Ochiai Yorinari, Kikuchi Daisuke, Hoteya Shu
Department of Gastroenterology, Toranomon Hospital, Tokyo, Japan.
Department of Gastroenterology, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan.
Gastroenterol Res Pract. 2024 Nov 14;2024:5620034. doi: 10.1155/grp/5620034. eCollection 2024.
Patient-reported outcomes (PROs) are becoming pivotal in managing gastroesophageal reflux disease (GERD). Current Japanese guidelines for GERD recommend vonoprazan (VPZ) as a treatment option for mild reflux esophagitis (RE). However, it has been hypothesized that 4 weeks of VPZ 20 mg is not always necessary for mild RE if the treatment outcome is based on patient symptoms. This study is aimed at elucidating the efficacy of a new tapering therapeutic strategy (step-down therapy) using VPZ for symptomatic mild RE based on PRO. This multicenter retrospective study examined VPZ's efficacy for step-down therapy between October 2021 and November 2022. Included were 63 consecutive patients from the outpatient clinics of Toranomon Hospital and Toranomon Hospital Kajigaya with symptoms associated with RE (frequency scale for the symptoms of GERD (FSSG) scores ≥ 8 points) and mild RE classified as the Los Angeles Classification Grade A or B. Step-down therapy was defined as a treatment period of 28 days. VPZ 20 mg was administered as the initial treatment. Afterward, patients were allowed to step down to VPZ 10 mg if their symptoms improved, and VPZ could be discontinued if symptoms disappeared. If symptoms worsened, the dosage could be increased from 10 to 20 mg VPZ, or VPZ could be restarted at 20 mg after discontinuation. The proportion of patients whose FSSG scores decreased by ≥ 3 points with step-down therapy was 76.2% (48/63 patients). The median FSSG scores before and after step-down therapy were 13 (range, 8-35) and 7 (range, 0-29), respectively ( < 0.01). Overall, 71.4% (45/63) of the patients stepped down from 20 to 10 mg VPZ, and 46% (29/63) of the patients discontinued VPZ. Step-down therapy using VPZ may be a viable treatment option for symptomatic patients with mild RE.
患者报告结局（PROs）在胃食管反流病（GERD）的管理中变得至关重要。日本目前的GERD指南推荐沃克（VPZ）作为轻度反流性食管炎（RE）的一种治疗选择。然而，有人推测，如果治疗结果基于患者症状，对于轻度RE，使用20毫克VPZ治疗4周并非总是必要的。本研究旨在阐明基于PRO采用VPZ的新型减量治疗策略（逐步递减疗法）对有症状的轻度RE的疗效。这项多中心回顾性研究在2021年10月至2022年11月期间考察了VPZ在逐步递减疗法中的疗效。纳入了来自东京虎之门医院和东京虎之门医院柏叶分院门诊的63例连续患者，这些患者有与RE相关的症状（胃食管反流病症状频率量表（FSSG）评分≥8分）且轻度RE被分类为洛杉矶分级A级或B级。逐步递减疗法定义为为期28天的治疗期。初始治疗给予20毫克VPZ。之后，如果患者症状改善，允许其减量至10毫克VPZ；如果症状消失，VPZ可以停药。如果症状恶化，剂量可从10毫克增加至20毫克VPZ，或者停药后可重新开始使用20毫克VPZ。采用逐步递减疗法FSSG评分降低≥3分的患者比例为76.2%（48/63例患者）。逐步递减疗法前后FSSG评分的中位数分别为13分（范围8 - 35分）和7分（范围0 - 29分）（<0.01）。总体而言，71.4%（45/63）的患者从20毫克VPZ减量至10毫克VPZ，46%（29/63）的患者停用了VPZ。对于有症状的轻度RE患者，采用VPZ的逐步递减疗法可能是一种可行的治疗选择。
