Update on the Use of Vonoprazan: A Competitive Acid Blocker

Graham, David Y.; Dore, Maria Pina

doi:10.1053/j.gastro.2018.01.018

Cited by 83 publications

(78 citation statements)

References 33 publications

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“…Most successful dual therapies have been reported from Asian populations who have a higher prevalence of slow PPI metabolizers than western populations, tend to have smaller parietal cell mass and a higher frequency of corpus gastritis . To achieve a reliable cure rate, a high dose of a PPI that is relatively unaffected by CYP2C19 genotypes, or vonoprazan, a potassium‐competitive acid blocker, which is unaffected by CYP2C19 genotypes, may be required . Comparative studies are needed to clinically determine the optimum dosing frequency of PPIs.…”

Section: Discussionmentioning

confidence: 99%

High‐dose PPI‐amoxicillin dual therapy with or without bismuth for first‐line Helicobacter pylori therapy: A randomized trial

Luo

Long

et al. 2019

Helicobacter

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Background A reliably highly effective high‐dose proton‐pump inhibitor plus amoxicillin (dual Helicobacter pylori therapy) has remained elusive. We compared whether the addition of bismuth to high‐dose dual therapy would improve the efficacy of high‐dose dual therapy as first‐line treatment. Methods This was an open‐label, randomized single‐center study of 160 treatment‐naive patients with H. pylori infection who were randomly assigned to 14‐day therapy with esomeprazole 40 mg twice a day plus amoxicillin 1 g three times a day with or without bismuth potassium citrate 600 mg (elemental bismuth 220 mg) twice a day. Antibiotic resistance was determined by agar dilution method and eradication by 13C‐urea breath test. Results The per‐protocol eradication rates were 96.1%; 95% CI = 88.9%‐99.2% (73/76) without bismuth vs 93.3%; 95% CI = 85.1%‐97.8% (70/75) with bismuth (P = 0.494). The intention‐to‐treat eradication rates were 92.5%; 95% CI = 84.4%‐97.2% (74/80) without bismuth and 88.8%; 95% CI = 79.7%‐94.7% (71/80) with bismuth (P = 0.416). Resistance to amoxicillin, clarithromycin, metronidazole, and levofloxacin was 0%, 31.7%, 81.4%, and 40.7%, respectively. Smoking reduced treatment effectiveness limited to those not receiving bismuth. The per‐protocol eradication rates were 70% (7/10) vs 100% (66/66) in smokers vs non‐smokers without bismuth (P = 0.002), and 100% (10/10) in smokers vs 92.3% (60/65) in non‐smokers with bismuth (P = 1.0). The adverse event rates were 7.5% (6/80) without bismuth vs 11.3% (9/80) with bismuth (P = 0.416). Conclusions Fourteen‐day high‐dose dual therapy was both effective and safe for first‐line treatment in a region of high prevalence antibiotic resistance. Adding bismuth only improved treatment effectiveness among smokers.

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Section: Discussionmentioning

confidence: 99%

High‐dose PPI‐amoxicillin dual therapy with or without bismuth for first‐line Helicobacter pylori therapy: A randomized trial

Luo

Long

et al. 2019

Helicobacter

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“…19 ) which is related to relative PPI potency. 5,8 The relative potency of PPIs shown in Figure 2 and Table 2 is based on data from western populations and represents the median for relatively large groups. 5,8 The relative potency of PPIs shown in Figure 2 and Table 2 is based on data from western populations and represents the median for relatively large groups.…”

Section: Whi Ch Ppi Whi Ch Dos E and What Doe S Doub Le-dos E Amentioning

confidence: 99%

“…19 ). 8 Use of an amoxicillin-antisecretory dural therapy has a potential advantage in that H. pylori culture and susceptibility testing are not required until or unless the pattern of resistance changes. 25 Vonoprazan is currently the most effective PPI and preliminary studies have shown that while 7-day therapy is promising no one has yet reliably achieved 95% or greater cure rates.…”

Section: What Doe S Doub Le-dos E Me An In Terms Of Ppi Ppi Dos Ementioning

confidence: 99%

“…However, in the presence of metronidazole resistance, this regimen requires concomitant antisecretory drug therapy. 7,8 In western populations, the relative potency of 10 mg of vonoprazan once daily is approximately equivalent to 60-70 mg of an omeprazole given bid 5 Typically, the best results with traditional PPI-containing therapies require a treatment duration of 14 days. However, PPIs vary greatly in relative potency assessed by their ability to maintain the intragastric pH at 4 or greater for a full 24 hours (pH4-time) ( Table 2 and Figure 1).…”

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Relative potency of proton‐pump inhibitors, Helicobacter pylori therapy cure rates, and meaning of double‐dose PPI

2018

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Background Helicobacter pylori treatment recommendations often recommend use of double‐dose PPI or greater. This is confusing because PPIs very markedly in relative potency such that a double dose of one may not even be equivalent to the single dose of another. Objective To relate the concept of double‐dose to specific amounts of the different PPIs Methods We used data standardizing PPI potency in terms of the duration of intragastric pH >4/24 hours (pH4‐time) to rank PPIs. Relative potency varies from 4.5 mg omeprazole equivalents (20 mg pantoprazole) to 72 mg omeprazole equivalents (40 mg rabeprazole). Results We defined PPI dosing for H. pylori therapy as low dose (eg, approximately 20 mg omeprazole equivalents, b.i.d.), high or double dose as approximately 40 mg omeprazole equivalents, b.i.d.) and high dose as approximately 60 mg omeprazole equivalents, b.i.d.). For example, standard double dose PPI would thus be 40 mg of omeprazole, 20 mg of esomeprazole or rabeprazole, 45 mg of lansoprazole, or 120 mg of pantoprazole each given b.i.d. Conclusions Simply doubling the dose of any PPI achieves markedly different effects on pH4‐time. However, PPIs can be used interchangeably and cost effectively based on their omeprazole equivalency.

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“…It is a potent long‐acting acid suppressant and can reliably achieve an intra‐gastric pH > 5, an important factor for successful H . pylori eradication . Previous studies indicated that vonoprazan‐based triple therapy was effective as first‐line or second‐line therapy for H .…”

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confidence: 99%