Vonoprazan: a promising advancement in proton pump inhibitor therapy

Authors

  • Shanmugapriya Vinayagam Department of Pharmacology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, India
  • Niti Mittal Department of Pharmacology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, India
  • Jyoti Kaushal Department of Pharmacology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20241662

Keywords:

Potassium-competitive acid blocker, Helicobacter pylori regimen, Proton pump inhibitors, Gastroeso-phageal reflux disease, Reflux esophagitis

Abstract

Vonoprazan, a potent potassium-competitive acid blocker (P-CAB), has emerged as a potential therapeutic option for acid-related disorders, particularly gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD). This comprehensive review aims to provide an overview of the efficacy, safety profile, and clinical implications of vonoprazan based on current literature. Efficacy studies have demonstrated vonoprazan's superiority over proton pump inhibitors (PPIs) in achieving effective acid suppression, rapid symptom relief, and promoting mucosal healing in patients with GERD and PUD. Moreover, its long-lasting acid suppression properties offer protection against Helicobacter pylori (H. pylori) infection, presenting it as a potential alternative to traditional triple H. pylori eradication regimens. Safety evaluations reveal a favourable tolerability profile with minimal adverse effects and a lower risk of drug interactions compared to PPIs. However, concerns regarding long-term safety, such as hypomagnesemia and the potential for rebound acid hypersecretion, necessitate further investigation. Additionally, the role of vonoprazan in special populations, such as the elderly and those with renal impairment, warrants exploration. Overall, vonoprazan represents a promising advancement in acid suppression therapy, offering efficacy, safety, and potential advantages over traditional agents.

References

Wang X, Teng G, Dong X, Dai Y, Wang W. Efficacy and safety of vonoprazan-amoxicillin dual therapy for Helicobacter pylori first-line treatment: a single-center, randomized, controlled trial. Therap Adv Gastroenterol. 2023;16:17562848231190976.

Suzuki S, Gotoda T, Kusano C, Ikehara H, Ichijima R, Ohyauchi M, et al. Seven-day vonoprazan and low-dose amoxicillin dual therapy as first-line Helicobacter pylori treatment: a multicentre randomised trial in Japan. Gut. 2020;69(6):1019-26.

Murakami K, Sakurai Y, Shiino M, Funao N, Nishimura A, Asaka M, et al. Vonoprazan, a novel potassium-competitive acid blocker, as a component of first-line and second-line triple therapy for Helicobacter pylori eradication: a phase III, randomised, double-blind study. Gut. 2016;65(9):1439-46.

Haruma K, Kinoshita Y, Yao T, Kushima R, Akiyama J, Aoyama N, et al. Randomised clinical trial: 3-year interim analysis results of the VISION trial to evaluate the long-term safety of vonoprazan as maintenance treatment in patients with erosive oesophagitis. BMC Gastroenterol. 2023;23(1):139.

Yang E, Ji SC, Jang IJ, Lee S. Evaluation of CYP2C19-Mediated Pharmacokinetic Drug Interaction of Tegoprazan, Compared with Vonoprazan or Esomeprazole. Clin Pharmacokinet. 2023;62(4):599-608.

Li J, Lv L, Zhu Y, Zhou Z, He S. A modified 14-day dual therapy with vonoprazan and amoxicillin amplified the advantages over conventional therapies for eradication of helicobacter pylori: a non-inferiority clinical trial. Infect Drug Resist. 2023;16:5637-45.

Chen S, Shen W, Liu Y, Dong Q, Shi Y. Efficacy and safety of triple therapy containing berberine, amoxicillin, and vonoprazan for Helicobacter pylori initial treatment: A randomized controlled trial. Chin Med J (Engl). 2023;136(14):1690-8.

Peng X, Chen HW, Wan Y, Su PZ, Yu J, Liu JJ, et al. Combination of vonoprazan and amoxicillin as the first-line Helicobacter pylori eradication therapy: a multicenter, prospective, randomized, parallel-controlled study. Clin Exp Med. 2023;23(7):4011-9.

