S977 Comparative Efficacy and Safety of Tegoprazan vs Proton Pump Inhibitors for Erosive Esophagitis: A Meta-Analysis of Randomized Controlled Trials

Introduction: Proton pump inhibitors (PPIs) remain the standard treatment option for erosive esophagitis (EE) but have notable limitations due to side effects associated with long-term use. Tegoprazan, a potassium-competitive acid suppressant (PCAB), may provide an alternative treatment option. In this study, we aim to evaluate the healing rates of erosive esophagitis using tegoprazan versus PPIs, along with their safety profiles. Methods: A comprehensive literature search was conducted in PubMed, Embase, and ClinicalTrials.gov through March 2025. Risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Pooled estimates were calculated using random-effects models in Review Manager 5.4. Results: Four randomized controlled trials encompassing a total of 812 patients were included in the analysis. Tegoprazan demonstrated similar healing rates to PPIs at both 4 weeks (relative risk [RR] 1.05; 95% confidence interval [CI] 0.99-1.11; P = 0.12) and 8 weeks (RR 1.02; 95% CI 0.98-1.06; P = 0.35). Subgroup analyses by dose (50 mg and 100 mg) showed no significant differences. While tegoprazan was associated with a slightly higher incidence of overall adverse events (61.8% vs 51.9%; RR 1.18; 95% confidence interval 0.99-1.40; P = 0.07), it had a lower incidence of headache (1.3% vs 4.2%; RR 0.40; 95% CI 0.08-2.00). Conclusion: Tegoprazan is non-inferior to PPIs in treating EE, demonstrating comparable efficacy and tolerability. It may serve as an effective alternative for patients experiencing side effects from PPI use. Further large-scale, long-term studies are warranted to validate these findings and assess patient-centered outcomes.