What is vonoprazan (proton pump inhibitor, PPI)?

From the Guidelines

Vonoprazan should not be used as first-line therapy for the treatment or prophylaxis of peptic ulcer disease (PUD) due to its higher costs and limited availability compared to traditional proton pump inhibitors (PPIs) 1. When considering the use of vonoprazan, it is essential to weigh the benefits and drawbacks of this medication. The acid inhibition properties of vonoprazan have been evaluated in the management of PUD, and studies have shown that it is noninferior to lansoprazole for gastric ulcer healing and duodenal ulcers 1. However, the current evidence suggests that vonoprazan may be more suitable for use in patients who have failed PPI treatment or have specific conditions such as Zollinger-Ellison syndrome, although more research is needed to support this indication 1.

Some key points to consider when using vonoprazan include:

• Vonoprazan has been shown to be noninferior to lansoprazole for secondary ulcer prophylaxis in patients at risk for ulcer recurrence, particularly those requiring long-term low-dose aspirin or nonsteroidal anti-inflammatory drug therapy 1.
• The medication has rapid and potent acid inhibition properties, which may be beneficial in patients with bleeding gastroduodenal ulcers and high-risk stigmata, although more evidence is needed to support its use in this population 1.
• Vonoprazan has been found to be noninferior to high-dose PPI for rebleeding at 3 days, 7 days, and 30 days in patients with high-risk stigmata ulcer bleeding 1.

Overall, while vonoprazan may have potential benefits in specific clinical scenarios, its use as first-line therapy for PUD is not recommended due to its higher costs and limited availability compared to traditional PPIs 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Overview of Vonoprazan

• Vonoprazan is a novel potassium-competitive acid blocker that has been evaluated for the treatment of acid-related diseases 2.
• It has been clinically used for the short-term treatment of gastroesophageal reflux disease (GERD), peptic ulcer disease, and Helicobacter pylori (H. pylori) infection in Japan 2.

Efficacy of Vonoprazan

• The healing rate of GERD and gastric ulcers by vonoprazan is more than 95% and 90%, respectively 2.
• Vonoprazan is effective in curing PPI-resistant GERD, with healing rates of 91.7% and 88.5% at weeks 4 and 8, respectively 3.
• It increases H. pylori eradication rate to more than 88% as part of both first-line and second-line therapy 2.
• Vonoprazan has been shown to be more effective than some proton pump inhibitors (PPIs) for patients with severe erosive esophagitis 4, 5.

Safety of Vonoprazan

• Vonoprazan has been shown to be safe and well-tolerated in short-term studies 2.
• Adverse event rates were similar for vonoprazan and PPIs 6.
• Vonoprazan is a safe option for the management of erosive oesophagitis, gastric/peptic ulcers, or peptic ulcers induced by chronic use of aspirin or NSAIDs 6.

Comparison with Proton Pump Inhibitors

• Vonoprazan has been compared to PPIs in several studies, with results showing that it is non-inferior to PPIs as therapy for patients with GERD 5.
• Subgroup analysis has shown that vonoprazan is more effective than some PPIs for patients with severe erosive esophagitis 4, 5.
• The safety outcomes for vonoprazan are similar to those for PPIs 5, 6.