Potassium-competitive acid blockers - are they the next generation of proton pump inhibitors?

Abstract

The modern lifestyle caters to an increase in the incidence of peptic ulcer disease, gastroesophageal reflux disease and several other acid-related conditions of the gut. The drugs to prevent these conditions work either through H2 receptor blockade or inhibition of the H⁺, K⁺ ATPase enzyme. Although proton pump inhibitors have been proven to be efficacious, they have a slow onset of action with limited resolution of symptoms in most patients. Potassium-competitive acid blockers (P-CABs) are novel drugs that bind reversibly to K⁺ ions and block the H⁺, K⁺ ATPase enzyme, thus preventing acid production. P-CABs have a fast onset of action and have dose-dependent effects on acid production. Animal studies exist that differentiate the better results of P-CABs from proton pump inhibitors; further human trials will give a comprehensive picture of the results and will help to elucidate the therapeutic benefits of this new group of drugs.

Keywords: Potassium-competitive acid blockers; Gastroesophageal reflux disease; Proton pump inhibitors; Peptic ulcer disease; Vonoprazan

Core tip: There have been tremendous changes in the treatment of acid-related diseases. In this rapidly evolving field, novel drugs such as potassium-competitive acid blockers (P-CABs) show promising potential. This review aims to provide a perspective on this new class of drugs by summarizing the mechanism of action, therapeutic benefits, adverse effects and approval status of various P-CABs in the market.