Vonoprazan is superior to lansoprazole for healing of severe but not mild erosive esophagitis: A systematic review with meta-analysis of randomized controlled trials.

Abstract

Healing rates of severe erosive esophagitis (EE; Los Angeles [LA] Grade C/D) in patients treated with a proton pump inhibitor (PPI) is suboptimal (~60-70%). Vonoprazan, a potassium-competitive acid blocker, is suggested to have better healing rates in patients with severe EE. This meta-analysis compares the efficacy and safety of vonoprazan 20mg versus lansoprazole 30mg daily in healing EE, specifically in those with LA Grade C/D. We searched MEDLINE, Embase, and CENTRAL on May 24, 2023. Studies that randomized EE patients to vonoprazan 20mg daily or lansoprazole 30mg daily and compared healing rates were included. The risk of bias was assessed using Cochrane's Risk of Bias 2 tool. The fixed-effect model was used to obtain the pooled efficacy and safety outcomes. Subgroup analysis was done to compare healing rates in mild (LA Grade A/B) versus severe EE and based on study location. Four randomized controlled trials (RCTs) with low risks of bias comprising 2208 participants were included. Vonoprazan 20mg was superior to lansoprazole 30mg daily in healing severe EE at all weeks (Week 2 RR 1.294 [95% CI 1.169-1.433], Week 4 1.160 [1.059-1.270], and Week 8 1.175 [95% CI 1.107-1.247]), but was similar for mild EE at all weeks (P-interaction<0.01). Vonoprazan 20mg was more efficacious than lansoprazole 30mg at Week 8 in Western versus Asian studies (P-interaction<0.01). Any, serious, and drug-related treatment-emergent adverse events were comparable between groups. Vonoprazan 20mg is superior to lansoprazole 30mg for healing severe EE but not mild EE. Vonoprazan 20mg daily has a similar safety profile to lansoprazole 30mg daily.