Vonoprazan vs Lansoprazole in Gastrointestinal Tract Ulcers: A Systematic Review and Meta-Analysis

Vonoprazan, a potent inhibitor of gastric acid secretion, is a recently introduced drug. It is debated to be better than or equal to proton pump inhibitors (PPIs) in the treatment of acid-based disorders and Endoscopic Submucosal Dissesction (ESD) induced ulcers. However, its efficacy regarding bleeding control, healing, and gastrointestinal tract (GIT) perforation after ulceration is not sufficiently studied upon. The purpose of this study is to determine the efficacy of vonoprazan vs lansoprazole and to compare the side effect profile of both drugs. Data was sourced from PubMed, Google Scholar, Cochrane databases. The initial search revealed 51 studies. After exclusion, 9 were included. All included studies were randomized controlled trials (RCTs) covering post-ESD treatment with Vonoprazan vs Lansoprazole over a period of 7 years (2016 to 2022), with sample sizes ranging from 14 to 250 subjects. The mean age of subjects was 65.02 years. The diagnostic modality was endoscopy. Study quality was calculated using the Modified Jadad or Oxford Scale. The pooled odds ratio of vonoprazan vs lansoprazole for ulcer healing rate was 1.34 (95% confidence interval [CI],1.00-1.79, I2=50%) with a statistically significant p-value of 0.05. The pooled Odds ratio of vonoprazan vs lansoprazole for bleeding control was 0.55 (95% CI, 0.24-1.27, I2=12%) with a p-value of 0.16 and that of vonoprazan vs lansoprazole for perforation was 1.49 (95% CI, 0.44-5.02, I2=0%), with a p-value of 0.52. Our study concluded that lansoprazole has a better ulcer healing rate than vonoprazan, while both have comparable bleeding and perforation control.