Vonoprazan in the Treatment of Gastroesophageal Reflux
Article Sidebar
Main Article Content
Abstract
Vonoprazan, a potassium-competitive acid blockers (P-CABs), was approved in Japan in 2014 and in Thailand in 2018 for the treatment and prevention of diseases caused by excessive secretion of gastric acid. Some of its pharmacokinetic properties differ from proton-pump inhibitors (PPIs) i.e., more rapid onset and a longer inhibition duration of acid secretion, making it suitable for the treatment of recurrent acid reflux. It also is stable in acid condition, and not destroyed by gastric acid. The drug is primarily metabolized in liver by CYP3A4, unlike the CYP2C19-metabolized PPIs, with polymorphisms leading to inter-individual variation of responses to the PPIs. Systematic reviews and meta-analyses directly comparing the efficacy and safety of vonoprazan 20 mg versus PPIs for the treatment of gastroesophageal reflux showed that efficacy and safety of vonoprazan 20 mg were not inferior to those of PPIs, but vonoprazan was significantly more effective than PPIs. The safety of the use of vonoprazan and PPIs was similar. Cost-effectiveness analysis of vonoprazan 20 mg versus lansoprazole 30 mg in the treatment of acute reflux concluded that P-CABs was more cost-effective. However, the study in this aspect is quite limited, cost-effectiveness of the treatment could not be definitely concluded.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
Kahrilas PJ, Shaheen NJ, Vaezi MF. American Gastroenterological Association Institute technical review on the management of gastroesophageal reflux disease. Gastroenterology 2008; 135: 1392-413.
Sandhu DS, Fass R. Current trends in management of gastroesophageal reflux disease. Gut Liver 2018; 12: 7-16.
Muangchan N. Nonerosive reflux disease: pathophysi ology and treatment guideline. Thammasat Medical Journal 2011; 11: 460-8.
Jung HK. Epidemiology of gastroesophageal reflux disease in Asia: A systematic review. J Neurogastro enterol Motil 2011; 17: 14-27.
De Giorgi F, Palmiero M, Esposito I, Mosca F, Cuomo R. Pathophysiology of gastro-oesophageal reflux disease. Acta otorhinolaryngolital 2006; 26: 241-6.
Penman ID. Alimentary tract and pancreatic disease. In: Walker BR, Colledge NR, Ralston SH, Penman ID, editors. Davidson’s Principles and practice of medicine 22nd ed. New York: Churchill Livingstone /Elsevier; 2014. p.865.
MacFarlane B. Management of gastroesophageal reflux disease in adults: a pharmacist’s perspective. Inter Pharm Res Pract 2018; 7: 41-52.
Committee for the Preparation of Clinical Guidelines for Treating Gastroesophageal Reflux Disease Patients. Thailand GERD guideline 2020. Bangkok: Thai Neurogastroenterology and Motility Society; 2020.
Yang X, Li Y, Sun Y, Zhang M, Guo C, Mirza IA, et al. Vonoprazan: a novel and potent alternative in the treatment of acid-related diseases. Dig Dis Sci 2018; 63: 302-11.
Oshima T, Miwa H. Potent potassium-competitive acid blockers: a new era for the treatment of acid-related diseases. J Neurogastroenterol Motil 2018; 24: 334-44.
Garnock-Jones KP. Vonoprazan: first global appro val. Drug 2015; 75: 439-43.
Vocenti® [package insert]. Japan: Takeda(Thailand) Ltd; 2018.
Otake K, Sakurai Y, Nishida H, Fukui H, Tagawa Y, Yamasaki H, et al. Characteristics of the novel potassium-competitive acid blocker vonoprazan fumarate (TAK-438). Adv ther 2016;33:1140-57.
Sugano K. Vonoprazan fumarate, a novel potas sium-competitive acid blocker, in the management of gartroesophageal reflux disease: safety and clinical evidence to date. Therap Adv Gastrornterol 2018; 11: 1-14.
Hirotoshi E. The first-in-class potassium-competitive acid blocker, vonoprazan fumarate:pharmacokinetic and pharmacodynamic considerations. Clin pharma cokinet 2016; 55: 409-18.
Ashida K, Sakurai Y, Hori T, Kudou K, Nishimura A, Hiramatsu N, et al. Randomised clinical trial: vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the healing of erosive oesophagitis. Aliment Pharmacol Ther 2016; 43: 240-51.
Ashida K, Sakurai Y, Nishimura A, Kudou K, Hiramatsu N, Umegaki E, et al. Randomised clinical trial: a dose-ranging study of vonoprazan, a novel potassium-competitive acid blocker, vs. lansoprazole for the treatment of erosive oesophagitis. Aliment Pharmacol Ther 2015; 42: 685-95.
Mori H, Suzuki H. Role of acid suppression in acid-related diseases: proton pump inhibitor and potas sium competitive acid blocker. J Neurogastroenterol Motil 2019; 25: 6-14.
Hoshino S, Kawami N, Takenouchi N, Umezawa M, Hanada Y, Hoshikawa Y, et al. Efficacy of vonopra zan for proton pump inhibitor-resistant reflux esopha gitis. Digestion 2017; 95: 156-61.
Miyazaki H, Igarashi A, Takeuchi T, Teng L, Uda A, Deguchi H, et al. Vonoprazan versus proton-pump inhibitors for healing gastroesophagesl reflux diseases: a systematic review. J Gastroenterol Hepa to 2019; 34: 1316-28.
Miwa H, Igarashi A, Teng L, Uda A, Deguchi H, Tango T. Systematic review with network meta-analysis: indirect comparison of the efficacy of vonoprazan and protonpump inhibitors for mainte nance treatment of gastroesophageal reflux disease. J Gastroenterol 2009; 54: 718-29.
Cheng Y, Liu J, Tan X, Dai Y, Xie C, Li X, et al. Direct comparison of the efficacy and safety of vonoprazan versus proton-pump inhibitors for gastro esophageal reflux disease: A systematic review and meta-analysis. Dig Dis Sci 2020. doi:10.1007/s1062 0-020-06141-5.
Habu Y. Vonoprazan versus lansoprazole for the Initial treatment of reflux esophagitis: a cost-effective ness analysis in Japan. Intern Med 2019; 58: 2427-33.
