S852 Efficacy of Vonoprazan Versus Lansoprazole in Erosive Esophagitis: A Systematic Review and Meta-Analysis

Introduction: The gold standard treatment for erosive esophagitis (EE) is proton pump inhibitors (PPIs) like lansoprazole. Recently, novel potassium-competitive acid blockers, such as vonoprazan and tegoprazan, have become a focus of interest. This systematic review and meta-analysis compares the efficacy of both treatments, including recurrence rates and healing rates across multiple studies. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and the Cochrane Library through May 2025. Eligible studies compared vonoprazan (10 mg or 20 mg), tegoprazan (25 mg), and lansoprazole in adults with EE. The primary outcomes were recurrence rate during maintenance and endoscopic healing rate in the induction phase. A random-effects model was applied using Comprehensive Meta-Analysis Software (version 3). Subgroup analyses were conducted by drug type, dose, and EE severity according to the Los Angeles (LA) score. Results: Six randomized controlled trials with a total of 3,655 patients were included. Both vonoprazan 10 mg and 20 mg significantly reduced the risk of EE recurrence at 24 weeks compared to lansoprazole, with odds ratios (OR) of 0.44 and 0.33 (P = .001 and P = .002, respectively), and the effect was more pronounced with the 20 mg dose. In the induction phase, both doses of vonoprazan were also associated with significantly higher healing rates than lansoprazole (OR 1.51 and 1.87; P = .001 and P < .001, respectively), with greater benefit observed at 20 mg. Subgroup analysis by LA Grade showed that vonoprazan 20 mg provided greater benefit in patients with severe erosive esophagitis (LA Grade C/D), maintaining healing at 24 weeks compared to lansoprazole 15 mg (OR 2.92 vs 2.20; both P < .001). The adverse event rate was similar between vonoprazan and lansoprazole, with no statistically significant difference. No significant differences in healing rates or recurrence at 24 weeks were observed between tegoprazan 25 mg and lansoprazole (P = .615 and P = .227, respectively). Conclusion: In EE, vonoprazan, especially at 20 mg, is superior to lansoprazole for both early healing and maintenance of remission, with the greatest benefit in patients with severe disease (LA Grade C/D). Tegoprazan 25 mg did not show significant differences from lansoprazole in this analysis. These findings support the use of vonoprazan, particularly at the higher dose, as a preferred option for the management of EE.