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Vonoprazan

Phase 3

Erosive Esophagitis | Small molecule | Gastrointestinal |Takeda Pharmaceutical Company Limited|Last Updated: Sep 7, 2023

Success Probability

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Trial Design

RandomizedDouble-BlindACTIVE_CONTROLLED
Total Trials2
Total Enrollment1,184

FDA Designations

No designations recorded

Clinical trial landscape

Vonoprazan · 5 trials · 4 indications

Phase 3 4Phase 2 1
NCT04198363A Study to Evaluate the Efficacy and Safety of Bismuth-Containing Quadruple Therapy With Oral Vonoprazan (TAK-438) 20 mg Compared to Esomeprazole 20 mg Twice Daily in Paticipants With Helicobacter Pylori InfectionHelicobacter Pylori
COMPLETED510 Analytics
NCT02388737Efficacy and Safety of Vonoprazan Compared to Lansoprazole in the Maintenance Treatment of Erosive EsophagitisErosive Esophagitis
COMPLETED703 Analytics
NCT02388724Efficacy and Safety of Oral Once-Daily Vonoprazan (TAK-438) in Participants With Erosive EsophagitisErosive Esophagitis
COMPLETED481 Analytics
NCT02037477Phase 3 Study to Evaluate the Acid-Inhibitory Effect of Multiple Oral Doses of Vonoprazan (TAK-438)Healthy Volunteers
COMPLETED20 Analytics
PHASE3COMPLETED
A Study to Evaluate the Efficacy and Safety of Bismuth-Containing Quadruple Therapy With Oral Vonoprazan (TAK-438) 20 mg Compared to Esomeprazole 20 mg Twice Daily in Paticipants With Helicobacter Pylori Infection
Helicobacter PyloriUnlock trial analytics
PHASE3COMPLETED
Efficacy and Safety of Vonoprazan Compared to Lansoprazole in the Maintenance Treatment of Erosive Esophagitis
Erosive EsophagitisUnlock trial analytics
PHASE3COMPLETED
Efficacy and Safety of Oral Once-Daily Vonoprazan (TAK-438) in Participants With Erosive Esophagitis
Erosive EsophagitisUnlock trial analytics
PHASE3COMPLETED
Phase 3 Study to Evaluate the Acid-Inhibitory Effect of Multiple Oral Doses of Vonoprazan (TAK-438)
Healthy VolunteersUnlock trial analytics

Study Endpoints

Primary Endpoints

Percentage of Helicobacter Pylori Positive (HP+) Participants With Successful HP Eradication at Week 4 Post-Treatment
Week 4 post-treatment

HP infection status was determined by \^13C Urea Breath Test (\^13C-UBT). The urea breath test is used to detect infection with HP, a bacteria associated with stomach ulcers, by testing individual breath samples in a central laboratory. The percentages are rounded off to report the nearest ten.

Percentage of Participants With Recurrence of Erosive Esophagitis as Confirmed on Endoscopy After the 24-week Maintenance Phase
24 weeks

Erosive esophagitis recurrence is defined as participants endoscopically confirmed to have erosive esophagitis (Los Angeles \[LA\] classification grades A to D) during the Maintenance Phase (24 weeks). Grade A: \>/=1 mucosal breaks \</=5 mm, none of which extends between the tops of the mucosal folds; Grade B: \>/=1 mucosal breaks \>5 mm, none of which extends between the tops of two mucosal folds; Grade C: mucosal breaks that extend between the tops of two or more mucosal folds, but which involve \<75% of esophageal circumference; Grade D: mucosal breaks which involve \>/=75% of esophageal circumference.

Percentage of Participants With Endoscopic Healing of Erosive Esophagitis During the 8-Week Treatment Phase
8 weeks

Endoscopic healing is defined as participants endoscopically diagnosed as Los Angeles classification grade O during the treatment phase. Grade O indicates there are no mucosal breaks in the mucosa.

