Vonoprazan vs proton pump inhibitors in treating post-endoscopic submucosal dissection ulcers and preventing bleeding

[], Martin; Zhou, Yi; Meng, Chun-Xu; Takagi, Tatsuya; Tian, Yinbao

doi:10.1097/md.0000000000019357

Cited by 15 publications

(15 citation statements)

References 40 publications

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“…However, two systematic reviews with meta-analysis [191,192] and a network metaanalysis [193] did not find evidence of any superiority of vonoprazan over PPIs although one of these [191] highlighted a faster ulcer healing with the P-CAB. A more extensive review [194], including both RCTs and observational studies, pointed out that-while the overall ulcer healing rate did not differ between vonoprazan and PPIs-this new antisecretory compound was more effective when treating H. pylori-positive patients with ESD ulcers (Table 7). Almost all the studies evidenced a non-significant trend towards a reduced occurrence of delayed bleeding (see below).…”

Section: Vonoprazan Efficacy In the Treatment Of Peptic Ulcermentioning

confidence: 99%

“…Factors which affected post-ESD bleeding were the type of antisecretory drug (p=0.016) and use of an antithrombotic agent (p=0.014) [215]. The benefit in prevention of delayed bleeding was not confirmed by a subsequent study [216] and by several meta-analyses [190][191][192]194] (Table 7). The equivocal results with no difference between the P-CAB, vonoprazan, and PPIs in preventing rebleeding may result from the antisecretory effects of both drugs raising pH above the pH threshold to heal and prevent rebleeding, especially after the effective coagulation of larger vessels which occurs in properly performed ESD.…”

Section: Vonoprazan Efficacy In the Treatment Of Peptic Ulcermentioning

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 Peptic Ulcermentioning

confidence: 99%

Section: Vonoprazan Efficacy In the Treatment Of Peptic Ulcermentioning

confidence: 99%

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

Scarpignato

Hunt

2021

Curr Treat Options Gastro

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“…This also pertains to patients receiving antithrombotic treatment. There have been six meta‐analyses of studies comparing P‐CABs with PPIs in the prevention of post‐ESD ulceration and/or bleeding 54‐59 . Pooled ulcer healing rates have been similar between vonoprazan and PPI treatment with limited evidence that delayed bleeding rates may be lower with vonoprazan.…”

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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“…The researchers showed that vonoprazan was more effective than PPIs for treating H. pylori-positive patients with ESD-induced gastric ulcers during the first two weeks of treatment. 27…”

Section: Management Of Gastric Ulcer Occurring After Endoscopic Submumentioning

confidence: 99%

<p>Vonoprazan Fumarate for the Treatment of Gastric Ulcers: A Short Review on Emerging Data</p>

Marabotto¹,

Ziola²,

Savarino³

et al. 2020

CEG

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Potassium-competitive acid blockers (P-CABs), such as vonoprazan, represent a novel and heterogeneous class of drugs that competitively block the potassium binding site of gastric H + /K + ATPase, thus potentially overcoming the limitations of proton-pump inhibitors. Different studies evaluated the efficacy of vonoprazan versus proton-pump inhibitors (PPIs) for the treatment of acid-related disorders, and, therefore, P-CABs present the same indications of PPIs: gastroesophageal reflux disease, gastric and duodenal ulcer healing, management of upper gastrointestinal bleeding, non-steroidal anti-inflammatory drug (NSAID)-associated ulcers and Helicobacter pylori eradication therapy. The aim of this review was to evaluate the role of vonoprazan for the treatment of peptic ulcer disease (PUD) and the management of gastric ulcer occurring after endoscopic submucosal dissection (ESD). Indeed, vonoprazan (at the dose of both 10 and 20mg) showed similar results to PPIs in patients taking long-term NSAIDs, in the absence of severe adverse effects, and provided a more rapid and effective treatment of ulcers induced by ESD. However, studies in medical literature are heterogeneous, mainly performed with a retrospective design, and often carried out in Japan only. For these reasons, further prospective, randomized studies are warranted in order to help physicians, patients, and policymakers regarding the use of vonoprazan in clinical practice.

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Vonoprazan vs proton pump inhibitors in treating post-endoscopic submucosal dissection ulcers and preventing bleeding

Abstract: Supplemental Digital Content is available in the text

Cited by 15 publications

References 40 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

<p>Vonoprazan Fumarate for the Treatment of Gastric Ulcers: A Short Review on Emerging Data</p>

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