Vonoprazan is a potassium-competitive acid blocker that offers several advantages over oral PPIs. These advantages include more potent acid suppression, stability in acidic environments, rapid onset of action, and a long-lasting half-life. Studies have shown that vonoprazan is equally effective as PPIs in treating conditions such as erosive esophagitis, Helicobacter pylori eradication, peptic ulcer disease, prevention of secondary ulcers from low-dose aspirin or NSAIDs, and post-gastric endoscopic submucosal dissection.
The objective of a study was to compare the effectiveness of vonoprazan and high-dose PPIs in preventing rebleeding from high-risk peptic ulcers (PUs) after hemostasis.
This was a multi-center, randomized, noninferiority trial conducted across six centers. Upon successful hemostasis, patients with high-risk PU bleeding were randomly assigned to receive either vonoprazan (20 mg twice daily for 3 days, then 20 mg once daily for 28 days) or high-dose PPIs (pantoprazole intravenous infusion at 8 mg/h for 3 days, followed by omeprazole 20 mg twice daily for 28 days).
The primary outcome measured was the 30-day rebleeding rate, and secondary outcomes included the 3-day and 7-day rebleeding rates, all-cause and bleeding-related mortality, rate of rescue therapy, blood transfusion needs, length of hospital stay, and safety.
The 30-day rebleeding rate was 7.1% for the vonoprazan group and 10.4% for the PPI group. The 3-day and 7-day rebleeding rates also showed vonoprazan to be noninferior (P < .001). All secondary outcomes were comparable between the two treatments.
In conclusion, vonoprazan effectively prevents 30-day rebleeding in high-risk PU patients, showing noninferiority to high-dose PPIs.
Geeratragool T, Kaosombatwattana U, Boonchote A, Chatthammanat S, Preechakawin N, Srichot J, Sudcharoen A, Sirisunhirun P, Termsinsuk P, Rugivarodom M, Limsrivilai J, Maneerattanaporn M, Pausawasdi N, Leelakusolvong S. Comparison of Vonoprazan Versus Intravenous Proton Pump Inhibitor for Prevention of High-Risk Peptic Ulcers Rebleeding After Successful Endoscopic Hemostasis: A Multicenter Randomized Noninferiority Trial. Gastroenterology. 2024 Apr 5:S0016-5085(24)00362-7. doi: 10.1053/j.gastro.2024.03.036. Epub ahead of print. PMID: 38582271.