S1017 Comparative Effectiveness of Vonoprazan vs Lansoprazole in Treating Erosive Esophagitis: A Meta-Analysis of Randomized Controlled Trials

Introduction: Erosive esophagitis (EE), a frequent outcome of gastroesophageal reflux disease (GERD), is commonly treated with proton pump inhibitors (PPIs), though responses can be inconsistent. Vonoprazan, a potassium-competitive acid blocker, offers a promising alternative. This meta-analysis evaluates its efficacy compared to lansoprazole, a widely used PPI. Methods: A comprehensive search of PubMed, MEDLINE, SCOPUS, Google Scholar, and Cochrane CENTRAL was conducted through May 2025 to identify randomized controlled trials comparing vonoprazan 20 mg and lansoprazole 30 mg for the treatment of EE. The primary outcomes assessed were rates of endoscopic healing of EE within 4-8 weeks of treatment and recurrence rates within 24-48 weeks. Secondary outcomes included changes in serum gastrin and pepsinogen I levels at 8 weeks. Safety was evaluated based on the incidence of treatment-emergent adverse events. A random-effects meta-analysis was performed, with pooled risk ratios (RR) and 95% confidence intervals (CI) reported for dichotomous outcomes, and mean differences (MD) for continuous outcomes. Results: Eight randomized controlled trials were included in the final analysis. Vonoprazan demonstrated comparable efficacy to lansoprazole in achieving endoscopic healing of erosive esophagitis within 4-8 weeks [RR 1.03 (0.99-1.07); P = 0.10; I² = 70%]. However, vonoprazan significantly reduced EE recurrence at 24-48 weeks compared to lansoprazole [RR 0.46 (0.25-0.86); P = 0.01; I² = 76%]. No significant differences were observed between the 2 drugs in serum gastrin and pepsinogen I levels after 8 weeks. Both treatments had similar safety profiles, with no significant difference in treatment-emergent adverse events [RR 1.03 (0.95-1.12); P = 0.47; I² = 44%]. Conclusion: This meta-analysis concludes that vonoprazan offers comparable efficacy and safety to lansoprazole in treating erosive esophagitis. However, vonoprazan showed superior performance in reducing EE recurrence over the long term, highlighting its potential as a more effective option for sustained management of GERD and EE without an increased risk of adverse events.