An update of pharmacology, efficacy, and safety of vonoprazan in acid-related disorders

ABSTRACT

Introduction

Patients with acid-related disorders (ARDs) of the upper digestive tract remain highly prevalent and need to be continuously investigated to improve their management.

Areas covered

This review provides a summary of the most recent advancements in the treatment of ARDs with particular focus on the new drugs available to overcome the unmet needs of traditional therapies.

Expert opinion

Proton pump inhibitors remain the best therapy in treating ARDs, but a consistent proportion of these patients continues to present mucosal lesions or to experience symptoms despite treatment. These cases pertain mainly to the most severe forms of erosive esophagitis or to non-erosive reflux disease. Also, the increasing rate of patients with H. pylori infection not responding to eradication therapy represents a difficult clinical condition. The recent advent of a new class of antisecretory drugs, such as the potassium competitive acid blockers and, among them the most studied vonoprazan, which are characterized by a better pharmacological profile than PPIs (rapid onset of action, longer lasting acid suppression, control of nocturnal acidity), has the potential to overcome the above-mentioned unmet needs. More research should be done to assess their efficacy in Western populations and their safety in patients treated in the long term.

KEYWORDS:

• Acid-related disorders
• P-CABs
• vonoprazan
• efficacy and safety

Article highlights

• A consistent proportion of patients with acid-related disorders continues to present mucosal lesions or to experience symptoms despite treatment with proton pump inhibitors (PPIs)

• Novel antisecretory drugs, such as the P-CABs, in particular vonoprazan, are characterized by a better pharmacological profile than PPIs since they have a rapid onset of action, longer-lasting acid suppression, and greater control of nocturnal acidity

• P-CABs have the potential in the next future to improve the management of patients with acid-related disorders, including gastro-esophageal reflux disease and peptic ulcers

• However, more studies are required to evaluate the clinical efficacy and safety of P-CABs in western populations, particularly in the long term

Declaration of interests

V Savarino has received in the last 2 years consultancy fees and honoraria for conferences from Reckitt, Takeda, Grunenthal, Teofarma, EG Stada Group and Alfasigma. E Savarino has received in the last 2 years consultancy fees and honoraria for conferences or Advisory boards from Abbvie, Alfasigma, Amgen, Bristol-Myers Squibb, EG Stada Group, Fresenius Kabi, Grifols, Janssen, Innovamedica, Malesci, Medtronic, Merck & Co, Novartis, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda, Unifarco. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.