Does voquezna affect kidney function similarly to pantoprazole?

Vonoprazan's Effect on Kidney Function Compared to Pantoprazole

Vonoprazan (Voquezna) appears to have a more favorable renal safety profile compared to pantoprazole, which has been associated with a decline in kidney function over time.

Evidence on Pantoprazole's Renal Effects

• Recent data from a post hoc analysis of the COMPASS trial showed that pantoprazole led to a statistically significant faster rate of eGFR decline compared to placebo (0.27 ml/min per 1.73 m² per year greater decline) 1
• This study included nearly 9,000 participants followed for a mean duration of 3.3 years, providing substantial evidence of pantoprazole's negative effect on kidney function 1
• The odds ratio for incident chronic kidney disease with pantoprazole use was 1.11, though this did not reach statistical significance 1

Vonoprazan's Renal Profile

• Vonoprazan (Voquezna) is a potassium-competitive acid blocker (PCAB) with improved pharmacodynamic and pharmacokinetic properties compared to proton pump inhibitors like pantoprazole 2
• Unlike some medications that require dose adjustments in renal impairment, vonoprazan does not have specific renal dosing recommendations in the available literature, suggesting less concern about renal effects 2
• The most common adverse events reported with vonoprazan include abdominal pain, constipation, diarrhea, nausea, and dyspepsia - notably absent are renal-related adverse events 2

Considerations for Medication Use in Renal Impairment

• Medications primarily eliminated by the kidneys typically require dose adjustments in patients with renal insufficiency to prevent accumulation and toxicity 3
• The risk of adverse effects with many medication classes increases in patients with renal insufficiency, particularly when dosing is not appropriately individualized 3
• Proton pump inhibitors like pantoprazole have been shown to have altered pharmacokinetics in patients with renal dysfunction, which may contribute to their renal effects 4

Clinical Implications

• When prescribing acid-suppressing medications for patients with existing renal impairment or at risk for kidney disease, vonoprazan may be preferred over pantoprazole based on current evidence 1, 2
• For patients already on pantoprazole who have declining kidney function without clear cause, consider switching to vonoprazan as an alternative therapy 1
• Regular monitoring of renal function is advisable for patients on long-term acid suppression therapy, particularly those taking pantoprazole 1

Limitations and Caveats

• Direct head-to-head studies comparing the renal effects of vonoprazan versus pantoprazole are currently lacking 2
• The mechanism by which pantoprazole affects kidney function is not fully understood and requires further investigation 1
• As vonoprazan is relatively new to the market, long-term safety data beyond clinical trials is still accumulating 2

In conclusion, current evidence suggests that vonoprazan has less impact on kidney function than pantoprazole, making it a potentially safer option for patients with or at risk for renal impairment who require acid-suppressing therapy.