S1017 Comparative Effectiveness of Vonoprazan vs Lansoprazole in Treating Erosive Esophagitis: A Meta-Analysis of Randomized Controlled Trials
Abstract
Introduction: Erosive esophagitis (EE), a frequent outcome of gastroesophageal reflux disease (GERD), is commonly treated with proton pump inhibitors (PPIs), though responses can be inconsistent. Vonoprazan, a potassium-competitive acid blocker, offers a promising alternative. This meta-analysis evaluates its efficacy compared to lansoprazole, a widely used PPI. Methods: A comprehensive search of PubMed, MEDLINE, SCOPUS, Google Scholar, and Cochrane CENTRAL was conducted through May 2025 to identify randomized controlled trials comparing vonoprazan 20 mg and lansoprazole 30 mg for the treatment of EE. The primary outcomes assessed were rates of endoscopic healing of EE within 4-8 weeks of treatment and recurrence rates within 24-48 weeks. Secondary outcomes included changes in serum gastrin and pepsinogen I levels at 8 weeks. Safety was evaluated based on the incidence of treatment-emergent adverse events. A random-effects meta-analysis was performed, with pooled risk ratios (RR) and 95% confidence intervals (CI) reported for dichotomous outcomes, and mean differences (MD) for continuous outcomes. Results: Eight randomized controlled trials were included in the final analysis. Vonoprazan demonstrated comparable efficacy to lansoprazole in achieving endoscopic healing of erosive esophagitis within 4-8 weeks [RR 1.03 (0.99-1.07); P = 0.10; I² = 70%]. However, vonoprazan significantly reduced EE recurrence at 24-48 weeks compared to lansoprazole [RR 0.46 (0.25-0.86); P = 0.01;…
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