A PRISMA-compliant systematic review and network meta-analysis depicted that in patients with  erosive esophagitis, Vonoprazan and all the proton-pump inhibitors (PPIs) considerably improved endoscopic cure rates when compared to placebo. For erosive esophagitis, Vonoprazan and PPIs are advised as first-line treatments. But, it is unclear how much first-line therapy is effective and safe, and there is still debate about whether Vonoprazan or a specific PPI should be used to treat erosive esophagitis.

The purpose of this study was to explore safety and effectiveness of Vonoprazan and PPIs in treating esophageal mucosal damage in erosive esophagitis patients. In order to find out randomized controlled studies of PPIs and Vonoprazan for the treatment of reflux esophagitis, pertinent databases were explored. Studies on Vonoprazan or standard-dose PPIs that investigated healing effects in erosive esophagitis and were published in Chinese or English were included. To assess the effectiveness and safety of the treatment, a network meta-analysis was carried out using Stata16.0.

Overall, 11,592 patients along with 41 publications were included. Ilaprazole was rated highest, followed by Esomeprazole, Vonoprazan, Pantoprazole, Lansoprazole, Omeprazole, Rabeprazole, and Placebo according to the surface under the cumulative ranking curve (SUCRA). With regards to the endoscopic cure rate, Vonoprazan and all PPIs considerably outperformed placebo.

None of the PPIs, Vonoprazan, or placebo significantly differed from one another in terms of the frequency of adverse events. No discernible difference was noted in the relative safety of all therapies. However, Ilaprazole, Esomeprazole, and Vonoprazan exhibited more advantages in the repair of mucosal erosion.