On-demand vonoprazan reasonable alternative to daily therapy for non erosive reflux disease

A recent study evaluating the efficacy of on-demand vonoprazan in managing heartburn has shown promising results. The research, led by Dr. Ronnie Fass and colleagues, aimed to explore the effectiveness of vonoprazan, a potassium-competitive acid blocker, as an alternative therapy for heartburn compared to daily treatment. This study was published in the Alimentary Pharmacology and Therapeutics journal.

The study involved 458 adults with nonerosive reflux disease (NERD) who experienced heartburn episodes for at least 6 months. Participants initially received once-daily vonoprazan 20 mg. Those who demonstrated at least 80% compliance and reported no heartburn during the last 7 days were eligible for the on-demand treatment period. The participants were randomized into groups receiving vonoprazan at doses of 10 mg, 20 mg, or 40 mg, or a placebo for 6 weeks. The primary goal was achieving heartburn relief within 3 hours and no further episodes for 24 hours post-treatment.

• Results indicated that on-demand vonoprazan was notably effective in alleviating heartburn within 3 hours in up to 70% of patients compared to the placebo group.
• Moreover, an exploratory analysis revealed that approximately 28.1% of patients experienced complete and sustained relief from heartburn just 1 hour after taking vonoprazan.
• Significantly more heartburn episodes were relieved within 3 hours and sustained for 24 hours in the vonoprazan groups (10 mg: 56%, 20 mg: 60.6%, 40 mg: 70%) compared to the placebo group (27.3%).

The study concluded that on-demand vonoprazan could be a viable alternative to daily therapy for patients with heartburn, providing rapid and complete relief within 1 hour in some individuals. Importantly, the treatment was well-tolerated without any serious adverse events reported. Dr. Fass and colleagues suggest that the efficacy and tolerability of on-demand vonoprazan could make it a compelling option for managing heartburn, warranting further investigation in larger clinical trials.

Reference:

Fass, R., Vaezi, M., Sharma, P., Yadlapati, R., Hunt, B., Harris, T., Smith, N., Leifke, E., & Armstrong, D. Randomised clinical trial: Efficacy and safety of on‐demand vonoprazan versus placebo for non‐erosive reflux disease. Alimentary Pharmacology & Therapeutics,2023;58(10):1016–1027. https://doi.org/10.1111/apt.17728