Potassium-competitive Acid Blockers Versus Proton Pump Inhibitors for Erosive Esophagitis: A Systematic Review and...

Area of Science:

• Gastroenterology
• Pharmacology
• Clinical Medicine

Background:

• Potassium-competitive acid blockers (P-CABs) are emerging as alternatives to proton pump inhibitors (PPIs) for treating erosive esophagitis (EE).
• This study compares the efficacy and safety of P-CABs and PPIs in patients with mild to severe EE, stratified by treatment phase.

Purpose of the Study:

• To compare the efficacy and safety of P-CABs versus PPIs in treating erosive esophagitis (EE).
• To stratify findings by treatment phase (initial vs. maintenance) and EE severity.

Main Methods:

• A systematic literature search of PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials.
• Inclusion of randomized controlled trials comparing P-CABs and PPIs for EE.
• Frequentist network meta-analysis to calculate pooled risk ratios (RRs) and risk differences, with P-scores for treatment ranking.

Main Results:

• Nineteen studies involving 5 P-CABs and 2 PPIs were analyzed.
• P-CABs showed superior healing efficacy in the initial phase, especially for severe EE (RR = 1.10).
• P-CABs demonstrated lower EE recurrence risk during maintenance (RR = 0.59), with vonoprazan ranking highest.

Conclusions:

• P-CABs, particularly vonoprazan, exhibit superior efficacy over PPIs in both initial and maintenance treatment of EE.
• Findings support P-CABs as a reliable first-line option for EE management, especially in high-risk patients.
• Comparable safety profiles between P-CABs and PPIs were observed.