Efficacy of Vonoprazan in Nonsteroidal Anti-Inflammatory Drug-Induced Ulcer in Terms of Ulcer Recurrence and Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis
Abstract
Objective To evaluate the efficacy and safety of vonoprazan therapy as compared to conventional proton pump inhibitors (PPIs) or no vonoprazan for nonsteroidal anti‐inflammatory drug (NSAID)‐induced ulcers. Methods A literature search was conducted across databases (PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov). The primary outcome was the risk of ulcer recurrence. Secondary outcomes comprised the risk of gastrointestinal (gastric/duodenal) bleeding; serum gastrin, pepsinogen I, and pepsinogen II levels; and safety. Pooled relative risks (RRs) and mean differences with a 95% confidence interval (CI) were determined, as appropriate, utilizing random effects models. Results A total of 744 articles were screened and three of them were included. The overall proportion of ulcer recurrence with vonoprazan therapy was 1.88% (95% CI: 0.98, 3.6) and the overall proportion of gastrointestinal (gastric/duodenal) bleeding with vonoprazan therapy was 1.03 (95% CI: 0.64, 1.64). As compared to PPI (lansoprazole), vonoprazan treatment led to a significant reduction in the risks of ulcer recurrence (RR: 0.55 (95% CI: 0.31, 0.97), p = 0.04, i 2 = 0 % ) and gastrointestinal bleeding (RR: 0.40 (95% CI: 0.16, 0.97), p = 0.04, i 2 = 0 % ). Vonoprazan treatment led to a dose‐dependent significant increase in serum gastrin, serum pepsinogen I, and serum pepsinogen II levels. There was no significant difference in the risk of any adverse event (RR: 0.99 (95% CI: 0.94, 1.04), p =…
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