Efficacy and safety of proton pump inhibitors versus vonoprazan in treatment of erosive esophagitis: A PRISMA-compliant systematic review and network meta-analysis

Abstract

Background: Proton-pump inhibitors (PPIs) and vonoprazan are recommended as first-line therapies for erosive esophagitis (EE). However, it is uncertain how the magnitude of efficacy and safety of first-line therapy, the choice of individual PPIs or vonoprazan in the treatment of EE remains controversial. This study aimed to evaluate the efficacy and safety of vonoprazan and PPIs in healing esophageal mucosal injury in patients with EE.Methods: Relevant databases were searched to collect randomized controlled trials of proton pump inhibitors and vonoprazan in the treatment of reflux esophagitis up to December 2021. Studies on standard-dose PPIs or vonoprazan that were published in Chinese or English and assessed healing effects in EE were included in the analysis. Stata16.0 was used to conduct a network Meta-analysis to evaluate the efficacy and safety of the treatment.Results: A total of 41 literatures were included with 11,592 enrolled patients. For the endoscopic cure rate, all the PPIs and vonoprazan significantly improve compared to Placebo; Based on the surface under the cumulative ranking curve, Ilaprazole ranked first, followed by esomeprazole, vonoprazan, pantoprazole, lansoprazole, omeprazole, rabeprazole and placebo therapy ranked the last. For the rate of adverse events, there was no significant difference among all the PPIs, vonoprazan, and placebo.Conclusions: Ilaprazole, esomeprazole and vonoprazan have more advantages in mucosal erosion healing, there was no significant difference in the comparative safety among all interventions.Abbreviations: CI = confidence interval, EE = erosive esophagitis, GERD = gastroesophageal reflux disease, NMA = network meta-analysis, OR = odds ratio, PPIs = proton-pump inhibitors, SUCRA = surface under the cumulative ranking curve.

Lansoprazole plus levosulpiride versus esomeprazole in participants with gastroesophageal reflux disease and erosive esophagitis: a double blinded randomized control trial

“…There was no significant difference in the rate of adverse events among all PPIs, vonoprazan, and placebo. The study concluded that ilaprazole, esomeprazole, and vonoprazan were more effective in healing mucosal erosion, but no significant differences were observed in terms of safety among all interventions 22 . This is in disagreement to our study.…”

“…Recently, Yang et al . 22 conducted a network meta-analysis to identify first-line therapies for erosive esophagitis and found that all PPIs and vonoprazan significantly improved endoscopic cure rates compared to placebo. Ilaprazole was ranked as the most effective followed by esomeprazole, vonoprazan, pantoprazole, lansoprazole, omeprazole, rabeprazole, and placebo based on the surface under the cumulative ranking curve.…”

Efficacy and safety of high-dose ilaprazole-amoxicillin dual therapy for Helicobacter pylori eradication: a prospective, single-center, randomized trial

“…Likewise, vonoprazan, a new potassium-competitive acid blocker, has an elimination half-life of up to 9 h (Sakurai et al, 2015). Notably, both ilaprazole and vonoprazan promote the healing of gastric mucosa by inhibiting gastric acids and maintaining a pH greater than 4 for protracted durations (Yang et al, 2022). Taken together, the combination of strong gastric acid suppression and the maintenance of a high intra-gastric pH are likely contributing factors to the high eradication rate observed with ilaprazole-based dual therapy.…”

Comparative efficiency and safety of potassium competitive acid blockers versus Lansoprazole in peptic ulcer: a systematic review and meta-analysis

“…Previous meta-analyses have examined the non-inferiority of P-CABs compared with lansoprazole in the treatment of H. pylori infection ( Jung, Kim, and Park, 2017 ), artificial ulcers after endoscopic submucosal dissection (ESD) ( Liu et al, 2019 ) and esophagitis (including reflux and erosive esophagitis) ( Miwa et al, 2019 ; Yang et al, 2022 ). Based on clinical and evidence-based medicine outcomes, P-CABs are currently recommended in guidelines for the management of two acid-related diseases: esophagitis and H. pylori eradication therapy ( Jung et al, 2021 ; Iwakiri et al, 2022 ; Zhou et al, 2022 ).…”