摘要
目的 利用快速卫生技术评估(HTA)工具对以伏诺拉生为基础的联合方案根除幽门螺杆菌(Hp)感染的有效性、安全性及经济性进行评估,为临床用药提供循证证据。方法 计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据库、中国生物医学文献服务系统、卫生技术评估(HTA)机构官方网站,收集伏诺拉生对比质子泵抑制剂(PPI)联合方案根除Hp的系统评价(SR)/meta分析、经济学评价和HTA报告,对符合纳入和排除标准的文献进行数据提取和质量评价,并对纳入的研究进行描述性分析或meta分析。结果 共纳入10篇文献,纳入文献的整体质量一般。其中9篇SR/meta分析、1篇药物经济学研究。结果显示,伏诺拉生组能显著提高初始和补救治疗方案的Hp根除率。以对克拉霉素是否敏感进一步亚组分析显示,在对克拉霉素敏感的患者中,伏诺拉生组不能显著提高Hp根除率;在对克拉霉素耐药的患者,伏诺拉生组具有明显优势。对青霉素过敏患者,伏诺拉生组与PPI组疗效相当,差异无统计学意义。安全性方面,与PPI组相比,伏诺拉生组的不良反应发生率、因不良事件导致的退出率差异无统计学意义;亚组分析显示,伏诺拉生组在随机对照试验(RCT)中的安全性与PPI组相比更好,而非RCT中安全性相当。经济性方面,与雷贝拉唑为基础的联合方案相比,伏诺拉生组虽成本更高,但治疗效果好,更具成本-效益优势。结论 以伏诺拉生为基础的联合方案在根除Hp感染中具有良好的有效性(尤其是对克拉霉素耐药的患者疗效显著)、安全性、经济性。
Objective Rapid Health Technology Assessment(HTA)tool was used to evaluate the efficacy,safety and economy of vonoprazan in the eradication of Helicobacter pylori infection,so as to provide evidence-based evidence for clinical rational drug use. Methods Systematic review/meta-analysis and economic evaluation and HTA reports about vonoprazan-based therapy compared with proton pump inhibitor(PPI)-based therapy in the eradication of Helicobacter pylori infection were collected by searching PubMed,Embase,Cochrane Library,CNKI,Wanfang database,CBM and health technology assessment(HTA)organization websites. Data extraction and quality evaluation were carried out for the literature that met the inclusion and exclusion criteria. Descriptive analysis or meta-analysis for included results were performed. Results A total of 10studies were included,including 9 systematic reviews/meta-analysis,and 1 economic study. The quality of included studies were mediocre. The results showed that vonoprazan group could significantly improve the Hp eradication rate of the initial and remedial treatment regimens. Subgroup based on whether it was sensitive to clarithromycin analysis showed that,among the patients who were sensitive to clarithromycin,vonoprazan group could not significantly improve the eradication rate of Hp;Among the patients resistant to clarithromycin,the vonoprazan group has obvious advantages. For penicillin allergic patients,the curative effect of vonoprazan group and PPI group was equal,and the difference was not statistically significant. In terms of safety,compared with the PPI group,there was no significant difference in the incidence of adverse events and dropout rate between the regimens caused by adverse events in the vonoprazan group. Subgroup analysis showed that the safety of the vonoprazan group in RCT was better than that of the PPI group,but the safety in non RCT was comparable. In terms of economy,compared with the rabeprazole based combination scheme,the vonoprazan group has higher cost,but the treatment effect is better and more cost-effective. Conclusion The combined regimen based on vonoprazan is effective(especially for the patients resistant to clarith romycin),safe and economical in eradicating Hp infection.
作者
王丽娜
张田
曹娅
朱柏霖
李婷
WANG Li-na;ZHANG Tian;CAO Ya;ZHU Bo-lin;LI Ting(Department of Pharmacy,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing Key Laboratory of Assessment of Clinical Drugs Risk and Indioidual Application,Beijing 100730,China)
出处
《临床药物治疗杂志》
2022年第10期17-22,共6页
Clinical Medication Journal
