OBJECTIVES : Reflux esophagitis (RE) is an esophageal mucosal injury that occurs secondary to the regurgitation of stomach contents. An 8-week course of proton pump inhibitors (PPIs) has been the mainstay for the management of RE. Vonoprazan, a novel potassium-competitive acid blocking agent, demonstrated strong, fast and long-lasting acid inhibitory effects in patients with RE of any grades. In this study, We conducted a network meta-analysis (NMA) to assess the efficacy of 4-week vonoprazan and 8-week PPIs in severe RE.

METHODS : Medline, EMBASE and Cochrane Central Register of Controlled Trials were searched up to April 20, 2020, aiming for publications of randomized controlled trials reporting healing rates of vonoprazan 20mg at 4 weeks and PPIs (esomeprazole, ilaprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole) in approved doses at 8 weeks among adults with severe RE. Bayesian NMAs with random-effect models were performed to compare each PPI versus vonoprazan. Odds ratios (ORs) and 95% credible intervals (CrIs) were reported. Between-study heterogeneity and consistency were evaluated.

RESULTS : Among 2,546 articles identified, 12 studies were selected into the NMA, which include 3 articles with vonoprazan and 9 articles with PPIs. Among patients with severe RE, the efficacy of 4-week vonoprazan was comparable to 8-week PPIs. Specifically, the ORs (CrIs）of PPIs vs. vonoprazan 20mg among patients with severe RE were as follows: esomeprazole 20mg 1.22 (0.51-3.01), esomeprazole 40mg 1.47 (0.76-2.86), lansoprazole 30mg 0.82 (0.44-1.56), omeprazole 20mg 0.90 (0.43-1.89), omeprazole 40mg 0.35 (0.04-2.09), pantoprazole 40mg 1.87 (0.50-7.35) and rabeprazole 20mg 1.06 (0.22-6.32). Ilaprazole was not included in the NMA due to lack of evidence in patients with severe RE. Heterogeneity existed in few comparisons and there was no evidence of inconsistency.

CONCLUSIONS : This NMA suggested that a 4-week course of vonoprazan had comparable efficacy to 8-week course of PPIs for patients with severe RE.