Vonoprazan Versus Lansoprazole in the Healing and Maintenance Phase of Erosive Esophagitis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Division

North Florida

Hospital

West Florida Hospital

Document Type

Manuscript

Publication Date

7-31-2025

Keywords

Erosive esophagitis (EE), Healing and maintenance phase, Lansoprazole, Proton pump inhibitors (PPIs), Vonoprazan

Disciplines

Digestive System Diseases | Internal Medicine | Medicine and Health Sciences

Abstract

BACKGROUND: Vonoprazan (VPZ), a potassium-competitive acid blocker, has emerged as an alternative to traditional proton-pump inhibitors like Lansoprazole (LPZ) for the treatment of erosive esophagitis (EE). Vonoprazan provides stronger acid suppression compared to PPIs; however, evidence regarding its effectiveness and safety in treating EE remains limited. We conducted a systematic review and meta-analysis to evaluate the comparative effectiveness and safety of VPZ versus LPZ in the healing and maintenance phases of EE.

METHODS: A comprehensive literature search was conducted across PubMed, Embase and Cochrane Library to identify eligible randomized controlled trials (RCTs) published till 12 December 2024 that evaluated efficacy and safety of VPZ and LPZ in patients with EE. Outcomes included endoscopic healing rates, recurrence rates, and treatment-emergent adverse events (TEAEs). Pairwise meta-analyses and network meta-analyses (NMA) were performed using Review Manager 5.4.1 and Bayesian models.

RESULTS: This meta-analysis included 7 RCTs with 4,903 patients. In the healing phase, VPZ showed significantly higher endoscopic healing rates than LPZ at Week 2 (RR: 1.09; 95% CI: 1.04-1.13; p <  0.0001, I

CONCLUSIONS: VPZ demonstrates greater efficacy in healing and maintaining remission in EE, particularly in severe cases, with a safety profile comparable to LPZ. These findings support VPZ as an effective alternative to PPIs. However, long-term studies are warranted.

Publisher or Conference

Digestive Diseases and Sciences

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