Shehryar Muhammad, Ahmad Rana Uzair, Kareem Hira Khalid, Khan Laiba, Ashraf Muhammad Fawad, Hassan Ahtizaz, Saeed Sabeena, Tareen Haseeb Khan, Nazir Dr Adnan, Ashraf Muhammad Aizaz
Mayo Hospital, Anarkali, Lahore, 54000, Punjab, Pakistan.
HIT Hospital, Taxila Cantt, Rawalpindi, Punjab, Pakistan.
Ann Med Surg (Lond). 2022 Sep 22;82:104760. doi: 10.1016/j.amsu.2022.104760. eCollection 2022 Oct.
Gastroesophageal reflux disease (GERD) is one of the most prevalent conditions worldwide and is conventionally treated by proton pump inhibitor therapy. However, around 40% of people have reported some form of resistance to this therapy. Vonoprazan has recently been approved for the treatment of GERD. Literature was searched on PubMed, Google Scholar, Embase and Medline. Inclusion criteria were 1) Human subjects; 2) papers published in English language; 3) study types that are RCTs. In pre-clinical studies, VPZ was unaffected by changes in pH, making it 1.2-2 times more potent than PPI, both in-vivo and in-vitro. In studies involving GERD, several RCTs proved higher efficacy of VPZ than conventional PPI. RCTs on patients affected by H. Pylori showed a higher efficacy than VPZ (95.8%) as compared to PPI (69.6%). In another RCT, adverse effects including diarrhea, nausea and body rash were observed in 32.7% of the people taking VPZ as compared to 40.5% of the people taking PPI. VPZ was shown to be much more cost effective as compared to PPI. This article concludes that VPZ is superior to PPI in terms of efficacy, safety and cost-effectiveness in reflux disorders and H. pylori eradication. Hence, use of vonoprazan should be preferred over conventional PPIs in these disorders. As most of the research was conducted in Japan, studies should be carried out in different regions of the world to explore if these results are extrapolated in those regions. Research is also needed to explore the efficiency of VPZ in scenarios of PPI resistance.
胃食管反流病（GERD）是全球最常见的疾病之一，传统上通过质子泵抑制剂治疗。然而，约40%的人报告对这种治疗存在某种形式的耐药性。沃克帕唑最近已被批准用于治疗GERD。在PubMed、谷歌学术、Embase和Medline上进行了文献检索。纳入标准为：1）人类受试者；2）以英文发表的论文；3）随机对照试验（RCT）类型的研究。在临床前研究中，沃克帕唑不受pH值变化的影响，在体内和体外的效力均比质子泵抑制剂高1.2至2倍。在涉及GERD的研究中，多项随机对照试验证明沃克帕唑的疗效高于传统质子泵抑制剂。对感染幽门螺杆菌的患者进行的随机对照试验显示，与质子泵抑制剂（69.6%）相比，沃克帕唑的疗效更高（95.8%）。在另一项随机对照试验中，服用沃克帕唑的人群中有32.7%出现腹泻、恶心和皮疹等不良反应，而服用质子泵抑制剂的人群中这一比例为40.5%。与质子泵抑制剂相比，沃克帕唑被证明具有更高的成本效益。本文得出结论，在反流性疾病和根除幽门螺杆菌方面，沃克帕唑在疗效、安全性和成本效益方面优于质子泵抑制剂。因此，在这些疾病中，应优先使用沃克帕唑而非传统质子泵抑制剂。由于大多数研究是在日本进行的，应在世界不同地区开展研究，以探索这些结果是否适用于那些地区。还需要进行研究，以探索沃克帕唑在质子泵抑制剂耐药情况下的疗效。
