Vonoprazan bests PPI in erosive oesophagitis

Treatment with vonoprazan leads to superior healing and maintenance of healing than the proton pump inhibitor (PPI) lansoprazole in patients with erosive oesophagitis, a new study has found.

The randomized trial included 1,024 patients for the analysis of healing and 893 healed patients for the analysis of maintenance. In the healing phase, vonoprazan was given at once-daily 20-mg doses, while the comparator lansoprazole was administered at 30 mg. The interventions lasted for 8 weeks.

For the maintenance of healing, patients were allocated to once-daily vonoprazan at 10- or 20-mg doses or to 15-mg lansoprazole for 24 weeks. The primary endpoint was the percentage of patients with healing and the maintenance of healing, evaluated using endoscopy at weeks 8 and 24, respectively.

In the primary analysis of healing, vonoprazan was noninferior to lansoprazole, an effect that was considered superior in subsequent exploratory analysis (92.9 percent vs 84.6 percent; difference, 8.3 percent, 95 percent confidence interval [CI], 4.5–12.2).

The same was true during the maintenance phase, in which vonoprazan was found to be noninferior to the PPI comparator on primary analysis and superior on secondary analysis (20-mg dose: difference, 8.7 percent, 95 percent CI, 1.8–15.5; 10-mg dose: difference, 7.2 percent, 95 percent CI, 0.2–14.1 percent).

“The impact of more potent acid inhibition with vonoprazan was seen predominantly in those with more severe esophagitis,” the researchers noted, adding that this finding also validates the value of maximizing acid inhibition in this patient population.