Comparison of the Use of Vonoprazan and Proton Pump Inhibitors for the Treatment of Peptic Ulcers Resulting from Endoscopic Submucosal Dissection: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND Currently, proton pump inhibitors (PPIs) are the first-line treatment for ulcers resulting from endoscopic submucosal dissection (ESD). Vonoprazan is a new oral potassium-competitive acid blocker (P-CAB). The aim of this systematic review and meta-analysis was to compare the efficacy, safety, and tolerance of vonoprazan with PPIs in the treatment of peptic ulcers resulting from ESD. MATERIAL AND METHODS Published results of randomized clinical trials (RCTs) comparing vonoprazan with PPIs in the treatment of ulcers resulting from ESD were identified up to March 2018. The main clinical endpoints evaluated were healing rate and adverse events. The meta-analysis included quality assessment of the studies, statistical analysis of endpoints, and sensitivity analysis using Revman version 5.3 meta-analysis software. RESULTS Systematic literature review identified seven published studies that included 548 patients. Five studies were published as full-text manuscripts, and two studies were published as abstracts. Meta-analysis of the vonoprazan treatment, compared with PPI treatment, for ESD showed that the pooled relative risk (RR) of healing rate was 0.64 (95% CI, 0.33-1.22) for the 4-week study group and 0.98 (95% CI, 0.84-1.15) for the 8-week study group. The RR for adverse events was 0.65 (95% CI, 0.31-1.38) (P>0.05). No statistical evidence of publication bias was found. CONCLUSIONS The findings of the systematic review and meta-analysis showed that the efficacy of vonoprazan was comparable with PPIs for the treatment of peptic ulcers following ESD. Further studies are required to support the safety and efficacy of vonoprazan compared with different types of PPIs.

Figure 1

Flowchart of the study design and literature search performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [15].

Figure 2

The results of the quality assessment of the enrolled studies.

Figure 3

Meta-analysis of the healing rate and subgroup analysis. (A) Meta-analysis of the healing rate and subgroup analysis in terms of esomeprazole and lansoprazole treatment of patients with ulcers resulting from endoscopic submucosal dissection (ESD). (B) Subgroup analysis at 8 weeks and 4 weeks. VPZ – vonoprazan; PPIs – proton pump inhibitors; ESD – endoscopic submucosal dissection.

Figure 4

Meta-analysis of the bleeding rate and perforation rate. (A) Meta-analysis of the delayed bleeding rate following treatment with vonoprazan (VPZ) and proton pump inhibitors (PPIs) in patients with ulcers resulting from endoscopic submucosal dissection (ESD). (B) Meta-analysis of the perforation rate following treatment with vonoprazan (VPZ) and PPIs in patients with ulcers resulting from ESD. VPZ – vonoprazan; PPIs – proton pump inhibitors; ESD – endoscopic submucosal dissection.

Figure 5

Funnel plot of the findings of the enrolled trials based on healing rate and delayed bleeding rate.