From the Guidelines
Vonoprazan is a potassium-competitive acid blocker (P-CAB) with potent acid suppressive effects.
Key Characteristics of Vonoprazan
- It has a more rapid onset of action and longer duration of acid suppression compared to proton pump inhibitors (PPIs) 1.
- Vonoprazan has been shown to be noninferior to PPIs in the treatment of peptic ulcer disease (PUD) and secondary ulcer prophylaxis 1.
- It has a lower risk of inter-individual pharmacokinetic variation due to its mechanism of action, which is not affected by CYP2C19 polymorphisms 1.
Clinical Uses of Vonoprazan
- Vonoprazan has been studied for the treatment of PUD, including gastric and duodenal ulcers, with healing rates comparable to those of PPIs 1.
- It has also been investigated for secondary ulcer prophylaxis in patients at risk for ulcer recurrence, with results showing noninferiority to PPIs 1.
- Additionally, vonoprazan has been explored as a potential treatment for Helicobacter pylori infection, with preliminary evidence suggesting benefits in first- and second-line dual therapy with amoxicillin 1.
Safety and Efficacy of Vonoprazan
- Randomized trial data indicate that vonoprazan is generally well-tolerated with a short-term and medium-term safety profile comparable to that of PPIs 1.
- However, long-term safety data are limited, and potential risks associated with potent acid suppression, such as elevated serum gastrin levels and increased risk of enteric infections, need to be further evaluated 1.
From the FDA Drug Label
Vonoprazan (as the fumarate), is a potassium-competitive acid blocker. Vonoprazan is a potassium-competitive acid blocker that suppresses basal and stimulated gastric acid secretion at the secretory surface of the gastric parietal cell through inhibition of the H+, K+-ATPase enzyme system in a potassium-competitive manner. It has been characterized as a type of gastric proton-pump inhibitor. 2
From the Research
Definition and Mechanism of Vonoprazan
- Vonoprazan is a novel potassium-competitive acid blocker (P-CAB) that provides reversible acid suppression by preventing K+ from binding to gastric H+/K+-ATPase 3.
- It has a unique mechanism of action that results in superior and more consistent acid suppression compared to traditional proton pump inhibitors (PPIs) 4.
Efficacy of Vonoprazan
- Vonoprazan has been shown to be effective in treating gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), and Helicobacter pylori (H. pylori) infection, with higher eradication rates for H. pylori when used in combination therapies 4, 3.
- It has a high healing rate for GERD and gastric ulcers, with rates of more than 95% and 90%, respectively 3.
- Vonoprazan is also effective in curing PPI-resistant GERD, with a healing rate of 91.7% at week 4 and 88.5% at week 8 5.
Safety Profile of Vonoprazan
- The safety profile of vonoprazan is favorable, with fewer adverse effects and drug interactions compared to PPIs 4.
- Clinical trials have shown that vonoprazan is well-tolerated, with no serious adverse events reported in some studies 5.
- The risk of adverse events, such as delayed bleeding and perforation, is similar to that of PPIs 6.
Comparison to Proton Pump Inhibitors
- Vonoprazan has been compared to PPIs in several studies, with results showing that it has superior efficacy in suppressing gastric acid secretion 4, 3.
- However, one study found that vonoprazan is not significantly better than PPIs in treating and preventing gastric and/or duodenal ulcers 6.
- Another study found that vonoprazan is effective in controlling symptomatic PPI-resistant GERD, with improved symptoms and quality of life 7.