentary Pharmacology & Therapeutics, Vol. 7, No. 6, 1993, pp. 635-641. doi:10.1111/j.1365-2036.1993.tb00145.x
[41] J. P. Galmiche, P. Barthelemy and B. Hamelin, “Treating the Symptoms of Gastro-Oesophageal Reflux Disease: A Double-Blind Comparison of Omeprazole and Cisapride,” Alimentary Pharmacology & Therapeutics, Vol. 11, No. 4, 1997, pp. 765-773. doi:10.1046/j.1365-2036.1997.00185.x
[42] P. W. Dettmar, J. Sykes, S. L. Little and J. Bryan, “Rapid Onset of Effect of Sodium Alginate on Gastro-Oesophageal Reflux Compared with Ranitidine and Omeprazole, and Relationship between Symptoms and Reflux Episodes,” International Journal of Clinical Practice, Vol. 60, No. 3, 2006, pp. 275-283. doi:10.1111/j.1368-5031.2006.00800.x
[43] N. Washington, R. J. Steele, S. J. Jackson, C. Washington and D. Bush, “Patterns of Food and Acid Reflux in Patients with Low-Grade Oesophagitis: The Role of an Anti-Reflux Agent,” Alimentary Pharmacology & Therapeutics, Vol. 12, No. 1, 1998, pp. 53-58. doi:10.1046/j.1365-2036.1998.00277.x
[44] N. Washington, J. L. Greaves and S. Y. Iftikhar, “A Comparison of Gastro-Oesophageal Reflux in Volunteers Assessed by Ambulatory pH and Gamma Monitoring after Treatment with Either Liquid Gaviscon or Algicon Suspension,” Alimentary Pharmacology & Therapeutics, Vol. 6, No. 5, 1992, pp. 579-588. doi:10.1111/j.1365-2036.1992.tb00572.x
[45] D. G. Maxton, J. P. Miller, P. J. Whorwell and J. K. Butler, “A Study of Algicon, an Antacid-Alginate Preparation, in Patients with Reflux Oesophagitis,” The British Journal of Clinical Practice, Vol. 42, 1988, pp. 368-371.
[46] S. H. Korn, A. Murakami, L. A. Stauffer and R. W. Tipping, “A Controlled Comparison of Symptom Relief Provided by a Famotidine/Antacid Combination Tablet for the Treatment of Frequent Heartburn,” Data on File of Merck Research Laboratories.
[47] G. Salanti, F. Kavvoura and J. Loannidis, “Exploring the Geometry of Treatment Networks,” Exploring the Geometry of Treatment Networks, Vol. 148, 2008, pp. 544- 553.
[48] T. Tran, A. M. Lowry and H. B. El-Serag, “Meta-Analysis: The Efficacy of Over-the-Counter Gastro-Oesophageal Reflux Disease Therapies,” Alimentary Pharmacology & Therapeutics, Vol. 25, 2006, pp. 143-153.
[49] J. P. Jansen, R. Fleurence, B. Devine, R. Itzler, A. Barrett, et al., “Interpreting Indirect Treatment Comparisons and Network Meta-Analysis for Health-Care Decision Making: Report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: Part 1,” Value in Health, Vol. 14, No. 4, 2011, pp. 417-428. doi:10.1016/j.jval.2011.04.002

  
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