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Gastroesophageal reflux disease (GERD) is one of the most common GI disorders affecting patients, with erosive esophagitis being the leading complication. Proton pump inhibitors (PPIs) are currently the mainstay of treatment for erosive esophagitis in Western countries. However, treatment success is limited by recurrence of erosive complications despite continued PPI use, as well as challenges with dosing compliance of PPIs before meals, which is necessary for effective inhibition of active proton pump action.

In this multicenter, double-blinded, randomized controlled trial, recently published in , Laine et al. compared the effectiveness of the PPI lansoprazole (Prevacid) versus vonoprazan (Voquezna), a potassium-competitive acid blocker from a new anti-secretory agent class with more proven potent inhibition of gastric acid compared with PPIs, for mucosal healing and maintenance.

Adults with endoscopically proven erosive esophagitis were randomized to 8 weeks of once-daily vonoprazan 20 mg or lansoprazole 30 mg. Patients with confirmed endoscopic healing were then randomized to vonoprazan 10 mg, vonoprazan 20 mg, or lansoprazole 15 mg daily maintenance for 24 weeks. Among the 1,024 randomized patients, vonoprazan was noninferior to lansoprazole for healing of erosive esophagitis at 8 weeks and superior on subsequent exploratory analysis.

Vonoprazan was also noninferior in heartburn-free days and superior in healing of severe (LA grade C/D) esophagitis at week 2 per secondary analyses. Among 878 patients in maintenance phase, both doses of vonoprazan were noninferior to lansoprazole for maintenance of healing at week 24. Both doses of vonoprazan were also superior to lansoprazole for maintenance of healing of erosive esophagitis of all grades per secondary analyses.

This study suggests that vonoprazan is noninferior and superior to lansoprazole in healing and the maintenance of healing of erosive esophagitis. Clinically, this potent acid-inhibitory agent may be most beneficial for more severe erosive disease (LA grade C/D esophagitis), and can be an effective alternative for those who have failed PPI use.

Laura S. Chiu, MD, MPH, is an assistant professor of medicine at Boston University School of Medicine.

You can read an interview with the lead study author here, and the abstract of the study here.