Network meta-analysis of comparing different dosages of potassium-competitive acid blocker with proton pump inhibitor in acid related disorders.

Abstract

Potassium-competitive acid blockers (P-CABs) have emerged as a promising treatment for acid-related disorders (ARDs). However, the optimal dosage for maximizing their efficacy remains unclear. This network meta-analysis aims to compare the efficacy and safety of various dosages of P-CABs and proton pump inhibitors (PPIs) for treating ARDs. We searched PubMed, EMBASE, the Cochrane Library, and Web of Science from inception to July 16, 2023. Data extraction was performed independently by two authors. The Cochrane Risk of Bias in Randomized Trials tool (RoB 2.0) was used for bias assessment. Efficacy and safety were compared using the odds ratio (OR) with 95% confidence intervals (CI). 12 articles were included in the present meta-analysis. For gastric/duodenal ulcers, the keverprazan 30mg (K30) exhibited the highest SUCRA value (92.8%) for healing rate. In terms of adverse events, lansoprazole 30mg (L30) exhibited the lowest SUCRA value (25.3%) in the treatment of gastric/duodenal ulcers. For healing rate in erosive esophagitis, the maximum SUCRA value of vonoprazan 40mg (V40) was 90.7% in the first subgroup (erosive esophagitis using vonoprazan, keverprazan, and lansoprazole), and maximum SUCRA value of T50 (72.1%) in second subgroup (erosive esophagitis using tegoprazan, fexuprazan, and esomeprazole). For adverse events in erosive esophagitis, L15 exhibited the lowest SUCRA value (12.2%) in the first group and E40 exhibited the lowest SUCRA value (24.4%) in the second group. K30 may be the most effective dosage for increasing the healing rate of gastric/duodenal ulcers. For erosive esophagitis, V40 and T50 may be the preferred dosages.