Is the new potent acid-inhibitory drug vonoprazan effective for healing idiopathic peptic ulcers? A multicenter observational study in Akita Prefecture, Japan

Sugawara, K.; Koizumi, Shigeto; Horikawa, Yohei; Mimori, Nobuya; Tsuji, Takeshi; Ishii, Hajime; Fujimori, Shusei; Onochi, Kengo; Watanabe, Hiroyuki; Iijima, Katsunori

doi:10.1007/s00535-019-01587-5

Cited by 13 publications

(10 citation statements)

References 42 publications

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“…The healing rates were 77.8% and 74.3%, respectively, a figure significantly lower than that achieved in H. pylori-associated ulcer (i.e., 93.5%). These results come from a multicenter, observational study in Akita Prefecture (Japan) [173] and need to be confirmed in a prospective, double-blind, controlled trial. In this study (in which patients with different ulcer pathogenesis were included), the overall healing rate was 85.1%, a value significantly lower than that observed in a phase 3 trial with vonoprazan for ulcer healing [174].…”

Section: Vonoprazan Efficacy In the Treatment Of Nsaid Gastropathymentioning

confidence: 98%

“…1.3-11.5) and NSAID use (OR: 3.0, 95% C.I. 1.1-8.7) were associated with refractoriness [173]. No comparative study versus PPIs has yet been performed, but vonoprazan appeared to be effective in healing a large NSAID-associated, gastric ulcer refractory to 2-month treatment with double-dose PPIs, followed by additional 2 months with PPIs and misoprostol [175].…”

Section: Vonoprazan Efficacy In the Treatment Of Nsaid Gastropathymentioning

confidence: 99%

“…Taking into account the healing efficacy of PPIs in patients with NSAID gastropathy, vonoprazan (20 mg daily, given for 6 weeks in DU and 8 weeks in GU) was evaluated in patients with NSAID ulcers or patients with H. pylori-positive, NSAIDassociated ulcers [173]. The healing rates were 77.8% and 74.3%, respectively, a figure significantly lower than that achieved in H. pylori-associated ulcer (i.e., 93.5%).…”

Section: Vonoprazan Efficacy In the Treatment Of Nsaid Gastropathymentioning

confidence: 99%

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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: Vonoprazan Efficacy In the Treatment Of Nsaid Gastropathymentioning

confidence: 98%

Section: Vonoprazan Efficacy In the Treatment Of Nsaid Gastropathymentioning

confidence: 99%

Section: Vonoprazan Efficacy In the Treatment Of Nsaid Gastropathymentioning

confidence: 99%

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

Scarpignato

Hunt

2021

Curr Treat Options Gastro

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“…Clinical trials of vonoprazan in peptic ulcer disease are summarised in Table 4 38,39 . Vonoprazan 20 mg once‐daily was non‐inferior to lansoprazole 30 mg once‐daily in healing gastric ulcer, although non‐inferiority was not demonstrated for duodenal ulcer healing in their primary analysis.…”

Section: Vonoprazan In Peptic Ulcer Diseasementioning

confidence: 99%

“…Similarly, the healing rate of NSAID‐related ulcers, irrespective of concomitant H pylori infection, was significantly lower than that of simple H pylori ‐associated ulcers. 38 …”

Section: Vonoprazan In Peptic Ulcer Diseasementioning

confidence: 99%

Review article: potassium‐competitive acid blockers for the treatment of acid‐related disorders

Abdel-Aziz

Metz

Howden

2021

Aliment Pharmacol Ther

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SummaryBackgroundPotassium‐competitive acid blockers (P‐CABs) are a novel group of acid‐suppressing medicines for the management of acid‐related disorders.AimsTo review published clinical pharmacology studies and clinical trials of P‐CABs.MethodsWe conducted a comprehensive literature search including Medline (PubMed), EMBASE, Web of Science and the Cochrane Library from inception until November 2020, for studies of the clinical pharmacology of P‐CABs and relevant clinical trials of those that are currently licensed or in development.ResultsMost publications concerned vonoprazan, which forms the bulk of this review. It is currently licensed in some Asian and South American countries and is being developed for North America. In clinically relevant doses, P‐CABs have produced more rapid and profound suppression of intragastric acidity than proton pump inhibitors (PPIs). Vonoprazan was non‐inferior to lansoprazole in healing erosive oesophagitis (2 randomised controlled trials [RCTs] in 1137 subjects) and superior in maintaining remission (1 RCT; 607 subjects). In 2 RCTs (1120 total subjects), both vonoprazan and tegoprazan were non‐inferior to lansoprazole for healing peptic ulcers. Three RCTs and numerous non‐randomised studies have compared vonoprazan‐based and PPI‐based regimens for Helicobacter pylori infection; vonoprazan‐based triple or dual regimens have been highly effective.ConclusionsP‐CABs have some potential advantages over PPIs. To date, most research has been conducted in Asia; results of clinical trials that are underway in the United States and Europe are anticipated in 2021.

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Cost-utility analysis of a ‘vonoprazan-first’ strategy versus ‘esomeprazole- or rabeprazole-first’ strategy in GERD

et al. 2019

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Is the new potent acid-inhibitory drug vonoprazan effective for healing idiopathic peptic ulcers? A multicenter observational study in Akita Prefecture, Japan

Cited by 13 publications

References 42 publications

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

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

Review article: potassium‐competitive acid blockers for the treatment of acid‐related disorders

Cost-utility analysis of a ‘vonoprazan-first’ strategy versus ‘esomeprazole- or rabeprazole-first’ strategy in GERD

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