Is Vonoprazan Effective in Healing Erosive Esophagitis?

A new medication, vonoprazan, was found to be equally effective as, and in some cases, superior to lansoprazole, in healing and maintenance of stomach acid in patients with severe acid reflux disease, according to a study published in Gastroenterology.

“For decades, proton pump inhibitors have been the mainstay of treatment for erosive esophagitis. The potassium-competitive acid blocker vonoprazan provides more potent acid inhibition than PPIs but data on its efficacy for erosive esophagitis are limited,” the researchers explained. With this study, the investigators concluded that vonoprazan was, in fact, “non-inferior and superior to the PPI lansoprazole in healing and maintenance of healing of erosive esophagitis.”

In the controlled trial, patients with erosive esophagitis randomly took once-daily vonoprazan 20mg or lansoprazole 30mg for up to 8 weeks. Then, they were re-randomized to once-daily vonoprazan 10mg, vonoprazan 20mg, or lansoprazole 15mg for 24 weeks. The study included 1024 adults.

In the primary analysis, vonoprazan was equally effective as lansoprazole, however, in the exploratory analysis, vonoprazan was better than lansoprazole (92.9 vs. 84.6%; 95% CI 4.5-12.2%) In the secondary analyses, vonoprazan and lansoprazole were more or less equal in giving the patients heartburn-free days, and at week 2, vonoprazan was better than lansoprazole in healing Grade C/D esophagitis.

In the maintenance phase, 878 patients reported that vonoprazan was equally effective as lansoprazole in primary analysis and “superior on secondary analysis of maintenance of healing (20mg vs. lansoprazole difference=8.7%, 1.8-15.5%; 10mg vs. lansoprazole difference=7.2%, 0.2-14.1%) and secondary analysis of maintenance of healing Grade C/D esophagitis (20mg vs. lansoprazole difference=15.7%, 2.5-28.4%; 10mg vs. lansoprazole difference=13.3%, 0.02-26.1%).”

Based on these findings, the research demonstrated the effectiveness of vonoprazan in healing and maintenance of healing of erosive esophagitis, especially the more severe cases.

—Priyam Vora

Reference:
Laine L, DeVault K, Katz P, Mitev S, Lowe J, Hunt B and Spechler S. Vonoprazan versus lansoprazole for healing and maintenance of healing of erosive esophagitis: A randomized trial. Gastroenterol. Published online: October 10, 2022. DOI: https://doi.org/10.1053/j.gastro.2022.09.041