Intragastric pH Time Course Over 24 Hours
At baseline (Day -2 to Day -1), administration period (Days 1 to Day 2 and Days 7 to Day 8)

Intragastric pH was measured continuously for 24 hours (hr) by pH monitor. pH holding time ratio (HTR) is the percentage of time a pH is maintained at a particular level. For example, pH 4 HTR is the percentage of time the pH = 4.

Percentage of Heartburn-Free 24-Hour Periods (Day and Night) During 4 Weeks of Treatment
4 Weeks

Participants used the Reflux Symptom Questionnaire Electronic Diary (RESQ-eD) every morning upon waking and every evening before going to sleep to document the presence of daytime and nighttime heartburn and regurgitation. The percentage of heartburn-free (HBF) 24-hour periods was calculated for each participant using the following formula: (total 24-hour periods that are heartburn free / total 24-hour periods for which both a daytime and nighttime result is marked) x 100%.

Secondary Endpoints

Percentage of Participants With Recurrence of Erosive Esophagitis After 12 Weeks of Treatment in the Maintenance Phase
12 weeks
Number of Participants With Adverse Events (AEs)
From Day 1 to 14 days after the last dose of study medication (up to 26 weeks)
Number of Participants With Abnormal Clinical Laboratory Findings
From Day 1 to 14 days after the last dose of study medication (up to 26 weeks)
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Study Design & Arms

AllocationRANDOMIZED
MaskingQUADRUPLE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Vonoprazan 20 mgEXPERIMENTALVonoprazan 20 mg, tablets, orally, twice daily given in combination with bismuth containing quadruple therapy (amoxicillin 1 gm, capsules, clarithromycin 500 mg, tablets, and bismuth potassium citrate 600 mg) orally, twice daily for up to 2 weeks.
Esomeprazole 20 mgACTIVE_COMPARATOREsomeprazole 20 mg, tablets, orally, twice daily given in combination with bismuth containing quadruple therapy (amoxicillin 1 gm, capsules, clarithromycin 500 mg, tablets, and bismuth potassium citrate 600 mg) orally, twice daily for up to 2 weeks.
Vonoprazan 10 mgEXPERIMENTALLansoprazole 30 mg, capsules or tablets, orally, once, daily, for up to 4 or 8 weeks or until confirmed healing of erosive esophagitis (EE) in healing phase for participants with ongoing EE. Vonoprazan 10 mg, tablets, orally, once, daily, and Vonoprazan 20 mg, placebo-matching tablets, orally, once, daily, and Lansoprazole 15 mg placebo-matching, capsules, orally, once, daily, for up to 24 weeks in maintenance phase for participants with confirmed EE healing.
Lansoprazole 15 mgACTIVE_COMPARATORLansoprazole 30 mg, capsules or tablets, orally, once, daily, for up to 4 or 8 weeks or until confirmed healing of erosive esophagitis (EE) in healing phase for participants with ongoing EE. Lansoprazole 15 mg, capsules, orally, once, daily, and Vonoprazan 10 mg, placebo-matching tablets, orally, once, daily, and Vonoprazan 20 mg, placebo-matching tablets, orally, once, daily, for up to 24 weeks in maintenance phase for participants with confirmed EE healing.
Lansoprazole 30 mgACTIVE_COMPARATORLansoprazole 30 mg, capsule, orally, once daily and vonoprazan placebo-matching tablet, orally, once daily for up to 8 weeks.
Sequence A (Cohort 1): Vonoprazan + EsomeprazoleEXPERIMENTALVonoprazan (TAK-438) 20 mg, orally, once daily for 7 days, followed by a washout period of at least 7 days; then esomeprazole 20 mg, orally, once daily for 7 days.
Sequence B (Cohort 1): Esomeprazole + VonoprazanEXPERIMENTALEsomeprazole 20 mg, orally, once daily for 7 days, followed by a washout period of at least 7 days; then vonoprazan 20 mg, orally, once daily for 7 days.
Sequence C (Cohort 2): Vonoprazan + Rabeprazole SodiumEXPERIMENTALVonoprazan 20 mg, orally, once daily for 7 days, followed by a washout period of at least 7 days; then Rabeprazole sodium 10 mg, orally, once daily for 7 days.
Sequence D (Cohort 2): Rabeprazole Sodium + VonoprazanEXPERIMENTALRabeprazole sodium 10 mg, orally, once daily for 7 days, followed by a washout period of at least 7 days; then vonoprazan 20 mg, orally, once daily for 7 days.
Esomeprazole 40 mgACTIVE_COMPARATOREsomeprazole 40 mg over-encapsulated tablets, orally, once daily for 4 weeks then esomeprazole placebo-matching capsules, orally, once daily for 2 weeks during the run-in period, followed by esomeprazole 40 mg, over encapsulated tablets, orally, once daily for 4 weeks during the active treatment period.
Vonoprazan 40 mgEXPERIMENTALEsomeprazole 40 mg over-encapsulated tablets, orally, once daily for 4 weeks then esomeprazole placebo-matching capsules, orally, once daily for 2 weeks during the run-in period, followed by vonoprazan 40 mg, over-encapsulated capsules, orally, once daily for 4 weeks during the active treatment period.

