Efficacy of Esomeprazole in NSAIDs Induced Gastric Ulcer: A Meta-Analysis
Background: Gastric ulcers are painful sores with discontinuity in the entire thickness of stomach lining. Proton pump inhibitors (PPIs) are among the major classes of drugs used in treatment of gastric ulcers by inhibiting H+/K+ATPase pump thus reducing acid secretion. The prototype of PPIs is omeprazole, one of its new derivatives, esomeprazole is known to have superior activity against NSAIDs induced gastric ulcer. We aimed to meta-analyzed various clinical studies on esomeprazole and tried to draw a conclusion that may suggest refined clinical efficacy.
Method: Utilizing databases of FDA listed clinical trials and PubMed. We shortlisted randomized controlled trials that were only related to esomeprazole's efficacy in NSAIDs induced gastric ulcer. Additionally, comparison was also evaluated in regard to adverse events of esomeprazole. Data extraction and assessment of study validity was performed independently.
Results: After critically analyzing four major important related clinical trials (n=3837), it was found that at 24 weeks, patients maintained on esomeprazole 20 mg OD (167/173) were gastric ulcer free, in comparison to placebo group (112/168). Similar results were obtained with 26 weeks treatment of esomeprazole at doses of 20 mg, 40 mg (808/818), and (798/804), respectively. While, outcome of another trial at the same dose, for the duration of 52 weeks, 125 out of 130 patients showed recovery from gastric ulcer, compared to 40/799 in placebo group. Similarly, in the other trial, patients who were given esomeprazole in combination with naproxen (500 mg), displayed positive effect in 166 out of 218 patients. Adverse events were observed only in 5/218 and 6/216, respectively.
Discussion and Conclusion: Esomeprazole therapy showed efficacious results, both when it was given for the period of 24 weeks and over 50 weeks without producing serious adverse effects. Reduction in the NSAIDs induced gastric ulcer by esomeprazole was achieved effectively in chosen clinical trial, suggesting esomeprazole, a preferable choice for reducing the gastric ulcers.
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