Systematic review and meta-analysis

Enhanced efficacy of proton-pump inhibitor therapy for peptic ulcer bleeding in Asia - A post hoc analysis from the Cochrane Collaboration

G. I. Leontiadis, V. K. Sharma, Colin Howden

Research output: Contribution to journalReview article

75 Citations (Scopus)

Abstract

Background: Proton-pump inhibitors reduce re-bleeding rates after ulcer bleeding. However, there is significant heterogeneity among different randomized-controlled trials. Aim: To see whether proton-pump inhibitors for ulcer bleeding produced different clinical outcomes in different geographical locations. Methods: This was a post hoc analysis of our Cochrane Collaboration systematic review and meta-analysis of proton-pump inhibitor therapy for ulcer bleeding. Sixteen randomized-controlled trials conducted in Europe and North America were pooled and re-analysed separately from seven conducted in Asia. We calculated pooled rates for 30-day all-cause mortality, re-bleeding and surgical intervention and derived odds ratios and numbers needed to treat with 95% confidence intervals. Results: There was no significant heterogeneity for any outcome. Reduced all-cause mortality was seen in the Asian randomized-controlled trials (odds ratios = 0.35: 95% confidence interval: 0.16-0.74: number needed to treat = 33), but not in the others (odds ratios = 1.36: 95% confidence interval: 0.94-1.96; number needed to treat - incalculable). There were significant reductions in re-bleeding and surgery in both sets of randomized-controlled trials, but the effects were quantitatively greater in Asia. Conclusions: Proton-pump inhibitor therapy for ulcer bleeding has been more efficacious in Asia than elsewhere. This may be because of an enhanced pharmacodynamic effect of proton-pump inhibitors in Asian patients.

Original languageEnglish (US)
Pages (from-to)1055-1061
Number of pages7
JournalAlimentary Pharmacology and Therapeutics
Volume21
Issue number9
DOIs
StatePublished - May 1 2005

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Proton Pump Inhibitors
Peptic Ulcer
Meta-Analysis
Hemorrhage
Numbers Needed To Treat
Ulcer
Randomized Controlled Trials
Odds Ratio
Confidence Intervals
Therapeutics
Mortality
North America

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

Cite this

@article{81b9f634c50d44768b95dce464c17d79,
title = "Systematic review and meta-analysis: Enhanced efficacy of proton-pump inhibitor therapy for peptic ulcer bleeding in Asia - A post hoc analysis from the Cochrane Collaboration",
abstract = "Background: Proton-pump inhibitors reduce re-bleeding rates after ulcer bleeding. However, there is significant heterogeneity among different randomized-controlled trials. Aim: To see whether proton-pump inhibitors for ulcer bleeding produced different clinical outcomes in different geographical locations. Methods: This was a post hoc analysis of our Cochrane Collaboration systematic review and meta-analysis of proton-pump inhibitor therapy for ulcer bleeding. Sixteen randomized-controlled trials conducted in Europe and North America were pooled and re-analysed separately from seven conducted in Asia. We calculated pooled rates for 30-day all-cause mortality, re-bleeding and surgical intervention and derived odds ratios and numbers needed to treat with 95{\%} confidence intervals. Results: There was no significant heterogeneity for any outcome. Reduced all-cause mortality was seen in the Asian randomized-controlled trials (odds ratios = 0.35: 95{\%} confidence interval: 0.16-0.74: number needed to treat = 33), but not in the others (odds ratios = 1.36: 95{\%} confidence interval: 0.94-1.96; number needed to treat - incalculable). There were significant reductions in re-bleeding and surgery in both sets of randomized-controlled trials, but the effects were quantitatively greater in Asia. Conclusions: Proton-pump inhibitor therapy for ulcer bleeding has been more efficacious in Asia than elsewhere. This may be because of an enhanced pharmacodynamic effect of proton-pump inhibitors in Asian patients.",
author = "Leontiadis, {G. I.} and Sharma, {V. K.} and Colin Howden",
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T2 - Enhanced efficacy of proton-pump inhibitor therapy for peptic ulcer bleeding in Asia - A post hoc analysis from the Cochrane Collaboration

AU - Leontiadis, G. I.

AU - Sharma, V. K.

AU - Howden, Colin

PY - 2005/5/1

Y1 - 2005/5/1

N2 - Background: Proton-pump inhibitors reduce re-bleeding rates after ulcer bleeding. However, there is significant heterogeneity among different randomized-controlled trials. Aim: To see whether proton-pump inhibitors for ulcer bleeding produced different clinical outcomes in different geographical locations. Methods: This was a post hoc analysis of our Cochrane Collaboration systematic review and meta-analysis of proton-pump inhibitor therapy for ulcer bleeding. Sixteen randomized-controlled trials conducted in Europe and North America were pooled and re-analysed separately from seven conducted in Asia. We calculated pooled rates for 30-day all-cause mortality, re-bleeding and surgical intervention and derived odds ratios and numbers needed to treat with 95% confidence intervals. Results: There was no significant heterogeneity for any outcome. Reduced all-cause mortality was seen in the Asian randomized-controlled trials (odds ratios = 0.35: 95% confidence interval: 0.16-0.74: number needed to treat = 33), but not in the others (odds ratios = 1.36: 95% confidence interval: 0.94-1.96; number needed to treat - incalculable). There were significant reductions in re-bleeding and surgery in both sets of randomized-controlled trials, but the effects were quantitatively greater in Asia. Conclusions: Proton-pump inhibitor therapy for ulcer bleeding has been more efficacious in Asia than elsewhere. This may be because of an enhanced pharmacodynamic effect of proton-pump inhibitors in Asian patients.

AB - Background: Proton-pump inhibitors reduce re-bleeding rates after ulcer bleeding. However, there is significant heterogeneity among different randomized-controlled trials. Aim: To see whether proton-pump inhibitors for ulcer bleeding produced different clinical outcomes in different geographical locations. Methods: This was a post hoc analysis of our Cochrane Collaboration systematic review and meta-analysis of proton-pump inhibitor therapy for ulcer bleeding. Sixteen randomized-controlled trials conducted in Europe and North America were pooled and re-analysed separately from seven conducted in Asia. We calculated pooled rates for 30-day all-cause mortality, re-bleeding and surgical intervention and derived odds ratios and numbers needed to treat with 95% confidence intervals. Results: There was no significant heterogeneity for any outcome. Reduced all-cause mortality was seen in the Asian randomized-controlled trials (odds ratios = 0.35: 95% confidence interval: 0.16-0.74: number needed to treat = 33), but not in the others (odds ratios = 1.36: 95% confidence interval: 0.94-1.96; number needed to treat - incalculable). There were significant reductions in re-bleeding and surgery in both sets of randomized-controlled trials, but the effects were quantitatively greater in Asia. Conclusions: Proton-pump inhibitor therapy for ulcer bleeding has been more efficacious in Asia than elsewhere. This may be because of an enhanced pharmacodynamic effect of proton-pump inhibitors in Asian patients.

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