Vonoprazan vs PPIs for Treating Heartburn in Patients With Erosive Esophagitis

At 1 week after treatment initiation, vonoprazan was equally or more effective than placebo and proton pump inhibitors (PPIs) for resolving heartburn in patients with erosive esophagitis, according to findings published in the Journal of Clinical Gastroenterology.

“Erosive esophagitis is a classification of gastroesophageal reflux disease (GERD) characterized by esophageal mucosal injury that is often accompanied by symptoms such as heartburn, sore throat, and swallowing difficulties,” said a research team in Japan. “PPIs are widely used for the treatment of erosive esophagitis; however, they are suboptimal as they require several days to reach maximum efficacy and they may not adequately inhibit gastric acid secretion at night.”

The systematic review and network meta-analysis included double-blind, randomized controlled trials written in English or Japanese from the MEDLINE and Cochrane CENTRAL Library databases. Researchers analyzed heartburn resolution rates in patients receiving either vonoprazan at a dosage of 20 mg once daily or a PPI such as omeprazole, lansoprazole, esomeprazole, pantoprazole, rabeprazole, dexlansoprazole, or S-pantoprazole.

There were 10 trials included for analysis. Researchers found vonoprazan was superior to placebo (median OR: 16.75, 95% CrI: 2.16–207.80) and ranked highest for treating heartburn on day 1, followed by esomeprazole at a dosage of 40 mg once daily.

Additionally, vonoprazan was superior to placebo and most PPIs at day 7 for resolving heartburn (median OR: 39.23, 95% CrI: 7.72–216.90). The only exception was rabeprazole at a dosage of 20 mg once daily, but researchers noted point estimates numerically favored vonoprazan.

“While PPIs take several days to exert their maximum effect, vonoprazan shows a strong acid secretion inhibitory effect from the first day of administration,” researchers concluded. “The early heartburn resolution effect of vonoprazan…may contribute to the improvement of [health-related quality of life] for patients with erosive esophagitis.”

Reference:
Oshima T, Igarashi A, Nakano H, Deguchi H, Fujimori I, Fernandez J. Network meta-analysis comparing vonoprazan and proton pump inhibitors for heartburn symptoms in erosive esophagitis. J Clin Gastroenterol. 2022;56(6):493-504. doi:10.1097/MCG.0000000000001707