Acid Blockers Appear Superior to PPIs in Erosive Esophagitis

TOPLINE:

While most potassium-competitive acid blockers demonstrate superior healing rates than proton pump inhibitors (PPIs) in patients with erosive esophagitis, both types of treatment offer relief compared with placebo, a meta-analysis suggests.

METHODOLOGY:

• Researchers conducted a database search up to May 31, 2023, for randomized controlled trials of potassium-competitive acid blockers and PPIs for the treatment of erosive esophagitis. They included 34 trials in a systematic review and a network meta-analysis comparing the efficacy of the two medication classes in this patient population.
• The trials included 25,054 patients with erosive esophagitis, and the treatments involved were standard or double doses of potassium-competitive acid blockers (tegoprazan, vonoprazane, keverprazan, and fexuprazan), PPIs (esomeprazole, ilaprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole), or placebo.
• The researchers compared the healing rates at 4 and 8 weeks.

TAKEAWAY:

• The main analysis found that both potassium-competitive acid blockers and PPIs showed better healing rates at 4 and 8 weeks than placebo. This finding held up in a subgroup analysis of patients with and without severe erosive esophagitis at both timepoints.
• For most treatments, the pooled healing rates at 8 weeks were significantly higher than those at 4 weeks.
• In the main analysis, ilaprazole 10 mg once daily had the best healing rate (surface under the cumulative ranking curve [SUCRA], 89.3) at 4 weeks, followed by vonoprazan 40 mg once daily (SUCRA, 86.7). At 8 weeks, keverprazan 20 mg once daily ranked best (SUCRA, 84.7), followed by ilaprazole 10 mg once daily (SUCRA, 82.0).
• The subgroup analysis found that healing rates were higher with most potassium-competitive acid blockers than with PPIs, particularly for patients with severe erosive esophagitis. Keverprazan 20 mg daily was found to have the highest healing rate at 8 weeks for both severe and non-severe erosive esophagitis, and vonoprazan 40 mg daily had a relatively higher healing rate at 4 weeks.

IN PRACTICE:

The finding that most potassium-competitive acid blockers showed a higher healing rate than PPIs, particularly for patients with severe erosive esophagitis, “may help inform future directions of treatment,” the authors wrote. But high-quality randomized controlled trials are required to confirm potassium-competitive acid blockers’ healing effect in patients with erosive esophagitis, they added.

SOURCE:

The study, led by Yin Liu of the Henan Cancer Hospital (Affiliated Cancer Hospital of Zhengzhou University), Zhengzhou, and Zhifeng Gao of the Department of Gastroenterology, The First People’s Hospital of Xuzhou, Xuzhou, China, was published online in Therapeutic Advances in Gastroenterology.

LIMITATIONS: 

The limitations of the study included heterogeneity and bias across included studies, a lack of head-to-head trials for all included treatments, and insufficient reporting on outcomes based on the severity of erosive esophagitis. 

DISCLOSURES:

The authors received no financial support for the study. There were no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.