Treatment with vonoprazan for 3weeks is not inferior to 8weeks for the management of gastric ESD: a multicenter noninferiority randomized study.

Abstract

Vonoprazan, a potassium-competitive acid blocker (VPZ), significantly reduces postoperative bleeding after gastric ESD; however, there is no consensus on the appropriate treatment duration. We conducted a randomized controlled study to demonstrate that the 3-week administration of VPZ is not inferior to the 8-week administration for ulcer healing. This is a prospective, open-label multicenter randomized controlled trial. Patients aged 20-85years undergoing gastric ESD were included in this study. The key exclusion criteria were patients with bleeding tendencies and those taking NSAIDs, steroids, PPIs, or VPZ medications. Eligible patients were randomly assigned to the VPZ 3w or 8w treatment group. The primary endpoint was the proportion of patients with complete closure of the post-ESD wound at 24weeks after ESD. The key secondary endpoints included the proportion of patients with complete closure of the post-ESD wound at 8weeks and the proportion of bleeding or perforation more than 3weeks after ESD. From May 2018 to October 2020, 234 patients were included. The proportion of patients with complete ulcer closure was significantly lower in the 3w group than in the 8w group (70.8% vs. 90.6%) at 8weeks post-treatment. The complete closure rates at 24weeks in the 3w and 8w groups were 99.1% and 99.2%, respectively. The absolute difference in the closure rate at 24weeks was -0.059% [95% confidence interval (CI) -3.4% to 3.2], and the lower limit of the 95% CI exceeded -10%, the preset threshold. None of the patients developed delayed bleeding 3weeks after ESD. This multicenter randomized study demonstrated that 3weeks of treatment with VPZ is sufficient for ulcer healing. Trial registry number. UMIN000031564.