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Direct Comparison of the Efficacy and Safety of Vonoprazan Versus Proton-Pump Inhibitors for Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis

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Abstract

Background

Gastroesophageal reflux disease (GERD) is a common disorder, and is typically treated with proton-pump inhibitors (PPIs) as the recommended first-line therapy. Recently, a new potassium-competitive acid blocker, vonoprazan, was launched in Japan. It is uncertain whether the standard dose of vonoprazan 20 mg is superior to that of PPIs for GERD, so a direct comparison of the therapeutic effects and adverse events between vonoprazan 20 mg and PPIs is needed.

Methods

MEDLINE, the Cochrane Central Register of Controlled Trials, and Embase were chosen as the literature sources. Randomized controlled trials for vonoprazan 20 mg and PPIs published in English were searched. Data from studies meeting the eligibility criteria were extracted individually by two researchers and compared to maintain consistency.

Results

Fifty-six articles were identified in the databases, and one study was manually searched and added to the analysis, ultimately yielding six eligible studies. For the main analysis, the risk ratios (RR) of efficacy and adverse events between vonoprazan and PPIs were 1.06 (0.99–1.13) and 1.08 (0.96–1.22), respectively. Subgroup analysis for patients with severe esophagitis at baseline showed significantly higher results for vonoprazan than lansoprazole, with an RR of 1.14 (1.06–1.22).

Conclusions

Our findings suggest that vonoprazan is non-inferior to PPIs as therapy for patients with GERD. Subgroup analysis indicates that vonoprazan is more effective than PPIs for patients with severe erosive esophagitis. The safety outcomes for vonoprazan are similar to those for PPIs.

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Abbreviations

GERD:

Gastroesophageal reflux disease

NERD:

Non-erosive reflux disease

EO:

Erosive esophagitis

VO:

Vonoprazan

RR:

Risk ratio

PPI:

Proton-pump inhibitors

CI:

Confidence interval

P-CAB:

Potassium-competitive acid blocker

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Funding

Funding was provided by the National Outstanding Youth Science Fund Project of the National Natural Science Foundation of China (Grant No. 81803907) and Beijing Science and Technology Plan Project (Grant No. Z171100001717021).

Author information

Author notes

  1. Yuan Cheng and Jiali Liu have contributed equally to the study as first authors.

Authors and Affiliations

  1. Graduate School of Beijing University of Chinese Medicine, Beijing, China

    Yuan Cheng, Jiali Liu, Xiang Tan, Qiongqiong Lu, Fushun Kou & Hui Jiang

  2. Gastroenterology Department, Dongfang Hospital, Beijing University of Chinese Medicine, No. 6, 1st Section, Fangxingyuan, Fangzhuang, Beijing, 100078, China

    Yuan Cheng, Jiali Liu, Xiang Tan, Chune Xie, Xiaohong Li, Qiongqiong Lu, Fushun Kou, Hui Jiang & Junxiang Li

  3. Department of Pharmacotherapy and Oriental Medicine, School of Pharmacy, Hyogo University of Health Sciences, Hyogo, Japan

    Yi Dai

  4. School of Life Science, Beijing University of Chinese Medicine, Beijing, 100029, China

    Yi Dai

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  1. Yuan Cheng
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Contributions

YC, JL-L, and XT performed the data screening and data collection; CE-X, XH-L performed the statistical analysis; YC, JL-L, XT, QQ-L, FS-K, YD and HJ performed data interpretation; YC and JL-L drafted the manuscript; YC, JL-L and JX-L edited the manuscript for intellectual content; JX-L supervised the project. All authors provided final approval of the submitted manuscript. YC and L-JL planned and designed the research; YC, XT and L-JL collected and analyzed the data; YC wrote the paper; all authors approved the final version of the manuscript.

Corresponding author

Correspondence to Junxiang Li.

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Cheng, Y., Liu, J., Tan, X. et al. Direct Comparison of the Efficacy and Safety of Vonoprazan Versus Proton-Pump Inhibitors for Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis. Dig Dis Sci 66, 19–28 (2021). https://doi.org/10.1007/s10620-020-06141-5

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  • DOI: https://doi.org/10.1007/s10620-020-06141-5

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