Vonoprozan Compared to PPIs for Peptic Ulcer Rebleeding Prevention

Vonoprazan proved noninferior to intravenous proton pump inhibitors (PPI) in preventing rebleeding in patients with high-risk peptic ulcers, according to a recent study published in Gastroenterology.

A multicenter, randomized, noninferiority trial was conducted across 6 centers. After undergoing pre-endoscopic and endoscopic therapy, patients with high-risk peptic ulcers (Forrest class Ia/Ib, IIa/IIb) were randomized to receive either vonoprazan (20 mg twice daily for 3 days, then once daily for 28 days) or high-dose PPI (pantoprazole intravenous infusion followed by oral omeprazole). The primary outcome was the 30-day rebleeding rate; secondary outcomes included rebleeding rates at 3 and 7 days, mortality, rescue therapy, blood transfusions, length of hospital stay, and safety.

Among 194 patients, baseline characteristics were similar between the 2 groups. The 30-day rebleeding rates were 7.1% in the vonoprazan group and 10.4% in the PPI group, confirming vonoprazan’s noninferiority (within a 10% margin) to PPI with a risk difference of -3.3%. The 3-day and 7-day rebleeding rates were also noninferior. Additionally, secondary outcomes, including mortality, need for rescue therapy, and hospital stay, were comparable between the 2 treatment groups.

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Reference
Geeratragool T, Kaosombatwattana U, Boonchote A, et al. Comparison of vonoprazan versus intravenous proton pump inhibitor for prevention of high-risk peptic ulcers rebleeding after successful endoscopic hemostasis: A multicenter randomized noninferiority trial. Gastroenterology. 2024;167(4):778-787.e3. doi:10.1053/j.gastro.2024.03.036