S1016 Second Generation Potassium-Competitive Acid Blockers Match Proton Pump Inhibitors in Healing and Safety for Erosive Esophagitis: A Systematic Review and Meta-Analysis of Four Double-Blind, Randomized Controlled Trials
Abstract
Introduction: Proton-pump inhibitors (PPIs) remain first-line therapy for erosive esophagitis (EO), yet incomplete acid control and nocturnal breakthrough limit their effectiveness in up to one-third of patients. Second-generation potassium-competitive acid blockers (PCABs)—notably tegoprazan and fexuprazan—provide faster, meal-independent and more durable pH elevation than the first-in-class agent vonoprazan. Despite their rapidly expanding clinical use, to our knowledge head-to-head performance against PPIs in double-blind randomized controlled trials (RCTs) has never been analyzed. Methods: A systematic search of PubMed, Embase, Scopus, and Cochrane Library identified 4 double-blind RCTs comparing second generation PCABs and PPIs for treatment of EO through May 2025. Data were analyzed using RevMan 4.2.1. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Mantel-Haenszel methods. Random- or fixed-effects models were applied based on heterogeneity (Higgins’ I²). Statistical significance was set at P < 0.05. Risk of bias was assessed using Risk of Bias 2.0. Results: Four double-blind RCTs comprising 1,085 patients with EO (PPI = 543; PCAB = 542) met eligibility. The efficacy endpoint showed endoscopic healing at 4 weeks was achieved in 83% of PPI‐treated vs 87% of PCAB-treated participants (421/505 vs 448/514; RR 0.96; 95% CI 0.91-1.01; I² = 0%), and at 8 weeks in 93% vs 95% (478/512 vs 490/518; RR 0.99; 95% CI 0.96-1.02; I² = 0%). The safety…
How strong is the evidence?
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: 1,085 participants or records.
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