A comparison of efficacy and safety of potassium-competitive acid blocker and proton pump inhibitor in gastric acid-related diseases: A systematic review and meta-analysis

Abstract

Background and aim: Potassium-competitive acid blocker (PCAB) is a recent alternative to proton pump inhibitor (PPI) for potent acid suppression. The current systematic review and meta-analysis aimed to compare the efficacy and safety of PCAB versus PPI in treating gastric acid-related diseases.

Methods: We searched up to June 5, 2022, for randomized controlled trials of gastric acid-related diseases that included erosive esophagitis, symptomatic gastroesophageal reflux disease (GERD), peptic ulcers, and Helicobacter pylori infection. The pooled risk ratio (RR) was evaluated for the efficacy outcome and treatment-emergent adverse events (TEAEs) as the safety outcome. Sensitivity analyses were performed to test the robustness of the study findings.

Results: Of the 710 screened studies, 19 studies including 7023 participants were analyzed. The RRs for the healing of erosive esophagitis with Vonoprazan versus PPI were 1.09 (95% confidence interval [CI] 1.03-1.14), 1.03 (95% CI 1.00-1.07), and 1.02 (95% CI 1.00-1.05) in Weeks 2, 4, and 8, respectively. There were no differences in the improvement of GERD symptoms and healing of gastric and duodenal ulcers between PCAB and PPI. The pooled eradication rates of H. pylori were significantly higher in Vonoprazan versus PPI first-line treatment (RR 1.13; 95% CI 1.04-1.22). The overall RR of TEAEs with Vonoprazan versus PPI was 1.08 (95% CI 0.89-1.31). Overall, the risk of bias was low to some concerns. Furthermore, sensitivity analyses confirmed the robustness of the study's conclusion.

Conclusion: Vonoprazan is superior to PPI in first-line H. pylori eradication and erosive esophagitis but non-inferior in other gastric acid-related diseases. Likewise, short-term safety is comparable in both treatment groups.

Keywords: gastric acid-related diseases; meta-analysis; potassium-competitive acid blocker; proton pump inhibitor; vonoprazan.

Figure 1

Summary of study search and study selection process (flow chart). [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

Bar graphs denoting (a) the crude/pooled healing rate of erosive esophagitis in patients receiving Vonoprazan and PPI and (b) the crude/pooled eradication rate of Helicobacter pylori infection in patients receiving first‐line treatment of () Vonoprazan (PCAB) and () PPI. The healing rate and eradication rate are presented in % with its 95% confidence interval. PCAB, potassium‐competitive acid blocker; PPI, proton pump inhibitor.

Figure 3

Forest plots comparing the healing rates of erosive esophagitis in patients receiving Vonoprazan and PPI at (a) Week 2, (b) Week 4, and (c) Week 8. The RR and 95% CI for each study are presented in logarithmic scale. The pooled RRs are derived from the random‐effects model. CI, confidence interval; PCAB, potassium‐competitive acid blocker; PPI, proton pump inhibitor; RR, risk ratio.

Figure 4

Forest plots comparing the eradication rates of Helicobacter pylori in patients receiving Vonoprazan and PPI as first‐line, second‐line, and third‐line treatment. The RR and 95% CI for each study are presented in logarithmic scale. The pooled RRs are derived from the random‐effects model. CI, confidence interval; PCAB, potassium‐competitive acid blocker; PPI, proton pump inhibitor; RR, risk ratio.

Figure 5

Forest plots comparing the healing rates of gastrointestinal ulcers in patients receiving Vonoprazan and PPI at (a) GU ‐ Week 4, (b) GU ‐ Week 8, (c) DU ‐ Week 4, and (d) DU ‐ Week 8. The RR and 95% CI for each study are presented in logarithmic scale. The pooled RRs are derived from the random‐effects model. CI, confidence interval; DU, duodenal ulcer; GU, gastric ulcer; PCAB, potassium‐competitive acid blocker; PPI, proton pump inhibitor; RR, risk ratio.

Figure 6

Forest plots comparing the treatment‐emergent adverse events in patients receiving Vonoprazan and PPI. The RR and 95% CI for each study are presented in logarithmic scale. The pooled RRs are derived from the random‐effects model. Subgroup analysis was performed based on the specific gastric acid‐related disease. CI, confidence interval; GERD, gastroesophageal reflux disease; PCAB, potassium‐competitive acid blocker; PPI, proton pump inhibitor; RR, risk ratio.