PHARMACEUTICALS · Published 2026-07-26 · DOI 10.3390/ph19081168
Jyotsna S. Ranbhise, Manish Kumar Singh, Hyeong Rok Yun, Sunhee Han, Sung Soo Kim, Insug Kang
For over three decades, Proton Pump Inhibitors (PPIs) have served as the established primary therapy for acid-suppressive therapy; however, their clinical utility is frequently compromised by their slow onset of action, meal-time dependency, and metabolic variability driven by <i>CYP2C19</i> polymorphisms. Potassium-competitive acid blockers (P-CABs) represent a definitive pharmacological shift, offering rapid, reversible, and genotype-independent inhibition of the H<sup>+</sup>/K<sup>+</sup>-ATPase. This review outlines the emergence of South Korea as a global epicenter for P-CAB innovation, predicated upon a strategic partnership between a high domestic burden of <i>Helicobacter pylori</i> infection and a rising incidence of refractory gastroesophageal reflux disease (GERD). We analyze the clinical and structural developments of indigenous Korean agents, specifically tegoprazan and fexuprazan, the latter of which features an optimized 9-h elimination half-life engineered to mitigate nocturnal acid breakthrough. A critical evaluation of recent clinical evidence is provided, including the most recent 2024 prospective Phase III data, which demonstrate that 14-day P-CAB-based triple therapy achieves significantly improved eradication rates in high-clarithromycin-resistance environments. Furthermore, we explore the emerging 2025 trend toward personalized, on-demand maintenance therapy and address critical long-term safety considerations, including the duration-dependent risk of metachronous gastric cancer identified in recent multicenter longitudinal studies. Ultimately, the South Korean clinical framework is providing the foundational evidence for a global transition toward P-CAB-centered treatment algorithms, redefining the standards of care in modern gastroenterology.
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Ranbhise, J., Singh, M., Yun, H., et al. (2026). Potassium-Competitive Acid Blockers as a New Frontier in Acid-Related Disorders and the Role of South Korean Pharmacological Innovation. PHARMACEUTICALS. https://doi.org/10.3390/ph19081168