Tegoprazan was superior to the proton pump inhibitor (PPI) lansoprazole in rapidly healing all grades of erosive esophagitis (EE), maintenance of healing, and relieving heartburn symptoms in patients with severe EE.

Two oral presentations at Digestive Disease Week (DDW) 2026 highlighted the novel potassium-competitive acid blocker (P-CAB)’s superiority, building on previous reports of positive results from the phase 3 TRIUMpH-EE clinical program.

Greater than 75% of patients were healed by week 2, study authors noted in their abstract.

“These results challenge what we have previously told patients about healing timelines for EE,” Felice Schnoll-Sussman, MD, Weill Cornell Medicine, New York City, told Medscape Medical News.

“Historically, we have framed EE healing as an 8-week process,” she said. “Seeing this endoscopic healing response at 2 weeks reframes what we know is achievable in GERD [gastroesophageal reflux disease] treatment.”

Superior to Lansoprazole

Schnoll-Sussman presented results from TRIUMpH-EE, a multicenter, randomized, double-blind, controlled trial conducted at sites across the US. A total of 1245 eligible patients had endoscopically confirmed EE (Los Angeles [LA] grades Triumph A-D); 463 patients with severe disease (LA grade C/D) were included.

Researchers randomized 623 patients to receive 100 mg tegoprazan once daily (mean age, 53.4 years; 52.6% women; 37.2% with LA grade C/D disease), and 622 to receive 30 mg lansoprazole (mean age, 53.8 years; 52.4% women; 37.1% with LA grade C/D disease) once daily for up to 8 weeks. Follow-up endoscopy was performed at weeks 2 and 8.

The primary endpoint was the proportion of patients with complete EE healing by week 8. Secondary endpoints included 24-hour heartburn-free days, healing of LA grade C/D patients at week 8, healing of LA grade C/D patients at week 2, healing of all patients at week 8, and healing of all patients at week 2.

Safety assessments included treatment-emergent adverse events, adverse events of special interest, and serum gastrin levels.

Tegoprazan met the primary endpoint, demonstrating complete healing at week 8, achieving both noninferiority and superiority (84.6% vs 78.0% with lansoprazole, P < .0001). It also met all secondary endpoints, achieving statistical significance, including superiority, for healing at week 2 (76.4% vs 67.0%).

Tegoprazan also demonstrated significantly higher healing rates in patients with LA C/D than lansoprazole at both week 2 (74.1% vs 54.5%; P < .0001) and week 8 (83.2% vs 68.0%; P = .0002).

Furthermore, tegoprazan was noninferior to lansoprazole for 24-hour heartburn-free days in all patients and demonstrated superior heartburn control in patients with LA C/D (60.9% vs 53.6%).

All adverse events were similar between groups, and below 3%, and mean serum gastrin levels remained within normal limits throughout the study in both arms.

“Tegoprazan 100 mg is the first P-CAB [potassium-competitive acid blocker ] to demonstrate superior healing of EE vs a PPI across all LA grades,” Schnoll-Sussman said. “These healing rates persist in patients with severe disease, [which] is important because the more severe population is where PPIs have historically underperformed.”

“The safety profile is worth noting, [and is] relevant for clinicians weighing long-term prescribing decisions in a class where safety questions have sometimes complicated patient conversations,” she added.

Mechanistically, she explained, “tegoprazan’s pKa of approximately 5.1 allows it to enter parietal cells efficiently, become activated once protonated in the acidic canaliculus, and self-regulate as gastric pH increases. The result is both rapid onset of acid suppression and sustained acid inhibition, without driving nontherapeutic over-suppression.”

In a separate presentation on TRIUMpH-EE at the meeting, C. Prakash Gyawali, MD, Washington University School of Medicine, St. Louis, reported that tegoprazan showed superior sustained healing over 24 weeks than lansoprazole in the maintenance phase of the trial across all LA grades of EE, with greater therapeutic differences in patients with severe EE (LA Grade C/D).

Superior to Vonoprazan?

Mark Malamood, MD, director of Benign Esophagology in the Temple Health Esophageal Disease Program, Philadelphia, said the findings were not surprising.

“There are ample data showing the efficacy of P-CABs from studies evaluating vonoprazan, the first P-CAB to come to market in the United States,” he told Medscape Medical News. “Real-world clinical experience has similarly shown P-CABs to be a powerful tool in treating acid gastroesophageal reflux, and it is expected that more than one agent will prove to be effective.”

A caveat to the current study is the use of lansoprazole for the control arm, as was done in the vonoprazan trials, he noted. “While efficacy across the PPI class is considered relatively equivalent, there are data based off the degree of gastric acid suppression suggesting that lansoprazole is the fourth most potent PPI after rabeprazole, esomeprazole, and omeprazole,” he said. “The findings of this study may have been more compelling if tegoprazan was compared to one of the stronger, and more commonly used, PPIs.”

Malamood also noted that patients with severe EE or difficult-to-control heartburn are often prescribed twice-daily PPI, and that a head-to-head against twice-daily therapy would more accurately reflect real-world clinical practice.

Regarding efficacy, he said, situations in which P-CAB therapy is preferable to PPI therapy include, among others, EE (particularly LA C or D) not responsive to PPI; heartburn despite PPI; and poor gastric acid suppression despite appropriate PPI.

That said, he added, “It is unclear to me [from] this study that tegoprazan offers meaningful advantages compared to vonoprazan.”

A 2024 systematic review and meta-analysis of randomized controlled trials comparing vonoprazan to lansoprazole “showed vonoprazan superiority for healing of LA C/D esophagitis, but only similar efficacy for milder forms” of the disease, he noted. In the current study, tegoprazan did have meaningful and statistically significant superiority compared to lansoprazole for healing of LA C/D esophagitis, he said, “but the touted difference across all severity levels was much more modest.”

Malamood would like to see a head-to-head comparison between tegoprazan and vonoprazan. “Tegoprazan may prove to be just as good, if not better, than vonoprazan in time, but if the claim of unique efficacy for healing of mild erosive esophagitis is its main differentiator, then it is not a very compelling argument.”

The presentations were funded by Braintree Laboratories, Inc. Schnoll-Sussman disclosed advisory or review panel relationships with Ethicon, Inc.; Medtronic plc; Braintree Laboratories, Inc.; Phathom Pharmaceuticals, Inc.; and Implantica AG. Malamood reported having no relevant financial disclosures.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.