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Gastroesophageal reflux disease (GERD) is a chronic disease with typical symptoms of regurgitation, heartburn, and chest pain.1 Its global prevalence as of 2019 was around 783.9 million, with India leading the world with the highest GERD incidence of 181.6 million.1 Non-erosive reflux disease (NERD) is a symptomatic non-erosive GERD that affects 50%–70% of patients and is reported with worse quality of life compared to other GERD phenotypes such as erosive esophagitis or Barrett’s esophagus.2 Coming to gastric infections, Helicobacter pylori (H. pylori) affects up to 50% of the population worldwide, with a higher prevalence in developing countries, and causes dyspepsia, peptic ulcers, chronic or atrophic gastritis, and even gastric cancer.3,4 Proton pump inhibitors (PPIs) have been the first-line approach for the management of GERD.5 However, their imitations have been recognized lately, with around 54% of patients continuing to remain symptomatic despite treatment.6,7 This PPI failure is one of the most common GERD presentations and demands repeated healthcare resource utilization.5 Vonoprazan is a novel potassium-competitive acid blocker with specific properties superior to PPIs, such as rapid onset of action and longer duration of action, and has become the drug of choice for the treatment of GERD treatment and H. pylori eradication.8,9 PPI-Refractory GERD To evaluate vonoprazan compared to PPIs, a retrospective study with patients experiencing persistent reflux symptoms and pathological esophageal acid exposure times (EAET) ≥4% even after ≥8 weeks of PPI treatment switched the patients to vonoprazan.5 Vonoprazan resulted in less EAET of 4.5% compared to 10.6% by PPIs during the 24-hour monitoring period, p=0.055. Acid reflux episodes were also significantly lower with vonoprazan compared to PPIs, p=0.03.5 NERD A phase 2 study in 207 patients evaluated vonoprazan 10 mg, 20 mg, and 40 mg for on-demand symptomatic NERD compared to placebo for 6 weeks after a 4-week run-in period.2 Complete and sustained relief from heartburn episodes was reported in 56%, 60.6%, and 70% of patients with vonoprazan 10 mg, 20 mg, and 40 mg, respectively, compared to only 27.3% by placebo.2 H. pylori Eradication Further, a 14-day open-label study compared vonoprazan + doxycycline + furazolidone (VDF-triple), vonoprazan + doxycycline + amoxicillin (VDA-triple), esomeprazole + bismuth + doxycycline + furazolidone (EBDF-quadruple), and esomeprazole + colloidal bismuth + doxycycline + amoxicillin (EBDA-quadruple) for H. pylori eradication.10 In the modified intention-to-treat analysis, 88.13% and 87.5% of patients had H. pylori eradicated by VDF-triple and VDA-triple therapy, respectively, with no significant difference among each other.10 On the other hand, 80% and 75% eradication were obtained by EBDF-quadruple and EBDA-quadruple therapies, respectively, with no significant difference among each other.10 However, vonoprazan-based VDF-triple therapy had a significantly higher eradication rate than PPI-based EBDF-quadruple therapy, p=0.047; and vonoprazan-based VDA-triple therapy was significantly better for H. pylori eradication than PPI-based EBDA-quadruple therapy, p=0.004.10 Conclusion Vonoprazan offers a more potent solution than PPIs and placebo for gastric acid complications in GERD phenotypes as well as for H. pylori eradication.2,5,10 |
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Vono-Always on Duty
Vono, containing Vonoprazan molecule, is a Potassium Competitive Acid Blocker which helps in treatment of Refractory GERD, Erosive Esophagitis, H.Pylori, Gastric & Duodenal Ulcers
