Efficacy of different administration methods of vonoprazan for gastroesophageal reflux disease: a retrospective cohort study.

Vonoprazan, a potassium competitive acid blocker (P-CAB), shows promise for gastroesophageal reflux disease (GERD). On-demand therapy may reduce costs and drug exposure. This study aimed to compare the efficacy of on-demand versus continuous vonoprazan treatment in the initial management of mild GERD. This observational cohort study enrolled patients with non-erosive reflux disease (NERD) and mild reflux esophagitis (LA grade A/B). Patients were allocated to either on-demand or continuous vonoprazan (20 mg/day) treatment for 4 weeks. Primary outcomes were changes in Gastroesophageal Reflux Disease Questionnaire (GerdQ) and Gastroesophageal Reflux Disease Health-Related Quality of Life (GERD-HRQL) scores. Secondary outcomes included treatment satisfaction, complete mucosal healing rate, and 24-week relapse rate. The GerdQ score and GERD-HRQL score of the on-demand treatment group decreased significantly after initial treatment compared with the previous one, with statistical significance (P < 0.001). Moreover, there were no significant differences in GerdQ and GERD-HRQL scores between the two groups after the treatment (P = 0.363, P = 0.037; the significance level was P < 0.025). Satisfaction (75.9% vs. 74.3%), complete mucosal healing rates (61.8% vs. 38.8%), and relapse rates (10.2% vs. 8.9%) were comparable in the on-demand and continuous treatment groups. Age (OR = 1.08, 95% CI: 1.05-1.11, P < 0.001) and alcohol consumption (OR = 4.31, 95% CI: 1.06-17.41, P = 0.04) were influential factors for symptom burden improvement, and treatment allocation (P = 0.069) had no significant effect on symptom burden improvement. Age (OR = 0.94, 95% CI: 0.91-0.96, P < 0.001) and pre-treatment Los Angeles grade B (OR = 3.28, 95% CI: 1.46-7.34, P = 0.004) were predictors of improved quality of life. This study found on-demand vonoprazan demonstrates comparable efficacy to continuous therapy for mild GERD, offering a cost-effective strategy with minimized drug accumulation risks.