Vonoprazan as effective as Lansoprazole in treating Severe Erosive Esophagitis: AGA

In a new study conducted by Loren Laine and team it was found that in the treatment and maintenance of the recovery from erosive esophagitis, vonoprazan was not inferior to the Proton pump inhibitors (PPI) lansoprazole. The findings of this study were published in Gastroenterology Journal.

PPIs have been the cornerstone of care for erosive esophagitis for many years. Vonoprazan, a potassium-competitive acid blocker, offers more powerful acid suppression than PPIs, but there isn't much information on how well it works for erosive esophagitis. Therefore, the purpose of this study was to compare the effectiveness of vonoprazan and lansoprazole in the treatment and maintenance of erosive esophagitis.

For up to 8 weeks, adults with erosive esophagitis were randomly assigned to receive either once-daily vonoprazan 20 mg or lansoprazole 30 mg. Once-daily vonoprazan 10 mg, vonoprazan 20 mg, or lansoprazole 15 mg for 24 weeks were given to patients who had healed. The primary endpoints were evaluated using non-inferiority comparisons, with superiority analyses being pre-specified if non-inferiority was shown. The primary endpoints were the percentage of patients who had healed by week-8 endoscopy and the maintenance of healing at week-24 endoscopy. Fixed-sequence testing protocols were used to analyze the primary and secondary outcomes.

The key findings of this study were:

1. Vonoprazan was better in the exploratory analysis of healing among 1024 patients who were in the healing phase and non-inferior to lansoprazole in the primary analysis.

2. Secondary studies revealed that vonoprazan was superior in healing Grade C/D esophagitis at week 2 and non-inferior in days without heartburn.

3. Vonoprazan was superior on secondary analyses of maintenance of healing and secondary analyses of maintenance of healing Grade C/D esophagitis among 878 patients in the maintenance phase. Vonoprazan was non-inferior to lansoprazole in the initial analysis.

In conclusion, the bulk of their research subjects (89–92%) were white patients, making the findings of this study mostly generalizable and limited to white patients. Furthermore, those with H. pylori or those who simply have heartburn may not be affected by these findings.

Reference: 

Laine, L., DeVault, K., Katz, P., Mitev, S., Lowe, J., Hunt, B., & Spechler, S. (2022). VONOPRAZAN VERSUS LANSOPRAZOLE FOR HEALING AND MAINTENANCE OF HEALING OF EROSIVE ESOPHAGITIS: A RANDOMIZED TRIAL. In Gastroenterology. Elsevier BV. https://doi.org/10.1053/j.gastro.2022.09.041