Dose and duration shape the efficacy of vonoprazan versus lansoprazole for erosive esophagitis: insights from meta-regression
Abstract
Background: Proton pump inhibitors (PPIs) are the standard treatment for erosive esophagitis (EE), yet 20%–40% of patients show inadequate response. Vonoprazan, a potassium-competitive acid blocker (P-CAB), provides faster and more sustained acid suppression than PPIs. Objectives: To evaluate the efficacy and safety of vonoprazan compared with lansoprazole in the treatment and maintenance of EE, and to explore dose–response and duration effects using meta-regression analysis. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Data sources and methods: Electronic databases (PubMed, Embase, Cochrane CENTRAL, ClinicalKey, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov) were searched through March 31, 2025. Eligible RCTs compared vonoprazan with lansoprazole for EE treatment. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Meta-regression assessed dose- and duration-dependent effects. Results: Seven RCTs involving 3754 participants (mean age 54.6 ± 3.2 years; 68.5% male) were included. Vonoprazan significantly improved healing rates versus lansoprazole (OR = 1.855; 95% CI: 1.386–2.482; p < 0.001; I2 = 8.38%) and recurrence-free rates (OR = 2.920; 95% CI: 1.636–5.211; p < 0.001; I2 = 70.99%). Serum gastrin levels were higher with vonoprazan (OR = 2.707; 95% CI: 1.430–5.123; p = 0.002). Meta-regression showed that longer treatment duration (β = 0.0163 per day; p < 0.0001)…
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