Efficacy of potassium-competitive acid blockers vs. proton pump inhibitors on gastric ulcers: Bayesian and frequentist network meta-analysis with cross-inference through a quality management system

Abstract Proton pump inhibitors (PPIs) have been the mainstay of treatment for gastric ulcer (GU) for over 30 years. However, since the discovery of a new class of acid suppressants, potassium-competitive acid blockers (P-CABs), the desire for a therapeutic agent has continued and the clinical trials on P-CABs have been conducted. In our study, a systematic review and network meta-analysis (NMA) were performed based on randomized controlled trials (RCTs) conducted since the development of P-CABs. In addition, the new methodology of the inference concept was applied to confirm the results. Our quality management system was also integrated throughout the research to guarantee the accuracy of the data. Initially, we screened 431 studies and extracted 10 homogeneous GU RCTs with 6315 participants. The odds ratios (ORs) for the 4-week cure rate in Bayesian + frequentist NMA, tegoprazan 100 mg (OR = 4.14, 95% credible interval [CI] 0.56–26.3) and pantoprazole 40 mg (OR = 4.12, 95% confidence interval [CI] 1.90–8.88) were the largest, respectively. The ORs for the 8-week cure rate in Bayesian + frequentist NMA, lansoprazole 30 mg (OR = 8.77, 95% [CI] 0.95–78.9) and lansoprazole 30 mg (OR = 7.91, 95% [CI] 2.60–24.03) was the largest, respectively. As the inference by grouping PPIs and P-CABs, the results show similar trends in terms of effectiveness between two therapeutic classes. In conclusion, our study shows that the cure rates of P-CABs in cases of GU are not inferior to those of PPIs.