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Meta-Analysis
20 July 2023

Network meta-analysis of multiple doses of vonoprazan for the treatment of erosive esophagitis

Authors: Jie He https://orcid.org/0009-0002-2108-9131, Yuanyuan Gao https://orcid.org/0009-0002-8611-8861, Ge Bai, Jie Wang, and Yongshun Sun https://orcid.org/0000-0002-6410-3004 [email protected]Author Info & Affiliations
Volume 12, Number 8
https://doi.org/10.57264/cer-2022-0165
PDFFormats

Abstract

Aim: 20 mg of vonoprazan (VPZ20) is recommended in most countries to treat erosive esophagitis (EE). Whether other doses of vonoprazan, such as 5 mg (VPZ5), 10 mg (VPZ10), 20 mg (VPZ20), and 40 mg (VPZ40) are more effective is unknown. Materials & methods: Three databases were electronically searched to identify studies published before November 2021. Network meta-analysis was performed using STATA 14.0. Results: VPZ20 and VPZ40 were comparable to PPI, VPZ5 and VPZ10 in 4- and 8-week healing rates, and this was also detected in patients with refractory EE. All regimens resulted in similar treatment-emergent adverse events (TEAEs). However, VPZ40 ranked first for healing rate and TEAEs; however, VPZ20 ranked worst for TEAEs. Conclusion: Different doses of VPZ are comparable in efficacy and safety, but VPZ40 may be best in both effectiveness and safety.

Tweetable abstract

A new network meta-analysis reveals that 40 mg of #vonoprazan may be the best dosing strategy for treating #erosive esophagitis from the perspective of both effectiveness and safety.

Plain language summary

What is this article about?

Erosive esophagitis refers to esophageal mucosal erosions on endoscopy and heartburn symptoms, accounting for 10% of gastroesophageal reflux disease (GERD). A recent meta-analysis has evaluated the efficacy and safety of 20 mg of vonoprazan as a novel potassium-competitive acid blocker. However, other doses, including 5 mg, 10 mg and 40 mg, are also used in practice. Therefore, this study aimed to determine the optimal dosing strategy of vonoprazan in treating erosive esophagitis.

What were the results?

Different doses of vonoprazan had comparable efficacy and safety; however, 40 mg of vonoprazan may be the best option for treating erosive esophagitis from the perspective of both efficacy and safety.

What do the results of the study mean?

In order to achieve a satisfactory healing rate and lower treatment-emergent adverse events for the treatment of erosive esophagitis in practice, priority should be given to choosing 40 mg of vonoprazan.

