Potassium-competitive acid blockers
Vonoprazan, a first-in-class potassium-competitive acid blocker (PCAB), competes for potassium on the parietal cells’ luminal aspect causing rapid, potent, and reversible inhibition of hydrogen-potassium ATPase, the proton pump of the acid-secreting parietal cell.[173]Hunt RH, Scarpignato C. Potent acid suppression with PPIs and P-CABs: what's new? Curr Treat Options Gastroenterol. 2018 Dec;16(4):570-90.
http://www.ncbi.nlm.nih.gov/pubmed/30361857?tool=bestpractice.com
PCABs have been reported to have a more rapid onset of action and a longer duration of acid suppression than proton-pump inhibitors (PPIs).[173]Hunt RH, Scarpignato C. Potent acid suppression with PPIs and P-CABs: what's new? Curr Treat Options Gastroenterol. 2018 Dec;16(4):570-90.
http://www.ncbi.nlm.nih.gov/pubmed/30361857?tool=bestpractice.com
Systematic reviews report greater Helicobacter pylorieradication rates when vonoprazan is substituted for the PPI in clarithromycin-based triple therapies and superior H pylori eradication rates, compared with PPI-containing therapies, for the treatment of clarithromycin-resistant H pyloristrains.[174]Jung YS, Kim EH, Park CH. Systematic review with meta-analysis: the efficacy of vonoprazan-based triple therapy on Helicobacter pylori eradication. Aliment Pharmacol Ther. 2017 Jul;46(2):106-14.
http://www.ncbi.nlm.nih.gov/pubmed/28497487?tool=bestpractice.com
[175]Li M, Oshima T, Horikawa T, et al. Systematic review with meta-analysis: Vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori. Helicobacter. 2018 Aug;23(4):e12495.
http://www.ncbi.nlm.nih.gov/pubmed/29873436?tool=bestpractice.com
[176]Tanabe H, Yoshino K, Ando K, et al. Vonoprazan-based triple therapy is non-inferior to susceptibility-guided proton pump inhibitor-based triple therapy for Helicobacter pylori eradication. Ann Clin Microbiol Antimicrob. 2018 Jun 28;17(1):29.
ncbi.nlm.nih.gov/pmc/articles/PMC6022507
http://www.ncbi.nlm.nih.gov/pubmed/29950163?tool=bestpractice.com
PCABs, like PPIs, are also effective in dual amoxicillin-based regimens as the increased acid suppressive effect increases the potential effectiveness of amoxicillin and circumvents the need for clarithromycin.[146]Fallone CA, Moss SF, Malfertheiner P. Reconciliation of recent Helicobacter pylori treatment guidelines in a time of increasing resistance to antibiotics. Gastroenterology. 2019 Jul;157(1):44-53.
http://www.ncbi.nlm.nih.gov/pubmed/30998990?tool=bestpractice.com
Future H pylori eradication trials with vonoprazan-based regimens with and without clarithromycin are planned for North America and Europe.[147]Howden CW. Emerging regimens for H. pylori infection should enhance efficacy and circumvent resistance. Dig Dis Sci. 2019 Oct;64(10):2691-2.
https://link.springer.com/article/10.1007%2Fs10620-019-05747-8
http://www.ncbi.nlm.nih.gov/pubmed/31346952?tool=bestpractice.com
Vonoprazan is currently only available in Japan.