What question did this study set out to answer?

This research aims to evaluate the efficacy of various potassium-competitive acid blockers compared to proton pump inhibitors in treating erosive esophagitis in GERD patients.

January 27, 2026

The Efficacy of Keveprazan, Vonoprazan, and Lansoprazole for the Treatment of Gastroesophageal Reflux Disease: A Network Meta-Analysis

Key Points

This research aims to evaluate the efficacy of various potassium-competitive acid blockers compared to proton pump inhibitors in treating erosive esophagitis in GERD patients.
Conducted a network meta-analysis of randomized controlled trials.
Included studies retrieved from PubMed, Embase, and CENTRAL from 1990 to 2022.
Compared oral treatments: 20 mg keveprazan, 10-40 mg vonoprazan, and 30 mg lansoprazole.
Analyzed efficacy and safety across different follow-up periods.
20 mg vonoprazan outperformed 30 mg lansoprazole in achieving erosive esophagitis healing at 2 weeks.
40 mg vonoprazan demonstrated greater efficacy than lower doses of vonoprazan.
Both vonoprazan and lansoprazole were less effective in severe reflux disease.
20 mg vonoprazan led to a significant reduction in serum gastrin and pepsinogen I levels.

Abstract

Background: Novel potassium-competitive acid blockers (P-CABs) are recognized to have more potent acid-suppressive efficacy than proton pump inhibitors (PPIs). This study comprehensively summarizes the clinical evidence regarding P-CABs in patients with gastrooesophageal reflux disease (GERD), with a particular focus on erosive oesophagitis (EO). Methods: A network meta-analysis was carried out by retrieving randomized controlled trials of P-CABs and PPIs for the management of EO patients from PubMed, Embase, and CENTRAL between January 1st, 1990, and November 19th, 2022. The selected participants received oral treatment with 20 mg keveprazan (KPZ), 10-40 mg vonoprazan (VPZ), or 30 mg lansoprazole (LPZ), once daily for 2-8 weeks. We compared the efficacy and safety of KPZ, VPZ, and LPZ at different doses and follow-up time points in EO patients. Results and Discussions: From 183 initially identified citations, six eligible studies were included, encompassing 2,864 participants. Robust evidence indicated that 20 mg VPZ was superior to 30 mg LPZ in achieving EO healing at the 2-week follow-up. Furthermore, 40 mg VPZ demonstrated greater efficacy than 5 mg VPZ. Both 20 mg VPZ and 30 mg LPZ were less effective in patients with severe reflux disease (LA classification C/D) than in those with mild disease (A/B). Additionally, 20 mg VPZ was more effective than 30 mg LPZ in reducing serum gastrin and pepsinogen I levels after 4 weeks of intervention. Notably, 20 mg KPZ was associated with a higher incidence of treatment-emergent adverse events (TEAEs) compared to 40 mg VPZ. Conclusion: In patients with EO, both 20 mg VPZ and 30 mg LPZ demonstrated relatively lower efficacy in subtypes C/D compared to subtypes A/B. Furthermore, 8-week interventions with either 20 mg VPZ or 30 mg LPZ provided significantly greater clinical benefit compared to 2-week regimens. Notably, 40 mg VPZ was associated with the lowest incidence of TEAEs, as well as TEAEs occurring in at least 2% of patients (TEAEs ≥2%).

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