Comparative Efficacy and Safety of Tegoprazan Versus Proton Pump Inhibitors for Erosive Esophagitis: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis evaluated the efficacy and safety of tegoprazan compared to proton pump inhibitors (PPIs) in the treatment of erosive esophagitis (EE). A comprehensive literature search was conducted across multiple electronic databases from inception to 25 March 2025. Randomized controlled trials comparing tegoprazan with PPIs in patients with endoscopically confirmed EE were included. Primary outcomes were healing rates and safety profiles. Four randomized controlled trials comprising 963 patients were included. Meta-analysis revealed comparable healing rates between tegoprazan and PPIs (RR: 1.03, 95% CI: 0.97-1.10), with no significant differences observed at both four weeks (RR: 1.05, 95% CI: 0.96-1.16) and eight weeks (RR: 1.01, 95% CI: 0.96-1.06). Safety analyses demonstrated similar profiles between treatments, with no significant differences in treatment-emergent adverse events (RR: 0.93, 95% CI: 0.73-1.35), drug-related adverse events (RR: 0.93, 95% CI: 0.51-1.69), or serious adverse events (RR: 1.07, 95% CI: 0.12-9.29). Symptom relief was comparable between groups across all studies, with tegoprazan showing consistent efficacy, regardless of CYP2C19 genotype. Most patients had mild to moderate EE (LA grades A and B), limiting conclusions about efficacy in severe cases. This first meta-analysis directly comparing tegoprazan with PPIs suggests that tegoprazan is an effective and safe alternative to PPIs for EE treatment. Its efficacy independent of CYP2C19 polymorphism represents a potential advantage. However, limitations include the small number of studies, predominantly Asian populations, and relatively short follow-up periods. Further research is needed to assess long-term outcomes and efficacy in diverse populations.