Vonoprazan can be suitable replacement for lansoprazole in treating erosive esophagitis
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Reviewed by Dat Tien Nguyen, B.A, ScM.
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Posted on October 24th, 2022
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Proton pump inhibitors (PPI), such as lansoprazole, are the gold standard therapy for erosive esophagitis; however, prior study had reported a failure rate range between 5% and 20% that increased to 30% with those with severe esophagitis. Thus, alternative therapies should be used for these patients; potassium-competitive acid blocker (PCAB) is a possible substitute. With a longer half life and a wider spectrum of action, PCAB can be an effective treatment. A multi-site study had compared the efficacy between lansoprazole and a PCAB in the form of vonoprazan.
The study included 1024 patients from the United States and Europe that had been diagnosed with erosive esophagitis by endoscopy. They were randomly assigned to receive either Vonoprazan 10 mg, Vonoprazan 20 mg, or Lansoprazole 15 mg. The patients were instructed to take their respective medications daily, 30 minutes before the morning meal, for 24 weeks. The study found that both treatments - at both dosage - were equally effective at induced healing after 8 and 24 weeks of therapy. For patients diagnosed with Grade C and D on the Los Angeles Esophagitis Grading Scale, vonoprazan is more effective at healing the ulcerated area than the lansoprazole at week 2 and 8 in these severe cases. In addition, the PCAB is non-inferior in preventing the occurrence of heartburn in 24 hour after the initiation of treatment. However, this resolution is not sustained beyond the 3rd day of therapy.
The study included 1024 patients from the United States and Europe that had been diagnosed with erosive esophagitis by endoscopy. They were randomly assigned to receive either Vonoprazan 10 mg, Vonoprazan 20 mg, or Lansoprazole 15 mg. The patients were instructed to take their respective medications daily, 30 minutes before the morning meal, for 24 weeks. The study found that both treatments - at both dosage - were equally effective at induced healing after 8 and 24 weeks of therapy. For patients diagnosed with Grade C and D on the Los Angeles Esophagitis Grading Scale, vonoprazan is more effective at healing the ulcerated area than the lansoprazole at week 2 and 8 in these severe cases. In addition, the PCAB is non-inferior in preventing the occurrence of heartburn in 24 hour after the initiation of treatment. However, this resolution is not sustained beyond the 3rd day of therapy.