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Zhuang Q, Chen S, Zhou X, Jia X, Zhang M, Tan N, Chen F, Zhang Z, Hu J, Xiao Y. Comparative Efficacy of P-CAB vs Proton Pump Inhibitors for Grade C/D Esophagitis: A Systematic Review and Network Meta-analysis. Am J Gastroenterol 2024; 119:803-813. [PMID: 38345252 DOI: 10.14309/ajg.0000000000002714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/30/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Los Angeles grade C/D esophagitis is a severe manifestation of gastroesophageal reflux disease that require active treatment and close follow-up. Potassium competitive acid blockers (P-CAB) are promising alternatives to proton pump inhibitors (PPI). We aimed to compare the efficacy and safety of P-CAB and PPI in healing grade C/D esophagitis to aid clinical decision-making. METHODS A systematic literature search was performed using PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials. Randomized controlled trials were eligible for inclusion if efficacy of P-CAB and PPI in healing grade C/D esophagitis was reported. Pooled risk ratios and risk difference with 95% credible intervals were used to summarize estimated effect of each comparison. The benefit of treatments was ranked using the surface under the cumulative probability ranking score. RESULTS Of 5,876 articles identified in the database, 24 studies were eligible. Studies included incorporated 3 P-CAB (vonoprazan, tegoprazan, and keverprazan) and 6 PPI (lansoprazole, esomeprazole, omeprazole, rabeprazole extended-release (ER), pantoprazole, and dexlansoprazole). Based on the failure to achieve mucosal healing, 20 mg of vonoprazan q.d. ranked the first among PPI in initial and maintained healing of grade C/D esophagitis (surface under the cumulative probability ranking score = 0.89 and 0.87, respectively). Vonoprazan had similar risk of incurring adverse events, severe adverse events, and withdrawal to drug when compared with PPI. For those who attempted lower maintenance treatment dose, 10 mg of vonoprazan q.d. was a reasonable choice, considering its moderate efficacy and safety. DISCUSSION Vonoprazan has considerable efficacy in initial and maintained healing of grade C/D esophagitis compared with PPI, with moderate short-term and long-term safety.
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Affiliation(s)
- Qianjun Zhuang
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Songfeng Chen
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xuyu Zhou
- Medical Information Research Institute, Sun Yat-sen University, Guangzhou, China
| | - Xingyu Jia
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mengyu Zhang
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Niandi Tan
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Fangfei Chen
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhanye Zhang
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junnan Hu
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yinglian Xiao
- Department of Gastroenterology and Hepatology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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He J, Gao Y, Bai G, Wang J, Sun Y. Network meta-analysis of multiple doses of vonoprazan for the treatment of erosive esophagitis. J Comp Eff Res 2023; 12:e220165. [PMID: 37470274 PMCID: PMC10508317 DOI: 10.57264/cer-2022-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 07/04/2023] [Indexed: 07/21/2023] Open
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.
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Affiliation(s)
- Jie He
- Gastrology/Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200000, China
| | - Yuanyuan Gao
- Apartment of Mental disease/Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200000, Shanghai, China
| | - Ge Bai
- Oncology/Shanxi University of Traditional Chinese Medicine, Taiyuan, Shanxi, 030000, China
| | - Jie Wang
- Gastrology/Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200000, China
| | - Yongshun Sun
- Gastrology/Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, 200000, China
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Xu W, Bai Z, Shang Y, Wang J, Wong Y, Qi X. Incidence and type of adverse events in patients taking vonoprazan: A systematic review and meta-analysis. Therap Adv Gastroenterol 2023; 16:17562848231167858. [PMID: 37113190 PMCID: PMC10126681 DOI: 10.1177/17562848231167858] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Background Vonoprazan, a novel acid-suppressive drug, is non-inferior to proton pump inhibitors (PPIs) for the management of gastric acid-related diseases. However, the safety of vonoprazan has not been systematically evaluated yet. Objectives To elucidate the incidence and type of adverse events (AEs) in patients taking vonoprazan. Design Systematic review and meta-analysis. Data sources and methods PubMed, EMBASE, and Cochrane Library databases were searched for all studies reporting the safety of vonoprazan. The incidences of any AEs, drug-related AEs, serious AEs, AEs leading to drug discontinuation, and common AEs were pooled. Odds ratios (ORs) were calculated to compare the incidence of AEs between patients taking vonoprazan and PPIs. Results Seventy-seven studies were included. The pooled incidences of any AEs, drug-related AEs, serious AEs, and AEs leading to drug discontinuation were 20, 7, 1, and 1%, respectively. The incidences of any AEs (OR = 0.96, p = 0.66), drug-related AEs (OR = 1.10, p = 0.44), serious AEs (OR = 1.14, p = 0.36), and AEs leading to drug discontinuation (OR = 1.09, p = 0.55) were not significantly different between patients taking vonoprazan and PPIs. In subgroup analyses, patients with peptic ulcer disease (PUD) had higher incidences of any AEs, serious AEs, and AEs leading to drug discontinuation than those with gastroesophageal reflux disease (GERD), Helicobacter pylori (H. pylori) infection, and artificial ulcer after gastric endoscopic submucosal dissection (ESD), but patients with H. pylori infection had a higher incidence of drug-related AEs than those with PUD, GERD, and artificial ulcer after gastric ESD. The incidence of AEs was higher in patients taking long-term use of vonoprazan than those taking short-term use of vonoprazan. Conclusion Vonoprazan is well tolerated and shows similar safety compared to PPIs. The safety of vonoprazan may be primarily influenced by its indications and duration. Registration PROSPERO CRD42022314982.
