S990 Vonoprazan Use Is Associated With Lower Hospitalization and Bleeding Rates in Patients With Erosive Esophagitis Compared to Proton Pump Inhibitors: A Multinational Real-World Analysis

Introduction: Prior studies have found vonoprazan, a potassium-competitive acid blocker, is non-inferior compared to standard-dose proton pump inhibitors (PPIs) for the management of erosive esophagitis. Erosive esophagitis is a common gastroesophageal condition traditionally managed with proton pump inhibitors (PPIs), which carry well-documented risks including increased hospitalization and bleeding rates. However, large-scale comparative data on clinical outcomes between vonoprazan and PPIs in erosive esophagitis patients remain limited. This study evaluates clinical outcomes in patients with erosive esophagitis treated with either vonoprazan or PPI. Methods: We conducted a retrospective cohort study using the TriNetX Global Research Network. Adult patients with erosive esophagitis were identified and stratified based on vonoprazan or PPI use. Propensity score matching (1:1) was performed, balancing for demographics, comorbidities, and concomitant medications. Outcomes included hospitalization, bleeding, acute kidney injury (AKI), infection by Clostridioides difficile, pneumonia, dysphagia, and diarrhea. Hazard ratio (HR) and 95% confidence intervals (CI) were calculated to quantify the associations between variables. Results: A total of 103,945 adult patients with erosive esophagitis were identified, of whom 1,452 (1.4%) were on vonoprazan. After matching, 1,448 patients on vonoprazan (mean age 63.0 years, 55.2% women) were compared to 1,448 on PPI (mean age 63.1 years, 54.1% women). Vonoprazan therapy was associated with significantly lower risk of hospitalization (HR 0.28; 95% CI 0.20-0.38), bleeding (HR 0.36; 95% CI 0.17-0.78), and AKI (HR 0.17; 95% CI 0.07-0.45) at 90 days. Similar trends were observed over 30 days. No significant differences were observed in infection by Clostridioides difficile, pneumonia, dysphagia, and diarrhea. Conclusion: In patients with erosive esophagitis, vonoprazan was associated with substantially reduced risk of hospitalization, bleeding, and AKI in the short- and long-term compared to PPI therapy. These findings suggest vonoprazan may offer superior clinical outcomes with similar tolerability than traditional PPI therapy. Nonetheless, clinical decision-making should remain individualized and further prospective studies are needed to confirm these findings.