Should potassium-competitive acid blockers replace proton pump inhibitors as first-line therapy for patients with severe (Los Angeles grade C or D) esophagitis?

Article Figures & Data

TABLE 2

Efficacy of vonoprazan and proton pump inhibitors for mucosal healing failure in initial and maintenance treatment of grade C and D esophagitis

	Risk ratio of treatment failure (95% credible interval)^a	SUCRA score
Initial treatment
Compared with vonoprazan 20 mg once daily	1.0	0.89
Keverprazan 20 mg	0.86 (0.14–4.32)	0.87
Dexlansoprazole 60 mg	2.23 (0.97–6.71)	0.66
Esomeprazole 40 mg	1.92 (0.84–5.61)	0.61
Rabeprazole extended release 50 mg	1.75 (0.64–6.28)	0.48
Pantoprazole 40 mg	2.97 (0.94–11.16)	0.29
Lansoprazole 30 mg	2.97 (1.64–6.71)	0.26
Esomeprazole 20 mg	2.99 (0.93–12.33)	0.29
Omeprazole 20 mg	3.5 (1.31–11.79)	0.15
Maintenance treatment
Compared with vonoprazan 20 mg once daily	1.0	0.87
Lansoprazole 30 mg	1.54 (0.24–11.81)	0.73
Vonoprazan 10 mg	3.05 (0.35–36.35)	0.50
Tegoprazan 20 mg	3.44 (0.12–111.46)	0.49
Esomeprazole 20 mg	4.00 (0.23–107.25)	0.44
Lansoprazole 15 mg	6.04 (0.88–63.38)	0.24
Pantoprazole 20 mg	7.38 (0.21–393.95)	0.22

↵^aBold indicates significant differences in treatment failure for lansoprazole 30 mg and omeprazole 20 mg compared with vonoprazan 20 mg in the healing phase; a significant difference in efficacy was not found between vonoprazan and the other proton pump inhibitors.
SUCRA = surface under the cumulative ranking
Adapted with permission from the American College of Gastroenterology. Zhuang Q, Chen S, Zhou X, et al. Comparative efficacy of P-CAB vs proton pump inhibitors for grade C/D esophagitis: a systematic review and network meta-analysis. Am J Gastroenterol 2024; 119(5):803–813. doi:10.14309/ajg.0000000000002714; journals.lww.com/ajg/pages/default.aspx.