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Vonoprazan shows efficacy similar to that of proton pump inhibitors with respect to symptomatic, endoscopic, and histological responses in patients with eosinophilic esophagitis

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Abstract

Background

Eosinophilic esophagitis (EoE) is a chronic allergic disease with esophageal symptoms and intraepithelial eosinophil infiltration. Effects of potassium-competitive acid blockers (P-CABs) on EoE have not been elucidated. We aimed to examine and compare the effects of P-CABs and PPIs on symptomatic, endoscopic, and histological responses of patients with EoE.

Methods

We analyzed 118 EoE patients who received PPI or P-CAB therapy with rabeprazole 10 mg (RPZ10, N = 22), rabeprazole 20 mg (RPZ20, N = 34), esomeprazole 20 mg (EPZ20, N = 25), or vonoprazan 20 mg (VPZ20, N = 33). We evaluated symptomatic responses by classifying the patients into three groups: complete relief, partial relief, and no change. Endoscopic responses were evaluated using the endoscopic reference score (EREFS) following PPI or P-CAB therapy. Histological responses were evaluated by determining eosinophil counts in esophageal biopsy samples and classifying the patients into two groups: complete remission [0/1 eosinophil/high-power field (eos/HPF)] and remission (< 15 eos/HPF).

Results

There were no differences among the therapy groups in terms of clinical characteristics, endoscopic findings, and histological findings of the patients before treatment. The rate of complete relief in clinical symptoms was 54.5% in the RPZ10 group, 64.7% in the RPZ20 group, 72.0% in the EPZ20 group, and 75.7% in the VPZ20 group. There were no significant differences in the therapeutic effect among the therapy groups. Similarly, endoscopic and histological complete remission rates were not significantly different among the therapy groups.

Conclusions

Vonoprazan showed similar efficacy to PPIs in EoE.

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Authors and Affiliations

  1. Department of Gastroenterology, Graduate School of Medicine, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Takuya Kuzumoto, Fumio Tanaka, Akinari Sawada, Yuji Nadatani, Koji Otani, Shuhei Hosomi, Noriko Kamata, Koichi Taira, Yasuaki Nagami, Tetsuya Tanigawa, Toshio Watanabe & Yasuhiro Fujiwara

Authors
  1. Takuya Kuzumoto
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  2. Fumio Tanaka
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  3. Akinari Sawada
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  4. Yuji Nadatani
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  5. Koji Otani
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  6. Shuhei Hosomi
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  7. Noriko Kamata
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  8. Koichi Taira
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  9. Yasuaki Nagami
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  10. Tetsuya Tanigawa
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  11. Toshio Watanabe
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  12. Yasuhiro Fujiwara
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Contributions

Data collection was performed by TK. Data analysis and manuscript writing were performed by TK and FT. This study was designed by YF. YF, AS, YN, KO, SH, NK, KT, YN, TT, and TW revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fumio Tanaka.

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Ethical statement

The study protocol was in accordance with the Declaration of Helsinki and was approved by the institutional review board of the Osaka City University Graduate School of Medicine (September 2018, Protocol number 4141). The need for informed consent has been waived by the institutional review board of the Osaka City University Graduate School of Medicine. We have disclosed the information about this study on our home page on the Internet and the patients had the opportunity to opt-out.

Conflict of interest

All authors have declared no conflict of interest with regard to this manuscript.

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Kuzumoto, T., Tanaka, F., Sawada, A. et al. Vonoprazan shows efficacy similar to that of proton pump inhibitors with respect to symptomatic, endoscopic, and histological responses in patients with eosinophilic esophagitis. Esophagus 18, 372–379 (2021). https://doi.org/10.1007/s10388-020-00783-0

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  • DOI: https://doi.org/10.1007/s10388-020-00783-0

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