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Supplementary Material

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References

Papers of special note have been highlighted as: • of interest; •• of considerable interest
1.
Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am. J. Gastroenterol. 101(8), 1900–1920; quiz 43 (2006).
PubMed
Google Scholar
2.
Eusebi LH, Ratnakumaran R, Yuan Y, Solaymani-Dodaran M, Bazzoli F, Ford AC. Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut 67(3), 430–440 (2018).
PubMed
Google Scholar
3.
Savarino E, de Bortoli N, De Cassan C et al. The natural history of gastro-esophageal reflux disease: a comprehensive review. Dis. Esophagus 30(2), 1–9 (2017).
PubMed
Google Scholar
4.
Altomare A, Guarino MP, Cocca S, Emerenziani S, Cicala M. Gastroesophageal reflux disease: update on inflammation and symptom perception. World J. Gastroenterol. 19(39), 6523–6528 (2013).
PubMed
Google Scholar
5.
Goh KL. Gastroesophageal reflux disease in Asia: a historical perspective and present challenges. J. Gastroenterol. Hepatol. 26(Suppl. 1), 2–10 (2011).
Google Scholar
6.
Ashida K, Sakurai Y, Hori T et al. Randomised clinical trial: vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the healing of erosive oesophagitis. Aliment. Pharmacol. Ther. 43(2), 240–251 (2016).
PubMed
Google Scholar
• Vonoprazan was not inferior to lansoprazole in erosive oesophagitis, and in the long-term maintenance study, vonoprazan was well tolerated and effective.
7.
Moraes-Filho JP, Navarro-Rodriguez T, Barbuti R, Eisig J, Chinzon D, Bernardo W. Guidelines for the diagnosis and management of gastroesophageal reflux disease: an evidence-based consensus. Arq. Gastroenterol. 47(1), 99–115 (2010).
PubMed
Google Scholar
8.
Fuchs KH, Babic B, Breithaupt W et al. EAES recommendations for the management of gastroesophageal reflux disease. Surg. Endosc. 28(6), 1753–1773 (2014).
PubMed
Google Scholar
9.
Iwakiri K, Kinoshita Y, Habu Y et al. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J. Gastroenterol. 51(8), 751–767 (2016).
PubMed
Google Scholar
10.
Hungin AP, Hill C, Molloy-Bland M, Raghunath A. Systematic review: patterns of proton pump inhibitor use and adherence in gastroesophageal reflux disease. Clin. Gastroenterol. Hepatol. 10(2), 109–116 (2012).
PubMed
Google Scholar
11.
Richter JE, Kahrilas PJ, Johanson J et al. Efficacy and safety of esomeprazole compared with omeprazole in GERD patients with erosive esophagitis: a randomized controlled trial. Am. J. Gastroenterol. 96(3), 656–665 (2001).
PubMed
Google Scholar
12.
Mizuno H, Matsuhashi N, Sakaguchi M et al. Recent effectiveness of proton pump inhibitors for severe reflux esophagitis: the first multicenter prospective study in Japan. J. Clin. Biochem. Nutr. 57(3), 233–238 (2015).
PubMed
Google Scholar
13.
Hori Y, Matsukawa J, Takeuchi T, Nishida H, Kajino M, Inatomi N. A study comparing the antisecretory effect of TAK-438, a novel potassium-competitive acid blocker, with lansoprazole in animals. J. Pharmacol. Exp. Ther. 337(3), 797–804 (2011).
PubMed
Google Scholar
14.
Matsukawa J, Hori Y, Nishida H, Kajino M, Inatomi N. A comparative study on the modes of action of TAK-438, a novel potassium-competitive acid blocker, and lansoprazole in primary cultured rabbit gastric glands. Biochem. Pharmacol. 81(9), 1145–1151 (2011).
PubMed
Google Scholar
15.
Kondo M, Kawamoto M, Hasuoka A, Kajino M, Inatomi N, Tarui N. High-throughput screening of potassium-competitive acid blockers. J. Biomol. Screen. 17(2), 177–182 (2012).
PubMed
Google Scholar
16.
Hoshino S, Kawami N, Takenouchi N et al. Efficacy of vonoprazan for proton pump inhibitor-resistant reflux esophagitis. Digestion 95(2), 156–161 (2017).
PubMed
Google Scholar
17.
Cheng Y, Liu J, Tan X et al. Direct comparison of the efficacy and safety of vonoprazan versus proton-pump inhibitors for gastroesophageal reflux disease: a systematic review and meta-analysis. Dig. Dis. Sci. 66(1), 19–28 (2021).
PubMed
Google Scholar
•• Vonoprazan was non-inferior to PPIs as therapy for patients with gastroesophageal reflux disease, and vonoprazan was more effective than PPIs for patients with severe erosive esophagitis.
18.
Ashida K, Sakurai Y, Nishimura A et al. Randomised clinical trial: a dose-ranging study of vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the treatment of erosive oesophagitis. Aliment. Pharmacol. Ther. 42(6), 685–695 (2015).
PubMed
Google Scholar
• Vonoprazan 20 mg or higher was highly efficacious for severe erosive oesophagitis.
19.
Iwakiri K, Sakurai Y, Shiino M et al. A randomized, double-blind study to evaluate the acid-inhibitory effect of vonoprazan (20 mg and 40 mg) in patients with proton-pump inhibitor-resistant erosive esophagitis. Therap. Adv. Gastroenterol. 10(6), 439–451 (2017).
PubMed
Google Scholar
• Vonoprazan 20 mg and 40 mg effectively resulted in an erosive esophagitis healing rate of more than 60.0%.
20.
Dias S, Caldwell DM. Network meta-analysis explained. Arch. Dis. Child. Fetal Neonatal Ed. 104(1), F8–F12 (2019).
PubMed
Google Scholar
21.
Hutton B, Salanti G, Caldwell DM et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann. Intern. Med. 162(11), 777–784 (2015).
