Adverse events of vonoprazan in the treatments of acid-related diseases: a systematic review and meta-analysis

Background and aims: vonoprazan, a novel potassium-com-petitive acid blocking agent, has better clinical outcomes in the treatment of acid-related diseases. However, some adverse events have been associated with vonoprazan for the treatment of acid-associated diseases. Therefore, this systematic review and meta-analysis aimed to explore the safety and tolerability of vonoprazan for acid-associated diseases. Methods: electronic databases were retrieved to determine randomized controlled trials (RCTs) of vonoprazan for ac-id-associated diseases with any adverse effects and discon-tinuation. Results: this systematic review and meta-analysis conform-ing to the selection criteria included 18 RCTs with a total of 7,932 participants. Compared with proton pump inhib-itors, oral vonoprazan treatment showed no significant increase in the incidence of adverse effects (95 % CI = 0.987-1.095, p = 0.141). Diarrhea or loose stools analysis showed that there was a statistically significant difference between vonoprazan and proton pump inhibitors (PPIs) treatment (95 % CI = 0.661-0.966, p = 0.021). However, there was no significant difference in constipation, rash or eruption, nau- sea or vomiting, bloating or abdominal pain, dysgeusia, na- sopharyngitis, neurological disorders, upper respiratorytract infection and abnormal investigations between vonoprazan and PPIs treatment. Conclusion: vonoprazan, which has better tolerability and safety, may significantly decrease diarrhea and loose stools in acid-related patients compared with PPIs. Our meta-anal- ysis led to safer strategies for treating acid-related diseases. More high-quality studies with larger sample sizes are need- ed to further elucidate its efficacy and safety.