Proton pump inhibitors decrease secretion of gastric acid. They act by blocking the last enzyme in the system that actively transports acid from gastric parietal cells into the gastrointestinal lumen, hydrogen–potassium adenosine triphosphatase, also known as the proton pump. Omeprazole, the first drug in this class, was introduced in 1989. Since then, 4 other proton pump inhibitors have been introduced: lansoprazole (1995), rabeprazole (1999), pantoprazole (2000), and esomeprazole (2001). In 2003 omeprazole became available over-the-counter in the United States. The purpose of this review is to compare the benefits and harms of different PPIs.

Contents

• Introduction
  • Purpose and Limitations of Systematic Reviews
  • Scope and Key Questions
• Methods
  • Literature Search
  • Study Selection
  • Data Abstraction
  • Validity Assessment
  • Data Synthesis
  • Peer and Public Review
• Results
  • Overview
  • Key Question 1. What is the comparative efficacy of different proton pump inhibitors in patients with symptoms of gastroesophageal reflux disease?
  • Key Question 2. What is the comparative effectiveness of different proton pump inhibitors in treating patients with peptic ulcer and nonsteroidal anti-inflammatory drug-induced ulcer?
  • Key Question 3. What is the comparative effectiveness of different proton pump inhibitors in preventing ulcer in patients taking a nonsteroidal anti-inflammatory drug?
  • Key Question 4. What is the comparative effectiveness of different proton pump inhibitors in eradicating Helicobacter pylori infection?
  • Key Question 5. Is there evidence that a particular treatment strategy is more effective or safer than another for longer-term treatment (more than 8 weeks) in patients with gastroesophageal reflux disease?
  • Key Question 6. What is the comparative safety of different proton pump inhibitors in patients being treated for symptoms of gastroesophageal reflux disease, peptic ulcer, and nonsteroidal anti-inflammatory drug-induced ulcer?
  • Key Question 7. Are there subgroups of patients based on demographics, other medications, or comorbidities for which a particular medication or preparation is more effective or associated with fewer adverse effects?
• Summary
• References
• Appendix A. Glossary
• Appendix B. Search strategies
• Appendix C. Excluded studies
• Appendix D. Quality assessment methods for drug class reviews for the Drug Effectiveness Review Project
• Appendix E. Esophagitis grading scales used in randomized controlled trials
• Evidence Tables

Update 4: May 2006
Update 3: May 2005
Update 2: April 2004
Update 1: April 2003
Original Report: November 2002

The medical literature relating to this topic is scanned periodically. (See http://www.ohsu.edu/ohsuedu/research/policycenter/DERP/about/methods.cfm for description of scanning process). Prior versions of this report can be accessed at the DERP website.

The Drug Effectiveness Review Project, composed of 15 organizations including 14 state Medicaid agencies and the Canadian Agency for Drugs and Technology in Health commissioned and provided funding for this report. These organizations selected the topic of the report and had input into its Key Questions. The content and conclusions of the report were entirely determined by the Evidence-based Practice Center researchers. The authors of this report have no financial interest in any company that makes or distributes the products reviewed in this report.

Suggested citation:

McDonagh MS, Carson S, Thakurta S. Drug class review: Proton pump inhibitors. Update 5. http://www.ohsu.edu/drugeffectiveness/reports/final.cfm.

The purpose of this report is to make available information regarding the comparative effectiveness and safety profiles of different drugs within pharmaceutical classes. Reports are not usage guidelines, nor should they be read as an endorsement of, or recommendation for, any particular drug, use, or approach. Oregon Health & Science University does not recommend or endorse any guideline or recommendation developed by users of these reports.