CLINICAL QUESTION

Is vonoprazan (Voquezna) more effective than proton pump inhibitors (PPIs) for the prevention and treatment of peptic ulcers?

BOTTOM LINE

Vonoprazan ($600/month) was no better than much less expensive PPIs for the prevention and treatment of gastric and duodenal ulcers. (Level of Evidence = 1a)

SYNOPSIS

Vonoprazan is the only potassium-competitive acid blocker approved by the US Food and Drug Administration. It is indicated for the treatment of erosive esophagitis and as part of regimens to eradicate Helicobacter pylori. The authors of the meta-analysis searched Medline, Cochrane, and EMBASE and identified 15 randomized controlled trials that compared vonoprazan with a PPI. The most common comparator was lansoprazole, 30 mg. Ten studies (n = 1,025 patients) evaluated treatment of ulcers that occurred after endoscopic submucosal dissection was performed to remove a suspicious gastric lesion. Two studies evaluated the treatment of gastric and duodenal ulcers (n = 1,621 patients), and two studies evaluated the prevention of ulcer recurrence (n = 1,263 patients). The risk of bias was high for the studies that evaluated ulcers due to endoscopic submucosal dissection because this was not an approved indication; other aspects of the study designs were at low risk of bias. Overall, vonoprazan was no better than PPIs for ulcer healing or shrinkage rates at any point between 2 and 8 weeks; this was true for ulcers due to endoscopic submucosal dissection and for naturally occurring gastric and duodenal ulcers. There was also no difference in the prevention of peptic ulcers at 24 weeks (relative risk [RR] = 0.48; 95% CI, 0.18–1.27 for 10 mg and RR = 0.60; 95% CI, 0.28–1.30 for 20 mg). There was no difference in safety outcomes, including risks of delayed bleeding or perforation.