Sa170 CIMETIDINE USE IN U.S.: EFFECTS OF FDA WITHDRAWAL OF RANITIDINE AND COVID-19 PANDEMIC

Background: Proton pump inhibitors (PPIs) are recommended as first-line drug treatment for reflux esophagitis (RE).Vonoprazan, a new potassium-competitive acid blocker, demonstrating rapid, potent and sustained acid-inhibitory effects, which may translate into a shorter healing time in patients with RE.The study aims to evaluate relative efficacies of 4-week vonoprazan as compared to 8-week PPIs standard therapy for patients with RE.Methods: A systematic literature search was performed in Medline, EMBASE and the Cochrane Central Register of Controlled Trials on April 20, 2020.Randomized controlled trials reporting healing rates of vonoprazan 20mg at 4 weeks and/or of PPIs (esomeprazole, ilaprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole) in licensed doses at 8 weeks among adults with RE were included.Bayesian network meta-analyses were performed to assess the comparative efficacies in patients with RE of any grade (main analysis) and with severe RE (≥grade 3 on Hetzel-Dent or Savary-Miller scales, or grade C or D on the Los Angeles scale).Odds ratios (OR) and 95% credible intervals (CrI) comparing PPIs versus vonoprazan were reported.Heterogeneity and consistency assessment were implemented.Results: Of 2,546 articles screened, 32 of them were eligible articles which include 3 articles with vonoprazan and 29 ones with PPIs for RE.In the main analysis, 4-week vonoprazan 20mg had comparable efficacy as 8-week PPIs.ORs of esomeprazole 20mg, esomeprazole 40mg, ilaprazole 10mg, lansoprazole 30mg, omeprazole 20mg, omeprazole 40mg, pantoprazole 40mg, rabeprazole 10mg bid and rabeprazole 20mg versus vonoprazan 20mg were 1.48 (0.70-3.06), 1.94 (1.03-3.62),2.25 (0.96-5.11), 1.36 (0.78-2.42), 1.20 (0.64-2.24), 1.52 (0.69-3.41), 1.68 (0.88-3.24), 1.00 (0.31-3.29) and 1.23 (0.58-2.61), respectively.Subgroup analysis among patients with severe RE showed similar results.In both analyses, heterogeneity existed in few comparisons and there was no evidence of inconsistency.Conclusion: This analysis suggested a shorter 4-week course of vonoprazan had comparable efficacy as standard course of PPIs for patients with RE of any grade and severe disease.