Comparison of the early effects of vonoprazan, lansoprazole and famotidine on intragastric pH: a three-way crossover study

Ohkuma, Kanji; Iida, Hiroshi; Inoh, Yumi; Kanoshima, Kenji; Ohkubo, Hidenori; Nonaka, Takashi; Fujita, Koji; Kusakabe, Akihiko; Inamori, Masahiko; Nakajima, Atsushi

doi:10.3164/jcbn.17-128

Cited by 19 publications

(15 citation statements)

References 34 publications

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“…In contrast to esomeprazole (and other PPIs), the antisecretory activity of vonoprazan was not dependent on the CYP2C19 genotype [29]. When compared with a PPI (lansoprazole, 30 mg) or an H 2 RA (famotidine, 20 mg) in H. pylori-negative healthy volunteers, the rise of intragastric pH with vonoprazan (20 mg) was higher and faster [30]. The acid inhibitory effect of vonoprazan (20 mg) was also more rapid and sustained than that of esomeprazole (20 mg) or rabeprazole (10 mg) in patients, who were CYP2C19 extensive metabolizers.…”

Section: ••]mentioning

confidence: 84%

Acid Suppressant Therapy: a Step Forward with Potassium-Competitive Acid Blockers

Scarpignato

Hunt

2021

Curr Treat Options Gastro

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Purpose of the review The introduction of H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) into clinical practice has been a real breakthrough in the treatment of acid-related diseases. PPIs are now the standard of care for the treatment of gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), Helicobacter pylori infection, NSAID-associated gastroduodenal lesions, and upper gastrointestinal bleeding (UGIB). However, despite their effectiveness, PPIs display some intrinsic limitations, which underlie the unmet clinical needs that have been identified over the past decades. Recent findings To address these needs, new long-acting compounds (such as tenatoprazole and AGN 201904-Z) and new PPI formulations, including instant release omeprazole (IR-omeprazole) and dexlansoprazole modified release (MR), have been developed. However, a major advance has been the development of the potassium-competitive acid blockers (P-CABs), which block the K+,H+-ATPase potassium channel, are food independent, are reversible, have a rapid onset of action, and maintain a prolonged and consistent elevation of intragastric pH. Vonoprazan and tegoprazan are the two marketed P-CABs while two other compounds (namely fexuprazan and X842) are under active development. Available for almost 6 years now, a considerable experience has been accumulated with vonoprazan, the efficacy and safety of which are detailed in this paper, together with the preliminary results of the other members of this new pharmacologic class. Summary Based on the available evidence, erosive reflux disease, H. pylori infection, and secondary prevention of NSAID gastropathy can be considered established indications for vonoprazan and are being explored for tegoprazan and fexuprazan. In the treatment of severe (LA C & D) reflux esophagitis and H. pylori eradication, vonoprazan proved to be superior to PPIs. Other uses of P-CABs are being evaluated, but clinical data are not yet sufficient to allow a definitive answer on its efficacy and possible superiority over the current standard of care (i.e., PPIs). The most notable indication of upper GI (non-variceal) bleeding, where vonoprazan would prove superior to PPIs, has not yet been explored. The safety of P-CABs in the short-term overlaps that of PPIs, but data from long-term treatment are needed.

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Section: ••]mentioning

confidence: 84%

Acid Suppressant Therapy: a Step Forward with Potassium-Competitive Acid Blockers

Scarpignato

Hunt

2021

Curr Treat Options Gastro

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“…Vonoprazan, a new pharmacological PPI that has recently emerged, has also been shown to inhibit acid secretion faster and more strongly than conventional PPIs such as lansoprazole and esomeprazole, and it is suggested that it may affect UBT results. ( 25 , 26 ) On the other hand, pantoprazole, a type of PPI, is reported to have the same antacid mechanism as other PPIs. However, it does not affect the UBT results.…”

Section: Discussionmentioning

confidence: 99%

Influence of acotiamide on <sup>13</sup>C-urea breath test for <i>Helicobacter pylori</i> diagnosis

Mizukami

Katsuta²,

Okamoto

et al. 2020

J. Clin. Biochem. Nutr.

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The Helicobacter pylori infection and functional dyspepsia are often coexisted. The effect of acotiamide, a drug for functional dyspepsia, on the result of Helicobacter pylori diagnosis has yet to be studied. We evaluated the influence of acotiamide on the results of Helicobacter pylori diagnosis in the 13 C urea breath test. Twenty patients with Helicobacter pylori positive functional dyspepsia were treated with 100 mg of acotiamide three times a day for two weeks. Changes in 13 C urea breath test were investi gated before and after administration, and two weeks after administration as the follow up period. The 13 C urea breath test and the medical questionnaire of modified frequency scale for the symptoms of gastroesophageal reflux disease were conducted at every period. Nineteen patients were included for analysis. No patients showed negative in 13 C urea breath test at Weeks 2 and 4. On the symptom scale, dyspepsia and total scores decreased from Week 0 to Week 2 and increased from Week 2 to Week 4, and the improvement rates of the dyspepsia score at Week 2 was 63%. In conclusion, we confirmed that acotiamide is unlikely to influence the result of 13 C urea breath test and it may improve the symptoms of functional dyspepsia during Helicobacter pylori eradication treatment.

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“…Vonoprazan, the first-in-class and most extensively studied potassium-competitive acid blocker (P-CAB), has a more rapid onset of action, longer duration, and more profound acid suppression than PPIs [62]. In clinical trials in Japan, investigators have substituted it for a PPI.…”

Section: Acid Suppression With Potassium-competitive Acid Blockersmentioning

confidence: 99%

“…Included trials were generally of low quality and had a high risk of bias due to lack of blinding and the use of poorly defined combinations and concentrations of probiotic strains [69,70]. Despite these limitations, some multi-strain probiotics may improve eradication rates [62,63], and may help to reduce side effects and thus improve compliance with treatment [69,70]. Probiotics may offer significant potential in this regard; however, further study is needed to elucidate their influence on ongoing H. pylori eradication efforts.…”

Section: Role Of Probiotics In H Pylori Managementmentioning

confidence: 99%

Update on the Management of Helicobacter pylori Infection

Saleem

Howden

2020

Curr Treat Options Gastro

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Purpose of review Our purpose was to provide an update on methods and indications for testing and treatment selection focusing on novel modalities. Recent findings Increasing antibiotic resistance has reduced treatment effectiveness. Antibiotic resistance testing is not widely available in North America where there are insufficient resistance and susceptibility data. Quadruple regimens (bismuth-based or concomitant/non-bismuth-based) have been recommended first-line. A rifabutin-based combination product recently approved by the US Food and Drug Administration is highly effective and should simplify treatment. The potassium-competitive acid blocker vonoprazan is being evaluated as part of dual or triple combination regimens. Molecular-based genotypic testing for antibiotic resistance and an effective H. pylori vaccine remain under development. Summary Inability to test for antibiotic resistance renders treatment selection empiric. However, resistance to rifabutin and amoxicillin remains rare. Effective management continues to comprise appropriate diagnostic testing for active infection, utilization of an effective regimen, and post-treatment testing.

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Comparison of the early effects of vonoprazan, lansoprazole and famotidine on intragastric pH: a three-way crossover study

Cited by 19 publications

References 34 publications

Acid Suppressant Therapy: a Step Forward with Potassium-Competitive Acid Blockers

Acid Suppressant Therapy: a Step Forward with Potassium-Competitive Acid Blockers

Influence of acotiamide on <sup>13</sup>C-urea breath test for <i>Helicobacter pylori</i> diagnosis

Update on the Management of Helicobacter pylori Infection

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