Once-daily vonoprazan 20 mg was equally effective as proton pump inhibitors (PPIs) for resolving heartburn on day 1 in patients with erosive esophagitis and equally or more effective on day 7, according to a study published in the Journal of Clinical Gastroenterology.

In this systematic review and network meta-analysis, researchers included 10 double-blind randomized controlled trials (RCTs) of adults with erosive esophagitis who received treatment with vonoprazan 20 mg once daily or a PPI (omeprazole, lansoprazole, esomeprazole, pantoprazole, rabeprazole, dexlansoprazole, S-pantoprazole). The literature search was conducted using the MEDLINE and the Cochrane CENTRAL Library databases. Rates of heartburn symptom resolution (defined as heartburn with a “none” rating on a ≥4-point scale [none, mild, moderate, or severe]) on day 1 and on day 7 were the primary outcomes, while heartburn resolution rates on day 1 for 7 consecutive days and on day 7 for 7 consecutive days were the secondary outcomes.

In the 9 RCTs that were included in the base-case analysis for heartburn resolution rate on day 1, point estimates of odds ratios (ORs) showed that vonoprazan 20 mg once daily was superior to each of the PPIs. For the base-case analysis of heartburn resolution rate on day 7, 10 studies found that vonoprazan 20 mg once daily was superior to placebo with a median OR of 39.23 (95% CI, 7.72-216.90). For the base-case analysis for heartburn resolution rate on day 1 and day 7 for 7 consecutive days, 7 studies evaluated vonoprazan 20 mg once daily, omeprazole 20 mg once daily, lansoprazole 30 mg once daily, esomeprazole 20 mg once daily, esomeprazole 40 mg once daily, and pantoprazole 40 mg once daily.


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Efficacy results showed that vonoprazan 20 mg once daily was superior to omeprazole 20 mg once daily (median OR, 6.15; 95% Cl, 1.35-33.22); lansoprazole 30 mg once daily (median OR, 5.35; 95% Cl 1.19-28.29); esomeprazole 20 mg once daily (median OR, 5.74; 95% Cl, 1.22-32.00); esomeprazole 40 mg once daily (median OR, 4.62; 95% Cl, 1.02-25.01); and pantoprazole 40 mg once daily (median OR, 5.67; 95% Cl, 1.21-31.53).

Study limitations included vulnerability to heterogeneity and bias, as is typical with literature-based meta-analyses. The researchers adopted a random-effects model to minimize the effect of heterogeneity. Cognitive bias was possible based on subjective symptom evaluation by patients. Direct comparison of vonoprazan with a PPI was also limited to 1 study with a small sample size (32 patients).

“It has been suggested that early symptom resolution of erosive esophagitis could lead to an improvement in patients’ [health-related quality of life (HRQoL)],” the study authors wrote. “Thus, the early heartburn resolution effect of vonoprazan, as shown in this network meta-analysis and in our previous RCT, may contribute to the improvement of HRQoL for patients with erosive esophagitis.”

Disclosure: This research was supported by Takeda Pharmaceutical Company, Ltd. Please see the original reference for a full list of disclosures.

References

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. Published online April 26, 2022. doi:10.1097/MCG.0000000000001707