Abstract:
Irritable Acid peptic disorders involve distinctive, but overlapping pathogenesis that
results in gastric hypersecretion, or lessened mucosal defense mechanism. Its associated
chronic diseases are most reported in daily clinical practice and produces substantial health
burden. For this, proton-pump inhibitors (PPIs) are potent inhibition of acid secretion.
However, many drugs in class of PPIs reduce, but do not completely eliminate vulnerability
for ulcers and thus representing its reduced potential of targeting physiopathologic pathways
and control to maintain intragastric pH ( > 4). Moreover, the decrease speed and duration of
action of these drugs have required new therapeutic candidate. Among all, dexlansoprazole
is the most effective proton pump inhibitor in this class. Potassium-competitive acid blockers
(P-CABs) are novel drugs that inhibit acid production and produce beneficial response.
Vonoprazan is recently approved P-CAB for the treatment of gastric hypersecretion disorders.
The increase stability in acidic environment, quick absorption, action in both acidic and
neutral conditions, long-term stability may address the best option to control acid-peptic
diseases. Therefore, the aim of the study was to evaluate and compare the efficacy and safety
of dexlanoprazole (Proton pump inhibitors) versus vonoprazan (potassium-competative acid
blocker) in the treatment of acid peptic disease. The present study was conducted at National
Medical Center, Karachi, Pakistan. A total of 100 acid peptic disease male and female patients
will be recruited between the age of 18 to 60 years and fulfilling the inclusion criteria of study.
Each patient will give written informed consent and experience 72-hours of wash-out period.
All patients will be randomized into 2 groups: group A: dexlansoprazole monotherapy (proton
pump inhibitor 60 mg OD) group B: vonoprazan monotherapy (potassium-competitive acid
blocker 20 mg OD) for 4 weeks. All the parameters will be identified at 0, 2 and 4th week.
At week 0, the statistical analysis shown insignificant results in both groups. Followed by 2
and 4th week of the treatment, significant difference was observed. Group II, i.e. patients
treated with vonoprazan were shown least signs as compared to group I patients, i.e
dexlansoprazole. Similarly, endoscopy was performed at week 0 and at week 4, significant
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difference was observed. Both treatment option produce positive effect in the treatment of
acid peptic disease. But reports of endoscopy in patients treated with vonoprazon were more
effective than other group. The safety profile of both tretments were also identified. At week
4, mean cholesterol in group A was 154.68 and in group B was 154.32, Mean triglyceride in
group A was 141.11 and in group B was 152.89, Mean HDL in group A was 145.18 and in
group B was 154.82. Mean LDL in group A was 153.24 and in group B and was 144.76 mg/dl.
At week 4, mean AST in group A was 134.92 IU/L and in group B was 160.08 IU/L. Mean
ALT in group A was 142.06 IU/L and in group B was 155.94 IU/L. Mean alkaline
phosphatase in group A was 139.68 IU/L and in group B was 155.32 IU/L. Mean total
bilirubin in group A was 152 and in group B and was 144. At week 4, mean creatinine in
group A was 152.39 and in group B was 151.94 IU/L. Mean Uric acid in group A was 152.50
and in group B was 153.50. Mean calcium in group A was 151.93 and in group B was 151.07,
Mean phosphorus in group A was 146.24 and in group B was 152.76 IU/L. In conclusion,
vonoprazan has been found to be more effective than dexlansoprazole alone in treating acid
peptic disease. Both vonoprazan and dexlansoprazole has better outcome in acid peptic
disease in terms of safety profile
