CHRONIC cough is a debilitating condition that can significantly impair quality of life, and gastro-oesophageal reflux disease (GORD) is a recognised contributor. Proton pump inhibitors (PPIs) are commonly prescribed to manage reflux-related symptoms, yet concerns about long-term use and delayed onset of action persist. Potassium-competitive acid blockers (P-CABs) are a newer alternative, offering faster relief and simpler dosing. In a recent study, P-CABs were evaluated for their effectiveness in treating GORD-related chronic cough, an area where treatment options remain limited. A key finding was that both treatment groups saw significant improvements in cough-related quality of life after just eight weeks.
The randomised, double-blind, active-controlled exploratory trial enrolled adults suffering from chronic cough lasting at least 8 weeks, with recent GORD or peptic symptom diagnosis. Participants were randomly assigned to receive either 40 mg of fexuprazan (a P-CAB) or 40 mg of esomeprazole (a PPI), taken once daily for 8 weeks. Placebos matched to each treatment were also administered to maintain blinding. The primary outcome was the change in Leicester Cough Questionnaire (LCQ) score from baseline. Secondary measures included changes in a cough severity Numerical Rating Scale (NRS) and the Reflux Disease Questionnaire (RDQ). Adverse events were monitored to assess safety.
Out of 190 individuals screened, 161 were randomised and 146 completed the study. Participants had a mean age of 39 years and were predominantly female (74.3%). Both treatment groups showed significant and similar improvement in LCQ scores over the 8-week period (fexuprazan: 4.9±4.0 vs esomeprazole: 5.3±3.8; p=0.558). Changes in cough severity and reflux symptoms, as measured by NRS and RDQ, were also statistically comparable. Adverse events were mostly mild and occurred at similar rates in both groups.
In conclusion, P-CABs appear to be as effective and well-tolerated as PPIs for patients with GORD-related chronic cough. Their faster onset and convenient dosing may offer practical benefits in clinical settings. However, the exploratory nature of the study and relatively short duration limit the generalisability of the findings. Larger, long-term trials are needed to confirm these results and better define the role of P-CABs in routine management of chronic cough linked to reflux.
Reference
Kang N et al. Efficacy and Safety of Fexuprazan Versus Esomeprazole for Gastroesophageal Reflux Disease-Related Chronic Cough: A Randomized, Double-Blind, Active-Controlled Exploratory Trial. Lung. 2025;203(1):59
