In a recent study conducted by Professor Dr. Tadayuki Oshima
and Professor Dr. Eitatsu Arai from Hyogo College of Medicine, in Japan , demonstrated that the potassium-competitive acid blocker (P-CAB) vonoprazan demonstrates superior efficacy in the treatment of patients with erosive oesophagitis compared with the proton pump inhibitor (PPI) lansoprazole, with the results of a small trial showing that the former more rapidly provides complete sustained heartburn relief during the first week of therapy.
“Vonoprazan is rapidly absorbed, requiring less than 2 hours after oral intake to reach maximal plasma concentrations, remains longer in the blood, quickly accumulates in parietal cells and continuously blocks acid secretion. In contrast, conventional PPIs require 3–5 days to achieve maximal and stable inhibition of acid secretion,” the researchers pointed out.
In the trial, 32 erosive oesophagitis patients (mean age, 63.4 years; 53.1 percent male) who experienced heartburn at least once a week were randomized to receive either vonoprazan 20 mg (n=16) or lansoprazole 30 mg (n=16) once daily before breakfast for 14 days. Daytime and nocturnal heartburn throughout the study were evaluated using a five‐point Likert scale.
At day 1 of treatment, significantly more patients in the vonoprazan vs lansoprazole group achieved the primary endpoint of complete relief of daytime and nocturnal heartburn for 7 consecutive days (31.3 percent vs 12.5 percent; hazard ratio [HR], 3.58; 95 percent CI, 1.16–11.08; p<0.05). [Aliment Pharmacol Ther
Results were consistent in separate assessments of relief of heartburn during the day (37.5 percent vs 18.8 percent; HR, 2.70; 0.94–7.74; p=0.07) and during the night (33.3 percent vs 9.1 percent; HR, 6.2; 1.72–22.52; p<0.01).
Significant reductions in reflux and dyspepsia symptoms occurred at days 7 and 14 with vonoprazan and only at day 14 with lansoprazole. The P-CAB also improved sleep quality.
were well tolerated, and no adverse events were reported during the study.
Overall, the findings indicate that vonoprazan can rapidly reduce gastric acidity and improve heartburn without adverse effects, researchers said.
“The effect of vonoprazan must be correlated with the potent inhibition of acid production from the first dose, although we did not directly measure acid suppressive effects in this study. Reflux symptoms including heartburn are not sufficiently relieved after the first dose of conventional PPIs in two‐thirds of patients due to a slow onset of action, and vonoprazan resolved this situation, at least in part,” they explained.
Researchers highlighted the need for larger studies to confirm the present data, especially because the study populatio
n was quite small, and to determine whether the rapid relief of night-time heartburn conferred by vonoprazan also results in improved subjective and objective sleep quality.
Reference: Randomised clinical trial: vonoprazan versus lansoprazole for the initial relief of heartburn in patients with erosive oesophagitis :Tadayuki Oshima , Eitatsu Arai ,Masato Taki ,Takashi Kondo , Hirokazu Fukui , Jiro Watari , Hiroto Miwa, First published: 27 December 2018, https://doi.org/10.1111/apt.15062