Hu Y, Xu X, Liu XS, He C, Ouyang YB, Li NS, et al. Fourteen-day vonoprazan and low- or high-dose amoxicillin dual therapy for eradicating Helicobacter pylori infection: A prospective, open-labeled, randomized non-inferiority clinical study. Front Immunol. 2023;13:1049908.

Lu L, Wang Y, Ye J, Han Y, Lou G, Li Y, et al. Quadruple therapy with vonoprazan 20 mg daily as a first-line treatment for Helicobacter pylori infection: A single-center, open-label, noninferiority, randomized controlled trial. Helicobacter. 2023;28(1):e12940.

Sue S, Kondo M, Sato T, Oka H, Sanga K, Ogashiwa T, et al. Vonoprazan and high-dose amoxicillin dual therapy for Helicobacter pylori first-line eradication: A single-arm, interventional study. JGH Open. 2022;7(1):55-60.

Yang F, Yu B, Qin L, Dai X. A randomized clinical study on the efficacy of vonoprazan combined with amoxicillin duo regimen for the eradication of Helicobacter pylori. Medicine (Baltimore). 2023;102(41):e35610.

Shinozaki S, Osawa H, Hayashi Y, Miura Y, Lefor AK, Yamamoto H, et al. Long-term vonoprazan therapy is effective for controlling symptomatic proton pump inhibitor-resistant gastroesophageal reflux disease. Biomed Rep. 2021;14(3):32.

Kim YI, Lee JY, Kim CG, Park B, Park JY, Choi J, et al. Ten-day bismuth-containing quadruple therapy versus 7-day proton pump inhibitor-clarithromycin containing triple therapy as first-line empirical therapy for the Helicobacter pylori infection in Korea: a randomized open-label trial. BMC Gastroenterol. 2021;21(1):95.

Lin Y, Xu H, Yun J, Yu X, Shi Y, Zhang D. The efficacy of vonoprazan combined with different dose amoxicillin on eradication of Helicobacter pylori: an open, multicenter, randomized clinical study. Ann Transl Med. 2022;10(18):987.

Yu J, Lv YM, Yang P, Jiang YZ, Qin XR, Wang XY. Safety and effectiveness of vonoprazan-based rescue therapy for Helicobacter pylori infection. World J Gastroenterol. 2023;29(20):3133-44.

Ashida K, Honda Y, Sanada K, Takemura Y, Sakamoto S. The safety and effectiveness of vonoprazan-based Helicobacter pylori eradication therapy; a prospective post-marketing surveillance. Expert Opin Drug Saf. 2019;18(12):1255-61.

Feng JH, Cheng J, Lao YJ, Huang K, Mou JL, Hu F, et al. The efficacy and safety of vonoprazan–amoxicillin dual therapy in eradicating helicobacter pylori: A systematic review and meta-analysis. Eur J Med Res. 2023;28(1):272.

Zhang WL, Lin BS, Li YY, Ding YM, Han ZX, Ji R. Efficacy and safety of Vonoprazan and amoxicillin dual therapy for helicobacter pylori eradication: A systematic review and meta-analysis. Digestion, 2023;104(4):249-61.

Liu L, Li F, Shi H, Nahata MC. The efficacy and safety of Vonoprazan and amoxicillin dual therapy for helicobacter pylori infection: A systematic review and network meta-analysis. Antibiotics. 2023;12(2):346.

Rokkas T, Gisbert JP, Malfertheiner P, Niv Y, Gasbarrini A, Leja M, et al. Comparative Effectiveness of Multiple Different First-Line Treatment Regimens for Helicobacter pylori Infection: A Network Meta-analysis. Gastroenterology. 2021;161(2):495-507.e4.

Drug Trials Snapshots: Voquezna Triple Pak, Voquezna Dual PAK. Available at: https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trials-snapshots-vonoprazan-triple-pak-vonoprazan-dual-pak. Accessed on 3 January 2024.

Downloads

Published

2024-06-25

How to Cite

Vinayagam, S., Mittal, N., & Kaushal, J. (2024). Vonoprazan: a promising advancement in proton pump inhibitor therapy. International Journal of Basic & Clinical Pharmacology, 13(4), 573–579. https://doi.org/10.18203/2319-2003.ijbcp20241662

Issue

Section

New Drug Update