ArticleTherapeutic advances in gastroenterology2025
Dose and duration shape the efficacy of vonoprazan versus lansoprazole for erosive esophagitis: insights from meta-regression.
Article in Therapeutic advances in gastroenterology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Proton pump inhibitors (PPIs) are the standard treatment for erosive esophagitis (EE), yet 20%-40% of patients show inadequate response. Vonoprazan, a potassium-competitive acid blocker (P-CAB), provides faster and more sustained acid suppression than PPIs. Objectives: To evaluate the efficacy and safety of vonoprazan compared with lansoprazole in the treatment and maintenance of EE, and to explore dose-response and duration effects using meta-regression analysis. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Data sources and methods: Electronic databases (PubMed, Embase, Cochrane CENTRAL, ClinicalKey, ProQuest, ScienceDirect, Web of Science, and ClinicalTrials.gov) were searched through March 31, 2025. Eligible RCTs compared vonoprazan with lansoprazole for EE treatment. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. Meta-regression assessed dose- and duration-dependent effects. Results: Seven RCTs involving 3754 participants (mean age 54.6 ± 3.2 years; 68.5% male) were included. Vonoprazan significantly improved healing rates versus lansoprazole (OR = 1.855; 95% CI: 1.386-2.482; Conclusion: Vonoprazan provides superior healing and maintenance efficacy compared with lansoprazole without increasing adverse events. Its benefits are dose- and duration-dependent, supporting vonoprazan as a first-line option for EE, particularly in severe or PPI-refractory cases. Trial registration: This study was registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY; INPLASY202590075; DOI: 10.37766/inplasy2025.9.0075).
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