S835 Comparative Efficacy of Potassium-Competitive Acid Blockers, Proton Pump Inhibitors, and H2-Receptor Antagonists for Healing and Maintenance of Erosive Esophagitis: A Network Meta-Analysis of 164 Randomized Trials
Abstract
Introduction: Proton pump inhibitors (PPIs) transformed erosive esophagitis (EE) management in the 1990s, largely replacing histamine-2 receptor antagonists (H2RAs) as first-line therapy. Recently, potassium-competitive acid blockers (PCABs) emerged as a novel class of acid-suppression, offering more rapid and sustained acid inhibition, independent of food intake. Although few trials suggest superiority of vonoprazan, a PCAB, over standard-dose lansoprazole for EE healing, comparative data against high-dose or dual-delayed release PPIs remain limited. This network meta-analysis aimed to rank the healing and maintenance of EE with acid suppressants including H2RA, PPI (standard, double, dual-delayed release doses), and PCAB. Methods: Literature search was performed in MEDLINE, Embase, and the Cochrane Library from inception to February 2, 2025. Randomized controlled trials (RCTs) were included if they compared acid-suppressive agents (PCAB, PPI, H2RA) in adults with endoscopically confirmed EE or previously healed EE. Primary outcomes were cumulative healing rates of EE at week 8 and maintenance rates at 6 months. A frequentist network meta-analysis determined risk ratios (RR) with 95% confidence intervals (95% CI), using omeprazole 20 mg once per day and placebo as reference for healing and maintenance outcomes, respectively. Treatments were ranked by P-scores. Sensitivity analyses used vonoprazan 20 mg and 10 mg once per day as alternate references for healing and…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 117 participants or records.
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