PubMed
Google Scholar
22.
Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J. Clin. Epidemiol. 64(2), 163–171 (2011).
PubMed
Google Scholar
23.
Higgins JP, Altman DG, Gotzsche PC et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 343, d5928 (2011).
PubMed
Google Scholar
24.
Cipriani A, Higgins JP, Geddes JR, Salanti G. Conceptual and technical challenges in network meta-analysis. Ann. Intern. Med. 159(2), 130–137 (2013).
PubMed
Google Scholar
25.
Salanti G. Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res. Synth. Methods 3(2), 80–97 (2012).
PubMed
Google Scholar
26.
Tu YK. Using generalized linear mixed models to evaluate inconsistency within a network meta-analysis. Value Health 18(8), 1120–1125 (2015).
PubMed
Google Scholar
27.
Higgins JP, Jackson D, Barrett JK, Lu G, Ades AE, White IR. Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res. Synth. Methods 3(2), 98–110 (2012).
PubMed
Google Scholar
28.
Yu-Kang T. Node-splitting generalized linear mixed models for evaluation of inconsistency in network meta-analysis. Value Health 19(8), 957–963 (2016).
PubMed
Google Scholar
29.
Lu G, Ades AE. Assessing evidence inconsistency in mixed treatment comparisons. J. Am. Stat. Assoc. 101(474), 447–459 (2006).
Google Scholar
30.
Lu G, Ades AE. Combination of direct and indirect evidence in mixed treatment comparisons. Stat. Med. 23(20), 3105–3124 (2004).
PubMed
Google Scholar
31.
Mbuagbaw L, Rochwerg B, Jaeschke R et al. Approaches to interpreting and choosing the best treatments in network meta-analyses. Syst. Rev. 6(1), 79 (2017).
PubMed
Google Scholar
32.
Sterne JA, Egger M, Smith GD. Systematic reviews in health care: investigating and dealing with publication and other biases in meta-analysis. BMJ 323(7304), 101–105 (2001).
PubMed
Google Scholar
33.
White I. Network: stata module to perform network meta-analysis. Statistical software components (2017). https://econpapers.repec.org/software/bocbocode/S458319.htm
Google Scholar
34.
Chaimani A, Higgins JP, Mavridis D, Spyridonos P, Salanti G. Graphical tools for network meta-analysis in STATA. PLoS One 8(10), e76654 (2013).
PubMed
Google Scholar
35.
Chen M, Dai N, Fei G, Chong CF, Funao N, Zhang S. A phase 3, randomized, double-blind, multicentre study to evaluate the safety and efficacy of TAK-438 20 mg once daily compared to lansoprazole 30 mg once daily in patients with erosive esophagitis: results from a chinese subcohort. United European Gastroenterol. J. 6(8), A513 (2018).
Google Scholar
36.
Huang B, Cui DJ, Zhao X et al. Clinical efficacy and safety of vonoprazan in the treatment of refractory reflux esophagitis [in Chinese]. Chin. J. Clin. Rational Drug Use 14(9A), 18–20 (2021).
Google Scholar
• Vonoprazan was effective in treating refractory reflux esophagitis.
37.
Okanobu H, Kohno T, Mouri R et al. Efficacy of vonoprazan 10 mg compared with 20 mg for the initial treatment in patients with erosive esophagitis: a randomized pilot study. Esophagus 18(3), 669–675 (2021).
PubMed
Google Scholar
• This revealed that initial treatment with vonoprazan 10 mg might be useful especially in patients with mild erosive esophagitis.
38.
Sakurai K, Suda H, Fujie S et al. Short-term symptomatic relief in gastroesophageal reflux disease: a comparative study of esomeprazole and vonoprazan. Dig. Dis. Sci. 64(3), 815–822 (2019).
PubMed
Google Scholar
• Showed no substantial differences in the symptom relief between the esomeprazole (20 mg/day) and vonoprazan (20 mg/day) groups at any time point.
39.
Uemura N, Kinoshita Y, Haruma K et al. Sa1194 – 1-year interim analysis results of vision trial: a randomized, open-label study to evaluate a long-term safety of vonoprazan as maintenance treatment in patients with erosive esophagitis. Gastroenterology 156(1 Suppl. 6), S-302–S-3 (2019).
Google Scholar
40.
Xiao Y, Zhang S, Dai N et al. Phase III, randomised, double-blind, multicentre study to evaluate the efficacy and safety of vonoprazan compared with lansoprazole in Asian patients with erosive oesophagitis. Gut 69(2), 224–230 (2020).
PubMed
Google Scholar
• This study demonstrated the non-inferior efficacy of vonoprazan versus lansoprazole in terms of erosive oesophagitis healing rate at 8 weeks.
41.
Li MJ, Li Q, Sun M, Liu LQ. Comparative effectiveness and acceptability of the FDA-licensed proton pump inhibitors for erosive esophagitis: a PRISMA-compliant network meta-analysis. Medicine (Baltimore) 96(39), e8120 (2017).
PubMed
Google Scholar
42.
Friedenberg FK, Hanlon A, Vanar V et al. Trends in gastroesophageal reflux disease as measured by the National Ambulatory Medical Care Survey. Dig. Dis. Sci. 55(7), 1911–1917 (2010).
PubMed
Google Scholar
43.
Halpern R, Kothari S, Fuldeore M et al. GERD-related health care utilization, therapy, and reasons for transfer of GERD patients between primary care providers and gastroenterologists in a US managed care setting. Dig. Dis. Sci. 55(2), 328–337 (2010).
PubMed
Google Scholar
44.
Tytgat GN. Shortcomings of the first-generation proton pump inhibitors. Eur. J. Gastroenterol. Hepatol. 13(Suppl. 1), S29–S33 (2001).
PubMed
Google Scholar
|