P1856 - Vonoprazan Is Superior to a Proton Pump Inhibitor in Healing Severe Erosive Esophagitis: A Meta-Analysis of Randomized Controlled Trials

Elvira Lesmana, MD¹, Daniel Martin Simadibrata, MD, MS², Ronnie Fass, MD^3
1Universitas Indonesia, New York, NY; ²University of Oxford, UK, Jakarta, Jakarta Raya, Indonesia; ³MetroHealth System, Case Western Reserve University, Cleveland, OH

Introduction: Although Proton Pump Inhibitor (PPI) is the therapy of choice for the healing of Erosive Esophagitis (EE), healing rates for patients with severe EE (Los Angeles [LA] Grade C/D) is suboptimal (~60-70%). Vonoprazan, a new acid-suppressive drug in the Potassium Competitive Acid Blocker class, is suggested to have better efficacy in healing EE, especially for those with severe esophagitis. This meta-analysis compares the efficacy and safety of Vonoprazan 20mg to PPI for healing EE, especially in those with LA Grade C/D.

Methods: We searched MEDLINE, Embase, and Central for studies published from database inception to May 24, 2023. Randomized Controlled Trials (RCTs), which randomized patients with EE to Vonoprazan 20mg or a PPI and compared the healing rates, were included in this meta-analysis. The risk of bias was assessed using Cochrane’s Risk of Bias 2 (RoB2) tool. The fixed-effect model was used to obtain the pooled efficacy and safety outcomes of Vonoprazan 20mg compared to PPI. Subgroup analysis was done to compare healing rates in patients with mild EE (LA Grade A/B) and severe EE.

Results: Overall, four RCTs with low risks of bias comprising 2208 participants were included. Lansoprazole 30mg was the only PPI used as the comparator in all included studies. As compared to Lansoprazole 30mg, Vonoprazan demonstrated superior healing rates in Weeks 2 (RR 1.092 [95%CI 1.041-1.145]; study n=4) and 8 (RR 1.057 [95%CI 1.029-1.087]; study n=4), but not in Week 4 (RR 1.030 [95%CI 0.987-1.075]; study n=3) (Figure 1A). In subgroup analyses, healing rates were significantly different in patients with mild vs. severe EE at Weeks 2, 4, and 8 (p-interaction< 0.01) (Figure 1B-C). Healing rates were similar in both Vonoprazan 20mg and Lansoprazole 30mg groups for mild EE, while superior for Vonoprazan 20mg in severe EE across all weeks. Any Treatment-emergent Adverse Event (TEAE), serious TEAE, and drug-related TEAE were comparable between the two groups.

Discussion: Vonoprazan 20mg is superior to Lansoprazole 30mg for healing severe EE but not mild EE. Vonoprazan 20mg has a similar safety profile to Lansoprazole 30mg.



Disclosures:


Elvira Lesmana, MD¹, Daniel Martin Simadibrata, MD, MS², Ronnie Fass, MD³. P1856 - Vonoprazan Is Superior to a Proton Pump Inhibitor in Healing Severe Erosive Esophagitis: A Meta-Analysis of Randomized Controlled Trials, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.