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Affiliation(s)
| | | | | | | | - Yujun Wong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
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Leowattana W, Leowattana T. Potassium-competitive acid blockers and gastroesophageal reflux disease. World J Gastroenterol 2022; 28:3608-3619. [PMID: 36161043 PMCID: PMC9372813 DOI: 10.3748/wjg.v28.i28.3608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/24/2022] [Accepted: 06/26/2022] [Indexed: 02/06/2023] Open
Abstract
Proton pump inhibitors (PPIs), the most commonly used antisecretory medi-cations in the management of reflux illness, virtually eliminate elective surgery for ulcer disease, and relegate anti-reflux surgery to patients with gastroesophageal reflux disease (GERD) who are inadequately managed by medical therapy. However, PPI medications still leave some therapeutic demands of GERD unmet. Furthermore, up to 40%-55% of daily PPI users have chronic symptoms, due to PPI refractoriness. Potassium-competitive acid blockers (P-CABs) transcend many of the problems and limits of PPIs, delivering quick, powerful, and extended acid suppression and allowing for treatment of numerous unmet needs. Recently, it has become clear that compromised mucosal integrity plays a role in the etiology of GERD. As a result, esophageal mucosal protection has emerged as a novel and potential treatment approach. An increasing body of research demonstrates that when P-CABs are used as primary drugs or add-on drugs (to regular treatment), they provide a considerable extra benefit, particularly in alleviating symptoms that do not respond to PPI therapy.
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Affiliation(s)
- Wattana Leowattana
- Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Tawithep Leowattana
- Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Bangkok 10110, Thailand
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Xu WT, Xu XB, Ren TS, Qi XS. Vonoprazan for treatment of gastroesophageal reflux disease: Research advances. Shijie Huaren Xiaohua Zazhi 2021; 29:1248-1253. [DOI: 10.11569/wcjd.v29.i21.1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease is a common gastrointestinal disease that can be effectively treated by drugs alone. Proton pump inhibitors are the currently mainstay drugs for the treatment of gastroesophageal reflux disease, but are insufficiently effective. Vonoprazan, which is a new type of drug that inhibits gastric acid secretion, has been employed for the management of gastroesophageal reflux disease. In this article, we comprehensively review the current evidence regarding clinical efficacy and safety of vonoprazan for the treatment of gastroesophageal reflux disease to guide the clinical decision.
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Affiliation(s)
- Wen-Tao Xu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
| | - Xiang-Bo Xu
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
| | - Tian-Shu Ren
- Department of Pharmacy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China
| | - Xing-Shun Qi
- Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China,Postgraduate College, Shenyang Pharmaceutical University, Shenyang 110016, Liaoning Province, China
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Yamashita K, Yamasaki M, Miyazaki Y, Matsuura N, Tanaka K, Makino T, Saito T, Yamamoto K, Takahashi T, Motoori M, Kurokawa Y, Kimura Y, Nakajima K, Eguchi H, Doki Y. Protein-enhanced feeds after esophagectomy for esophageal cancer attenuate postoperative catabolism: a prospective observational study. Surg Today 2021; 52:624-632. [PMID: 34694492 DOI: 10.1007/s00595-021-02389-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/22/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE To evaluate if nutritional supplements can attenuate postoperative catabolism in esophageal cancer patients after radical esophagectomy. METHODS We analyzed data prospectively from 30 patients who underwent curative esophagectomy for esophageal cancer between August and December, 2019. We compared postoperative nitrogen balance and changes in body composition between patients who received protein-enhanced enteral feeds (PEF) or other enteral feeds (OF). RESULTS Postoperative enteral feeding was administered safely to all patients. The average nitrogen balance was significantly higher in the PEF group than in the OF group on postoperative days (PODs) 3 (2.41 vs. - 1.50 g, P = 0.002), 4 (3.74 vs. - 0.08 g, P = 0.006), and 5 (3.27 vs. 0.11 g, P = 0.031). The cumulative nitrogen balance in the 7 days after surgery was significantly higher in the PEF group than in the OF group (6.12 vs. - 8.40 g, P = 0.025). The bodyweight loss and lean body mass loss on POD 14 were equivalent in the two groups (bodyweight loss 3.70 vs. 2.87%, P = 0.25; lean body mass loss, 4.34 vs. 1.91%, P = 0.33). CONCLUSIONS PEF improved the postoperative nitrogen balance significantly in patients who underwent esophagectomy.
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Affiliation(s)
- Kotaro Yamashita
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan.
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
| | | | - Norihiro Matsuura
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kiyokazu Nakajima
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2 Yamada-oka, Suita City, Osaka, 565-0871, Japan
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