Summary

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• Voquezna (vonoprazan) is indicated for the healing of all grades of erosive esophagitis and relief of heartburn associated with erosive esophagitis in adults; maintaining the healing of all grades of erosive esophagitis and relief of heartburn associated with erosive esophagitis in adults; treatment of Helicobacter pylori (H. pylori) infection in adults in combination with amoxicillin and clarithromycin; and treatment of H. pylori infection in adults in combination with amoxicillin.
• This summary is based on the review of 35 systematic review(s)/meta-analysis(es). ^[1-35]
• Artificial Ulcers Post-ESD: Vonoprazan significantly reduced the rate of delayed postoperative bleeding compared to PPIs (RR = 0.46, 95% CI = 0.23-0.91, P = 0.03). No significant differences were found in ulcer healing, shrinkage rates, or ulcer perforation rates.
• Helicobacter pylori Eradication: Vonoprazan-based regimens had higher eradication rates than bismuth quadruple therapy in both ITT (90.28% vs. 83.64%) and PP analyses (94.80% vs. 89.88%). VA dual therapy was effective (85.0% ITT, 90.0% PP), superior to PPI-based triple therapy (82.0% vs. 71.4% ITT) but less effective than vonoprazan-containing quadruple therapy (83.1% vs. 93.3%).
• Erosive Esophagitis (EE): Vonoprazan 20 mg outperformed lansoprazole 30 mg in healing severe EE (LA Grade C/D) at all observed weeks (e.g., Week 2 RR 1.294). The healing rates were comparable in mild EE, but vonoprazan was more effective in severe EE at two weeks.
• PPIs-Resistant GERD: Vonoprazan was highly effective in healing and maintaining PPI-resistant EE and showed moderate efficacy in improving FSSG scores.
• No significant differences were found in the incidence of adverse events between vonoprazan and PPIs for artificial ulcers post-ESD.
• Vonoprazan-based regimens exhibited a lower rate of adverse events compared to bismuth quadruple therapy in Helicobacter pylori eradication (14.50% vs. 25.89%).
• Vonoprazan 20 mg had a similar safety profile to lansoprazole 30 mg for erosive esophagitis, with comparable incidence rates of any adverse events, serious adverse events, and drug-related adverse events between the two treatments.
• Subgroup analysis indicated that 7-day VA dual therapy for H. pylori eradication had lower eradication rates compared to 10-day and 14-day regimens. Differences in efficacy were observed in Erosive Esophagitis based on the severity (mild vs. severe). In Nocturnal Acid Breakthrough, subgroup differences were noted based on language classification, study design, age, BMI, continent, disease status, duration of therapy, and time of administration. There were no specific safety concerns across different subgroups for Artificial Ulcers Post-ESD, Erosive Esophagitis, or PPIs-Resistant GERD.