Conventional
proton pump inhibitors (PPIs) are used as a first-line
therapy to treat
acid-related diseases worldwide. However, they have a number of limitations including slow onset of action, influence by
cytochrome P450 polymorphisms, unsatisfactory effects at night, and instability in acidic conditions. Alternative formulations of conventional PPIs have been developed to overcome these problems; however, these drugs have only introduced small advantages for controlling
acid secretion compared to conventional PPIs.
Potassium-competitive
acid blockers (P-CABs) were developed and have beneficial effects including rapid, long-lasting, and reversible inhibition of the gastric
hydrogen potassium ATPase, the
proton pump of the stomach.
Vonoprazan was recently innovated as a novel, orally active P-CAB. It is currently indicated for the treatment of gastric and
duodenal ulcers,
reflux esophagitis, and prevention of low-dose
aspirin- or nonsteroidal anti-inflammatory drug-related gastric and
duodenal ulcer recurrence in Japan.
Vonoprazan does not require enteric coating as it is
acid-stable, and it can be taken without food because it is quickly absorbed.
Vonoprazan accumulates in parietal cells under both acidic and neutral conditions. It does not require an acidic environment for activation, has long-term stability at the site of action, and has satisfactory safety and tolerability. Thus,
vonoprazan may address the unmet medical need for the treatment of
acid-related diseases.