Esophagus to Small Intestine
Am J Gastroenterol. 2024;119(5):803–13
Comparative efficacy of P-CAB vs. proton-pump inhibitors for grade C/D esophagitis: A systematic review and network meta-analysis
Introduction: Los Angeles grade C/D esophagitis is a severe manifestation of gastroesophageal reflux disease that require active treatment and close follow-up. Potassium-competitive acid blockers (P-CABs) are promising alternatives to proton-pump inhibitors (PPIs). The authors aimed to compare the efficacy and safety of P-CABs and PPIs in healing grade C/D esophagitis to aid clinical decision-making.
Methods: A systematic literature search was performed using PubMed, Medline, and Cochrane Central Register of Controlled Trials. Randomized controlled trials were eligible for inclusion if efficacy of P-CABs and PPIs in healing grade C/D esophagitis was reported. Pooled risk ratios and risk difference with 95% credible intervals were used to summarize estimated effect of each comparison. The benefit of treatments was ranked using the surface under the cumulative probability ranking score.
Results: Of 5876 articles identified in the database, 24 studies were eligible. Studies included incorporated 3 P-CABs (vonoprazan, tegoprazan, and keverprazan) and 6 PPIs (lansoprazole, esomeprazole, omeprazole, rabeprazole extended-release [ER], pantoprazole, and dexlansoprazole). Based on the failure to achieve mucosal healing, 20 mg of vonoprazan once daily ranked the first among PPIs in initial and maintained healing of grade C/D esophagitis (surface under the cumulative probability ranking score = 0.89 and 0.87, respectively). Vonoprazan had similar risk of incurring adverse events, severe adverse events, and withdrawal to drug when compared with PPIs. For those who attempted lower maintenance treatment dose, 10 mg of vonoprazan once daily was a reasonable choice, considering its moderate efficacy and safety.
Discussion: Vonoprazan has considerable efficacy in initial and maintained healing of grade C/D esophagitis compared with proton-pump inhibitors, with moderate short-term and long-term safety.