伏诺拉生治疗消化性溃疡和ESD术后溃疡安全性和有效性的伞形评价OA

OBJECTIVE To analyze the safety and efficacy of vonoprazan(VPZ)in the treatment of peptic ulcer(PU)and post-endoscopic submucosal dissection(ESD)ulcers,providing evidence-based pharmaceutical evidence for clinical practice and medical decision-making.METHODS Retrieved from CNKI,Wanfang,VIP,CBM,PubMed,Embase,Web of Science,and the Cochrane Library,meta-analyses/systematic reviews related to VPZ in the treatment of PU and post-ESD ulcers were collected.Two researchers independently performed literature screening,data extraction,quality assessment of included studies,and evaluation of literature overlap.By employing the umbrella review analysis,a fresh meta-analysis was conducted on all relevant raw research data when a high degree of overlap was identified among the included studies.RESULTS A total of 17 meta-analyses were included,with quality ranging from high to very low;all outcome measures involved showed a very high level of overlap in the included meta-analyses(corrected covered area:22.22%-100%).In the treatment of post-ESD ulcers,compared to proton pump inhibitor(PPI),VPZ significantly improved the ulcer healing rate at 4 weeks post-ESD[RR=1.27,95%CI(1.03,1.56),Z=2.21,P=0.027]and the ulcer contraction rate post-ESD[MD=0.08,95%CI(0.00,0.16),Z=2.09,P=0.037],while significantly reducing the ulcer recurrence rate in patients with a history of PU[RR=0.49,95%CI(0.32,0.73),Z=3.49,P=0.001];the delayed bleeding rate in the VPZ group was significantly lower than that in the lansoprazole subgroup[RR=0.47,95%CI(0.25,0.90),Z=2.28,P=0.02].In the treatment of PU,the incidence of adverse events with VPZ was significantly higher than that with PPI in the duodenal ulcer subgroup[RR=1.13,95%CI(1.02,1.26),Z=2.38,P=0.017].CONCLUSIONS For post-ESD ulcers,VPZ demonstrates superior therapeutic efficacy compared to PPI and can reduce ulcer recurrence rates in patients with a history of PU.However,it does not offer advantages in terms of safety for duodenal ulcer treatment.