From the Guidelines
Vonoprazan is effective in treating peptic ulcers, but it is not recommended as first-line therapy due to its higher cost and limited availability compared to proton pump inhibitors (PPIs) 1. When considering treatment options for peptic ulcers, it is essential to weigh the benefits and drawbacks of each medication. Vonoprazan, a potassium-competitive acid blocker (P-CAB), has been shown to be noninferior to lansoprazole in healing gastric and duodenal ulcers 1. Key points to consider when treating peptic ulcers with vonoprazan include:
- Vonoprazan 20 mg has been demonstrated to be noninferior to lansoprazole 30 mg in healing gastric ulcers at 8 weeks and duodenal ulcers at 6 weeks 1
- The efficacy of vonoprazan may be affected by the etiology of the ulcer, with higher healing rates observed in HP-associated ulcers compared to idiopathic or nonsteroidal anti-inflammatory drug–related ulcers 1
- Vonoprazan may be useful in patients who have failed PPI treatment or have Zollinger-Ellison syndrome, although more research is needed to support its use in these cases 1
- Vonoprazan has also been shown to be effective in secondary ulcer prophylaxis, with noninferiority to lansoprazole in preventing ulcer recurrence in patients at risk for ulcer recurrence 1 Overall, while vonoprazan is effective in treating peptic ulcers, its use as first-line therapy is not recommended due to its higher cost and limited availability compared to PPIs 1.
From the Research
Treatment of Peptic Ulcers
- Vonoprazan is a potassium-competitive acid blocker that has been studied for its efficacy in treating peptic ulcers 2.
- A systematic review and meta-analysis found that Vonoprazan is not significantly better than proton pump inhibitors (PPIs) in treating and preventing gastric and/or duodenal ulcers 2.
- The healing rates of gastric and/or duodenal ulcers were similar in both Vonoprazan and PPI groups at all weeks, and the recurrence prevention of peptic ulcers was not different between the two groups 2.
Comparison with Other Treatments
- A study compared the efficacy and safety of Vonoprazan with PPIs for peptic ulcer disease or postprocedural artificial ulcers, and found that Vonoprazan is noninferior in healing artificial ulcer and peptic ulcer disease, with a possible statistical advantage in preventing delayed bleeding and drug-induced ulcers 3.
- Another study found that the addition of probiotics to standard triple therapy significantly improves the H. pylori eradication rate and ulcer healing rate among patients with H. pylori-positive peptic ulcer disease 4.
Other Treatment Options
- Chinese patent medicines combined with conventional triple/quadruple therapy have been found to be effective in treating H. pylori-positive peptic ulcers, with some combinations showing higher complete ulcer healing rates and H. pylori eradication rates than others 5.
- Compression therapy is the most effective treatment for venous ulcers, and superficial vein surgery or endovenous interventions can help prevent recurrence 6.