Summary

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• Vonoprazan (Voquezna) is indicated for healing all grades of erosive esophagitis, relief of heartburn associated with erosive esophagitis in adults, and treatment of Helicobacter pylori infection in combination with amoxicillin and clarithromycin or just amoxicillin.
• The information is derived from 35 systematic reviews/meta-analyses.
• In treating severe erosive esophagitis (Los Angeles Grade C/D), vonoprazan 20 mg shows superior efficacy compared to lansoprazole 30 mg but has similar safety profiles and effectiveness for mild cases across different regions.
• For Helicobacter pylori eradication, vonoprazan-based regimens demonstrate higher eradication rates and lower adverse events than traditional PPI-based therapies. Dual therapy with amoxicillin shows fewer adverse events but slightly lower efficacy than triple therapy involving clarithromycin.
• Post-endoscopic submucosal dissection patients benefit more from vonoprazan due to reduced delayed postoperative bleeding and better ulcer shrinkage in H. pylori-positive individuals; however, overall ulcer healing rates are mixed when compared to PPIs.
• Vonoprazan effectively inhibits nocturnal acid production better than other ASDs including traditional PPIs across various subgroups such as age, BMI, and geographical region.
• Safety profile comparisons indicate that vonoprazan has a comparable incidence of adverse events to PPIs. Specific populations like those with peptic ulcer disease may experience higher incidences of certain side effects.
• Population-specific findings highlight that Western populations see greater benefits in severe EE treatment while dual therapy excels particularly against clarithromycin-resistant H. pylori infections; regional differences affect the outcomes significantly.