Vonoprazan Versus Lansoprazole in the Healing and Maintenance Phase of Erosive Esophagitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
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Authors
Ali, Syed Hasham
Rayamajhi, Sushil
Bharadwaj, Hareesha Rishab
Gaur, Aditya
Fuad, Muhtasim
Dhali, Arkadeep
Dahiya, Dushyant Singh
Bone, Matan
Mohan, Babu
Guha, Sushovan
Issue Date
2025-07-31
Type
Journal Article
Systematic Review
Meta-Analysis
Comparative Study
Review
Systematic Review
Meta-Analysis
Comparative Study
Review
Language
en
Keywords
Erosive esophagitis (EE) , Healing and maintenance phase , Lansoprazole , Proton pump inhibitors (PPIs) , Vonoprazan
Alternative Title
Abstract
Background: Vonoprazan (VPZ), a potassium-competitive acid blocker, has emerged as an alternative to traditional proton-pump inhibitors like Lansoprazole (LPZ) for the treatment of erosive esophagitis (EE). Vonoprazan provides stronger acid suppression compared to PPIs; however, evidence regarding its effectiveness and safety in treating EE remains limited. We conducted a systematic review and meta-analysis to evaluate the comparative effectiveness and safety of VPZ versus LPZ in the healing and maintenance phases of EE.
Methods: A comprehensive literature search was conducted across PubMed, Embase and Cochrane Library to identify eligible randomized controlled trials (RCTs) published till 12 December 2024 that evaluated efficacy and safety of VPZ and LPZ in patients with EE. Outcomes included endoscopic healing rates, recurrence rates, and treatment-emergent adverse events (TEAEs). Pairwise meta-analyses and network meta-analyses (NMA) were performed using Review Manager 5.4.1 and Bayesian models.
Results: This meta-analysis included 7 RCTs with 4,903 patients. In the healing phase, VPZ showed significantly higher endoscopic healing rates than LPZ at Week 2 (RR: 1.09; 95% CI: 1.04-1.13; p < 0.0001, I2 = 0%) and among patients with severe EE (LA classification C/D) at both Week 2 (RR: 1.26; 95% CI: 1.15-1.38; p < 0.00001, I2 = 0%) and Week 8 (RR: 1.13; 95% CI: 1.03-1.24; p = 0.007, I2 = 67%). No significant differences were observed in TEAEs, severe adverse events, or treatment discontinuation. In the maintenance phase, VPZ 20 mg reduced recurrence rates compared to LPZ 15 mg (RR: 0.41; 95% CI: 0.17-0.85) without differences in TEAEs.
Conclusions: VPZ demonstrates greater efficacy in healing and maintaining remission in EE, particularly in severe cases, with a safety profile comparable to LPZ. These findings support VPZ as an effective alternative to PPIs. However, long-term studies are warranted.
Description
Citation
Ali, SY. et al. (2025) 'Vonoprazan Versus Lansoprazole in the Healing and Maintenance Phase of Erosive Esophagitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials', Digestive Diseases and Sciences. 70(10) pp. 3260-3272. Available at: https://doi.org/10.1007/s10620-025-09290-7
Publisher
Springer Nature
License
© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Journal
Digestive diseases and sciences
Volume
70
Issue
10
PubMed ID
ISSN
1573-2568