Proton pump inhibitors (PPIs) are widely used for managing acid-related gastrointestinal conditions. Understanding the comparative potency of different PPIs is essential for clinicians to optimize treatment strategies and ensure cost-effective prescribing. This meta-analysis aims to establish quantitative dose equivalents for various PPIs based on their dose-dependent effects on intragastric pH levels.
This research synthesized data from 57 clinical studies that investigated the impact of PPIs on mean 24-hour intragastric pH. Through rigorous pharmacodynamic modeling, the study determined the relative potencies of five common PPIs in comparison to omeprazole. The findings revealed the following potency ratios: pantoprazole at 0.23, lansoprazole at 0.90, omeprazole at 1.00 (the reference), esomeprazole at 1.60, and rabeprazole at 1.82. Notably, patients with gastroesophageal reflux disease (GERD) required approximately 1.9 times higher doses of PPIs to achieve comparable acid suppression to healthy volunteers. Conversely, individuals positive for Helicobacter pylori needed only about 20% of the standard dose to reach the same increase in mean 24-hour intragastric pH.
In conclusion, this meta-analysis offers valuable quantitative insights into the clinical potency of different PPIs. These derived dose equivalents can be instrumental in guiding clinicians when switching between PPIs and in making informed decisions regarding the cost-effectiveness of specific PPIs for individual patients. It is important to acknowledge that these estimates are derived from a limited range of tested doses and varying study conditions, suggesting a cautious interpretation of the absolute values is warranted.
