P2810 - Vonoprazan Use Is Associated With Lower Hospitalization and Bleeding Rates in Patients With Erosive Esophagitis Compared to Proton Pump Inhibitors: A Multinational Real-World Analysis

Do Han Kim, MD, MSc¹, Donghyun Ko, MD, MSc², Carlos G. Diola, MD¹, Jose A. Porres, MD³, Carlos Elizondo Alatorre, MD⁴, Paul T. Kroner, MD, MSc⁵, Pedro Palacios Argueta, MD⁶, Frank J. Lukens, MD⁷, Juan E.. Corral, MD, MPH⁸
1Icahn School of Medicine at Mount Sinai, New York, NY; 2Department of Medicine, Bridgeport Hospital, Yale New Haven Health, Bridgeport, CT, USA, Bridgeport, CT; 3Universidad Francisco Marroquin, School of Medicine, Guatemala City, Guatemala, Guatemala, Sacatepequez, Guatemala; 4NYC Health + Hospitals/Metropolitan, New York, NY; 5Department of Gastroenterology, Riverside Health System, Newport News, VA, USA, Newport News, VA; 6Thomas Jefferson University Hospital, Philadelphia, PA; 7Mayo Clinic, Jacksonville, FL; 8Gastroenterology and Liver Center, Prisma Health, Greenville, South Carolina, USA., Greenville, SC

Introduction: Prior studies have found vonoprazan, a potassium-competitive acid blocker, is non-inferior compared to standard-dose proton pump inhibitors (PPIs) for the management of erosive esophagitis. Erosive esophagitis is a common gastroesophageal condition traditionally managed with proton pump inhibitors (PPIs), which carry well-documented risks including increased hospitalization and bleeding rates. However, large-scale comparative data on clinical outcomes between vonoprazan and PPIs in erosive esophagitis patients remain limited. This study evaluates clinical outcomes in patients with erosive esophagitis treated with either vonoprazan or PPI.

Methods: We conducted a retrospective cohort study using the TriNetX Global Research Network. Adult patients with erosive esophagitis were identified and stratified based on vonoprazan or PPI use. Propensity score matching (1:1) was performed, balancing for demographics, comorbidities, and concomitant medications. Outcomes included hospitalization, bleeding, acute kidney injury (AKI), infection by Clostridium difficile, pneumonia, dysphagia, and diarrhea. Hazard ratio (HR) and 95% confidence intervals (95%CI) were calculated to quantify the associations between variables.

Results: A total of 103,945 adult patients with erosive esophagitis were identified, of whom 1,452 (1.4%) were on vonoprazan. After matching, 1,448 patients on vonoprazan (mean age 63.0 years, 55.2% female) were compared to 1,448 on PPI (mean age 63.1 years, 54.1% female). Vonoprazan therapy was associated with significantly lower risk of hospitalization (HR:0.28, 95%CI: 0.20-0.38), bleeding (HR:0.36, 95%CI: 0.17-0.78), and AKI (HR:0.17, 95%CI: 0.07-0.45) at 90 days. Similar trends were observed over 30 days. No significant differences were observed in infection by Clostridium difficile, pneumonia, dysphagia, and diarrhea.

Discussion: In patients with erosive esophagitis, vonoprazan was associated with substantially reduced risk of hospitalization, bleeding, and AKI in the short- and long-term compared to PPI therapy. These findings suggest vonoprazan may offer superior clinical outcomes with similar tolerability than traditional PPI therapy. Nonetheless, clinical decision-making should remain individualized and further prospective studies are needed to confirm these findings.


Figure: Outcomes of Vonoprazan versus Proton Pump Inhibitor Use in Patients with Erosive Esophagitis

Disclosures:
Do Han Kim indicated no relevant financial relationships.
Donghyun Ko indicated no relevant financial relationships.
Carlos Diola indicated no relevant financial relationships.
Jose Porres indicated no relevant financial relationships.
Carlos Elizondo Alatorre indicated no relevant financial relationships.
Paul Kroner indicated no relevant financial relationships.
Pedro Palacios Argueta indicated no relevant financial relationships.
Frank Lukens indicated no relevant financial relationships.
Juan Corral indicated no relevant financial relationships.

Do Han Kim, MD, MSc¹, Donghyun Ko, MD, MSc², Carlos G. Diola, MD¹, Jose A. Porres, MD³, Carlos Elizondo Alatorre, MD⁴, Paul T. Kroner, MD, MSc⁵, Pedro Palacios Argueta, MD⁶, Frank J. Lukens, MD⁷, Juan E.. Corral, MD, MPH⁸. P2810 - Vonoprazan Use Is Associated With Lower Hospitalization and Bleeding Rates in Patients With Erosive Esophagitis Compared to Proton Pump Inhibitors: A Multinational Real-World Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.