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image of The Efficacy of Keveprazan, Vonoprazan, and Lansoprazole for the Treatment of Gastroesophageal Reflux Disease: A Network Meta-Analysis

Abstract

Background

Novel potassium-competitive acid blockers (P-CABs) are recognized to have more potent acid-suppressive efficacy than proton pump inhibitors (PPIs). This study comprehensively summarizes the clinical evidence regarding P-CABs in patients with gastro-oesophageal reflux disease (GERD), with a particular focus on erosive oesophagitis (EO).

Methods

A network meta-analysis was carried out by retrieving randomized controlled trials of P-CABs and PPIs for the management of EO patients from PubMed, Embase, and CENTRAL between January 1st, 1990, and November 19th, 2022. The selected participants received oral treatment with 20 mg keveprazan (KPZ), 10-40 mg vonoprazan (VPZ), or 30 mg lansoprazole (LPZ), once daily for 2-8 weeks. We compared the efficacy and safety of KPZ, VPZ, and LPZ at different doses and follow-up time points in EO patients.

Results and Discussions

From 183 initially identified citations, six eligible studies were included, encompassing 2,864 participants. Robust evidence indicated that 20 mg VPZ was superior to 30 mg LPZ in achieving EO healing at the 2-week follow-up. Furthermore, 40 mg VPZ demonstrated greater efficacy than 5 mg VPZ. Both 20 mg VPZ and 30 mg LPZ were less effective in patients with severe reflux disease (LA classification C/D) than in those with mild disease (A/B). Additionally, 20 mg VPZ was more effective than 30 mg LPZ in reducing serum gastrin and pepsinogen I levels after 4 weeks of intervention. Notably, 20 mg KPZ was associated with a higher incidence of treatment-emergent adverse events (TEAEs) compared to 40 mg VPZ.

Conclusion

In patients with EO, both 20 mg VPZ and 30 mg LPZ demonstrated relatively lower efficacy in subtypes C/D compared to subtypes A/B. Furthermore, 8-week interventions with either 20 mg VPZ or 30 mg LPZ provided significantly greater clinical benefit compared to 2-week regimens. Notably, 40 mg VPZ was associated with the lowest incidence of TEAEs, as well as TEAEs occurring in at least 2% of patients (TEAEs ≥2%).

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2026-01-31

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The Efficacy of Keveprazan, Vonoprazan, and Lansoprazole for the Treatment of Gastroesophageal Reflux Disease: A Network Meta-Analysis
Bentham Science Publishers ; https://doi.org/10.2174/0115680266415138251125112043
/content/journals/ctmc/10.2174/0115680266415138251125112043
/content/journals/ctmc/10.2174/0115680266415138251125112043
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  • Article Type:     Research Article
Keywords: Potassium-competitive acid blocker ; Proton pump inhibitor ; Keveprazan ; Lansoprazole ; Vonoprazan ; Erosive oesophagitis

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