title: Vonoprazan for treatment of gastroesophageal reflux: pharmacodynamic and pharmacokinetic considerations.
abstract: About 30-40% of GERD patients report an inadequate response to proton pump inhibitors (PPIs) due to their suboptimal pharmacological profiles. Recently, a new synthesized P-CABs, vonoprazan, showed higher suppression of gastric acid secretion as compared to lansoprazole. Areas covered: This review provides an update on the pharmacokinetic properties of vonoprazan and their correlates with pharmacodynamics; preliminary data on the therapeutic efficacy of vonoprazan as compared to lansoprazole in GERD patients Expert opinion: At variance from all available PPIs, vonoprazan acts directly on H+,K+-ATPase irrespectively of its activity, providing a fast onset of action without requiring acid activation and specific administration timing. Clinical and pharmacological investigations have confirmed a more rapid, potent and prolonged inhibition of acid secretion, including a better nighttime acid control, and a less antisecretory variability, as compared with PPIs. Preliminary data in patients with erosive esophagitis (EE) have shown the non-inferiority of vonoprazan to lansoprazole in terms of symptom relief and healing rate. Since these pharmacokinetic advantages, it is expected that it will have a significant favorable impact on GERD management. However, the clinical use of vonoprazan raises also some issues about its efficacy and safety in the long-term that deserve verification and careful investigation.
authors.affiliation: a Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology , University of Padua , Padua , Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.affiliation: b Division of Gastroenterology, Department of Internal Medicine , University of Pisa , Pisa , Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Martinucci
authors.affiliation: c Division of Gastroenterology, Department of Internal Medicine , University of Genoa , Genoa , Italy.
authors.forename: Manuele
authors.initials: M
authors.lastname: Furnari
authors.affiliation: c Division of Gastroenterology, Department of Internal Medicine , University of Genoa , Genoa , Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Romana
authors.affiliation: c Division of Gastroenterology, Department of Internal Medicine , University of Genoa , Genoa , Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Pellegatta
authors.affiliation: c Division of Gastroenterology, Department of Internal Medicine , University of Genoa , Genoa , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Moscatelli
authors.affiliation: c Division of Gastroenterology, Department of Internal Medicine , University of Genoa , Genoa , Italy.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Bodini
authors.affiliation: c Division of Gastroenterology, Department of Internal Medicine , University of Genoa , Genoa , Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Marabotto
authors.affiliation: c Division of Gastroenterology, Department of Internal Medicine , University of Genoa , Genoa , Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Savarino
authors.affiliation: b Division of Gastroenterology, Department of Internal Medicine , University of Pisa , Pisa , Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: de Bortoli
authors.affiliation: d Division of Pharmacology and Chemotherapy , University of Pisa , Pisa , Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Blandizzi
keywords: GERD; P-CABs; Vonoprazan; gastro-esophageal reflux disease; pharmacokinetics