Vonoprazan versus lansoprazole in erosive esophagitis - A systematic review and meta-analysis of randomized controlled trials

Saurabh Chandan; Smit Deliwala; Babu P Mohan; Daryl Ramai; Banreet Dhindsa; Jay Bapaye; Lena L Kassab; Ojasvini Choudhry Chandan; Antonio Facciorusso; Douglas G Adler

doi:10.1007/s12664-023-01384-2

Vonoprazan versus lansoprazole in erosive esophagitis - A systematic review and meta-analysis of randomized controlled trials

Indian J Gastroenterol. 2023 Aug;42(4):475-484. doi: 10.1007/s12664-023-01384-2. Epub 2023 Jul 7.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Creighton University School of Medicine, Omaha, NE, USA.
² Division of Digestive Diseases, Emory University, Atlanta, GA, USA.
³ Gastroenterology and Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, USA.
⁴ Department of Gastroenterology and Hepatology, University of Nebraska Medical Center|, Omaha, NE, USA.
⁵ Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA.
⁶ Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
⁷ Department of Pediatric Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA.
⁸ Gastroenterology Unit, Department of Surgical and Medical Sciences, University of Foggia, Foggia, Italy.
⁹ Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO, USA. Douglasadler@centura.org.

PMID: 37418052
DOI: 10.1007/s12664-023-01384-2

Abstract

Background: Proton-pump inhibitors (PPIs) are the mainstay of treatment in erosive esophagitis (EE). An alternative to PPIs in EE is Vonoprazan, a potassium competitive acid blocker. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing vonoprazan to lansoprazole.

Methods: Multiple databases searched through November 2022. Meta-analysis was performed to assess endoscopic healing at two, four and eight weeks, including for patients with severe EE (Los Angeles C/D). Serious adverse events (SAE) leading to drug discontinuation were assessed. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

Results: Four RCTs with 2208 patients were included in the final analysis. Vonoprazan 20 mg once-daily was compared to lansoprazole 30 mg once-daily dosing. Among all patients, at two and eight weeks post-treatment, vonoprazan resulted in significantly higher rates of endoscopic healing as compared to lansoprazole, risk ratios (RR) 1.1, p<0.001 and RR 1.04, p=0.03. The same effect was not observed at four weeks, RR 1.03 (CI 0.99-1.06, I²=0%) following therapy. Among patients with severe EE, vonoprazan resulted in higher rates of endoscopic healing at two weeks, RR 1.3 (1.2-1.4, I²=47%), p=<0.001, at four weeks, RR 1.2 (1.1-1.3, I²=36%), p=<0.001 and at eight weeks post-treatment, RR 1.1 (CI 1.03-1.3, I²=79%), p=0.009. We found no significant difference in the overall pooled rate of SAE and pooled rate of adverse events leading to drug discontinuation. Finally, the overall certainty of evidence for our main summary estimates was rated as high (grade A).

Conclusion: Based on limited number of published non-inferiority RCTs, our analysis demonstrates that among patients with EE, vonoprazan 20 mg once-daily dosing achieves comparable and in those with severe EE, higher endoscopic healing rates as compared to lansoprazole 30 mg once-daily dosing. Both drugs have a comparable safety profile.

Keywords: Erosive esophagitis; Lansoprazole; PPI; Vonoprazan.

Publication types

Meta-Analysis
Systematic Review
Review
Comment

MeSH terms

Esophagitis*
Humans
Lansoprazole / adverse effects
Peptic Ulcer*
Proton Pump Inhibitors / adverse effects
Pyrroles / adverse effects
Randomized Controlled Trials as Topic

Substances

Lansoprazole
1-(5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl)-N-methylmethanamine
Proton Pump Inhibitors
Pyrroles