Abstract
BackgroundLong-term maintenance treatment of gastroesophageal reflux disease (GERD) is important to prevent relapse. Proton-pump inhibitors (PPIs) are used for both treatment and maintenance therapy of GERD. Recently, a potassium-competitive acid blocker vonoprazan was launched in Japan. We evaluated the comparative efficacy of vonoprazan and other PPIs for GERD maintenance.MethodsA systematic literature search was performed using MEDLINE and Cochrane Central Register of Controlled Trials. Double-blind randomized controlled trials (RCTs) of PPIs, vonoprazan, and placebo for GERD maintenance published in English or Japanese were selected. Among them, studies conducted at the recommended dose and for the recommended use, and containing information on maintenance rate based on endoscopic assessment, were included. The comparative efficacies of treatments were estimated by performing a Bayesian network meta-analysis, which assessed the consistency assumption. Outcomes were number or rate of patients who maintained remission.ResultsOf 4001 articles identified, 22 RCTs were eligible for analysis. One study published as an abstract was hand-searched and added. The consistency hypothesis was not rejected for the analysis. The odds ratio of vonoprazan 10 mg to each PPI was 13.92 (95% credible interval [CI] 1.70–114.21) to esomeprazole 10 mg; 5.75 (95% CI 0.59–51.57) to rabeprazole 10 mg; 3.74 (95% CI 0.70–19.99) to lansoprazole 15 mg; and 9.23 (95% CI 1.17–68.72) to omeprazole 10 mg.ConclusionsThe efficacy of vonoprazan in GERD maintenance treatment may be higher than that of some PPIs. However, a direct comparison of vonoprazan and PPIs is required to confirm these effects.
Highlights
Gastroesophageal reflux disease (GERD) is a chronic digestive disorder resulting from the reflux of gastric contents into the esophagus and is often accompanied by symptoms of heartburn, regurgitation, and dysphagia [1]
We evaluated the comparative efficacy of vonoprazan and other pump inhibitors (PPIs) for gastroesophageal reflux disease (GERD) maintenance
The data of two other studies [21, 22] were adopted for subgroup analysis instead of one study (Study ID 719 included in the main analysis) [23], because they reported the results of the same randomized controlled trials (RCTs) at different time points (Table 1)
Summary
Gastroesophageal reflux disease (GERD) is a chronic digestive disorder resulting from the reflux of gastric contents into the esophagus and is often accompanied by symptoms of heartburn, regurgitation, and dysphagia [1]. Long-term continuous maintenance treatment with drugs that are safe and tolerable is required for some patients with GERD [6]. PPIs are currently used for the long-term treatment of patients with recurrent GERD. PPIs achieve better acid suppression and show higher tolerability than conventionally used histamine H2-receptor antagonists (H2RAs), approximately half of the patients treated with PPIs experience incomplete gastric acid control during the nighttime, a phenomenon called nocturnal gastric acid breakthrough, which makes the disease intractable [7]. Long-term maintenance treatment of gastroesophageal reflux disease (GERD) is important to prevent relapse. Proton-pump inhibitors (PPIs) are used for both treatment and maintenance therapy of GERD. Double-blind randomized controlled trials (RCTs) of PPIs, vonoprazan, and placebo for GERD
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