masterThesis
Efecto del consumo concomitante de inhibidores de bomba protones y levotiroxina : revisión sistemática y metaanálisis
Autor
Guzmán Prado, Yuli
Sierra Arango, Fernando
Kattah Calderon, William
Institución
Resumen
Several studies claim that gastric acid has an important role on levothyroxine (LT4) absorption with controversial findings about proton-pump inhibitors (PPI) and LT4 interaction. The aim of this study was to evaluate the effect of concomitant use of PPI and LT4 on TSH level in adult patients with primary hypothyroidism.
A systematic review was conducted using databases including: Medline, Embase, Lilacs, Bireme, Scielo, Cochrane and University of York, Access Pharmacy, Google Scholar, Dialnet and Opengray. Summaries of intervention effects were provided by calculating TSH mean differences, 95% confidence intervals and two sided p values. Heterogeneity between the studies on effect measures was assessed using both the χ2 test and the I2 statistic. Additional subgroup analyses by age and sensitivity analyses were carried out. Review Manager program endorsed by the Cochrane Collaboration was used.
We identified 5 elegible studies for qualitative analysis and 3 for meta-analysis. The mean difference obtained was 0.21 mIU/L (95% CI: 0.02 to 0.40, p = 0.03; I2: 0%). In the subgroup analysis (over 55 years) the mean difference was 0.21 mIU/L (95% CI: 0.01 to 0.40, p = 0.27; I2: 19%). In the sensitivity analysis the study with larger sample was excluded and the mean difference was 0.49 mIU/L (95% CI -0.12 to 1.11, p = 0.12; I2: 0%).
The difference on TSH value after LT4 and PPI consumption does not represent a clinically significant difference. However, it is necessary to carry out randomized controlled trials and to evaluate the effect on free T4 level.