Efficacy of Vonoprazan in Nonsteroidal Anti‐Inflammatory Drug‐Induced Ulcer in Terms of Ulcer Recurrence and Gastrointestinal Bleeding: A Systematic Review and Meta‐Analysis

Objective To evaluate the efficacy and safety of vonoprazan therapy as compared to conventional proton pump inhibitors (PPIs) or no vonoprazan for nonsteroidal anti‐inflammatory drug (NSAID)‐induced ulcers. Methods A literature search was conducted across databases (PubMed, Embase, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov). The primary outcome was the risk of ulcer recurrence. Secondary outcomes comprised the risk of gastrointestinal (gastric/duodenal) bleeding; serum gastrin, pepsinogen I, and pepsinogen II levels; and safety. Pooled relative risks (RRs) and mean differences with a 95% confidence interval (CI) were determined, as appropriate, utilizing random effects models. Results A total of 744 articles were screened and three of them were included. The overall proportion of ulcer recurrence with vonoprazan therapy was 1.88% (95% CI: 0.98, 3.6) and the overall proportion of gastrointestinal (gastric/duodenal) bleeding with vonoprazan therapy was 1.03 (95% CI: 0.64, 1.64). As compared to PPI (lansoprazole), vonoprazan treatment led to a significant reduction in the risks of ulcer recurrence (RR: 0.55 (95% CI: 0.31, 0.97), p = 0.04, i 2 = 0 % ) and gastrointestinal bleeding (RR: 0.40 (95% CI: 0.16, 0.97), p = 0.04, i 2 = 0 % ). Vonoprazan treatment led to a dose‐dependent significant increase in serum gastrin, serum pepsinogen I, and serum pepsinogen II levels. There was no significant difference in the risk of any adverse event (RR: 0.99 (95% CI: 0.94, 1.04), p = 0.64, i 2 = 36 % ) following vonoprazan therapy as compared to lansoprazole. The GRADE of evidence was moderate. Conclusion Vonoprazan could significantly reduce the risk of ulcer recurrence and gastrointestinal bleeding as compared to lansoprazole in patients with NSAID‐induced ulcers.