Interventions

NameTypeDescription
VonoprazanDRUGVonoprazan Tablets
AmoxicillinDRUGAmoxicillin Capsules
ClarithromycinDRUGClarithromycin Tablets
Bismuth Potassium citrateDRUGBismuth Potassium citrate
EsomeprazoleDRUGEsomeprazole Tablets
LansoprazoleDRUGLansoprazole capsules or tablets
Vonoprazan PlaceboDRUGVonoprazan placebo-matching tablets
Lansoprazole PlaceboDRUGLansoprazole placebo-matching capsules
Rabeprazole sodiumDRUGRabeprazole sodium tablets
Esomeprazole PlaceboDRUGEsomeprazole placebo-matching capsules
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Eligibility Criteria

Age Range18 Years to N/A
SexALL
Healthy VolunteersNo
Study Sites29

Inclusion Criteria: 1\. Helicobacter pylori (HP)-positive participants as determined by \^13C-urea breath test (\^13C-UBT) at the start of the study (Visit 1 \[screening\]) and who require HP eradication in Physician judgment. Exclusion Criteria: 1. Participant had any of the following conditions...

Countries:ChinaMalaysiaSouth KoreaTaiwanJapanBelgiumBulgariaCzechiaEstoniaPolandUnited Kingdom
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Frequently asked questions about Vonoprazan

What is Vonoprazan used for?

Vonoprazan is an investigational small molecule being studied for gastrointestinal conditions including erosive esophagitis, gastroesophageal reflux, and Helicobacter pylori infection. It has also been evaluated in healthy volunteers. The drug is in Phase 3 clinical development and is not yet approved by the FDA.

How does Vonoprazan work?

Vonoprazan is a potassium-competitive acid blocker that suppresses gastric acid secretion. It works by competitively inhibiting the gastric proton pump, reducing acid production in the stomach. This mechanism is being studied for the treatment of acid-related gastrointestinal disorders.

Who makes Vonoprazan?

Vonoprazan is being developed by Takeda Pharmaceutical Company Limited, which trades under the ticker TAK. The drug is currently in Phase 3 clinical trials for gastrointestinal indications.

What phase is Vonoprazan in?

Vonoprazan is in Phase 3 clinical development. It is an investigational drug and has not received FDA approval. Clinical trials have been completed for erosive esophagitis and other gastrointestinal conditions.

What clinical trials is Vonoprazan in?

Vonoprazan has completed several clinical trials, including NCT02388724 and NCT02388737 for erosive esophagitis, NCT02037477 in healthy volunteers, and NCT02743949 for gastroesophageal reflux. These trials were Phase 2 and Phase 3 studies with active controls.

Is Vonoprazan the same as TAK-438?

Yes, Vonoprazan is also known as TAK-438. Clinical trial records refer to the drug by both names, such as in the Phase 3 study NCT02037477, which evaluates multiple oral doses of Vonoprazan (TAK-438).