Dr Colin Howden on the Recent FDA Approval of Vonoprazan

Following the recent FDA approval for vonoprazan (Voquenza) in the treatment of gastroesophageal reflux disease, Colin Howden, MD, professor of medicine at the University of Tennessee Health Science Center, joined for an interview to discuss the inner workings of the drug, patient monitoring, and potential future uses.

Transcript

Can you explain the mechanism of action of vonoprazan and how it differs from other acid-blocking medications?

Vonoprazan belongs to a class of drugs called potassium-competitive acid blockers, often abbreviated P-CABs, and these are drugs that interact with the proton pump that hydrogen potassium ATPase to block the secretion of acid by parietal cells. P-CABS, including vonoprazan, bind in a non-covalent manner to the potassium-binding site of the proton pump, and they prevent the exchange of potassium ions for hydrogen ions. They work in a different mechanism from proton pump inhibitors because they're binding is ionic and non-covalent. Vonoprazan and other P-CABS do not require chemical conversion in the parietal cell before they are activated, unlike proton pump inhibitors. In comparison to proton pump inhibitors, vonoprazan starts to inhibit gastric acid secretion more rapidly and it produces a greater degree of suppression of gastric acidity that'll last for longer than conventional doses of proton pump inhibitors.

Are there steps health care providers should take to monitor and manage patients on vonoprazan therapy?

While there are no specific requirements or recommendations, if patients are receiving other drugs that may influence serum magnesium levels, notably diuretics, then there's a suggestion that they may want to check magnesium levels. But this is not a requirement.

Do you foresee any additional indications or developments for vonoprazan, or is it primarily intended for erosive esophagitis treatment?

Aside from erosive esophagitis, the Food and Drug Administration is also reviewing it for a possible indication of non-erosive reflux disease, sometimes referred to as NERD. As I said, that's currently under review by the Food and Drug Administration, and their decision will be offered by the middle of 2024.

This transcript has been lightly edited for clarity.