7 Out of 10 Suffer from GERD… ‘Fexuprazan’ Gains Attention for Rapid and Nighttime Relief
(Jakarta, May 21, 2025)
Gastroesophageal reflux disease (GERD) is on the rise in Indonesia. According to a study by the University of Indonesia’s Faculty of Medicine (Journal of Clinical Gastroenterology, April 2024), GERD prevalence among Indonesian adults increased from 61.8% in 2019 to 67.9% in 2021, affecting nearly 7 out of 10 individuals. The Westernization of dietary habits, chronic stress, obesity, and aging populations are cited as major factors contributing to this increase.
Daewoong Pharmaceutical, South Korea’s leading healthcare group, is drawing attention for developing Fexuprazan, a new treatment for GERD, which has recently demonstrated its efficacy and safety in clinical trials conducted among Indonesian patients. Although PPIs are typically taken once a day, their short half-life often requires patients to take them twice daily to control nighttime acid secretion, leading to inconvenience. In contrast, Fexuprazan, with the longest half-life among P-CAB drugs (approximately 9 hours), provides sufficient acid suppression throughout the night with just a once-daily dose, offering greater dosing convenience, cost-effectiveness, and superior control of nocturnal heartburn symptoms compared to PPIs.
◆ Rising GERD Cases Lead to New Treatment Options with P-CABs
Historically, proton pump inhibitors (PPIs) have been the first-line treatment for GERD. First introduced about 40 years ago, proton pump inhibitors (PPIs) are absorbed into the body in an inactive form and become activated only in the acidic environment of the stomach. Once activated, they bind to the final stage of acid production—the proton pump—to exert their effect.
Because of this complex activation process, PPIs do not provide immediate relief after ingestion. They must be taken 30 to 60 minutes before meals, as activation requires the stomach to be in an acidic state. Moreover, PPIs can only act on already activated proton pumps. Since new pumps are continuously produced in the stomach, it typically takes 3 to 5 days of consistent use to see noticeable effects. With a short half-life of just 1 to 2 hours, the duration of action is limited, and the drugs are often insufficient to suppress acid production during the night. As a result, some patients continue to experience nighttime heartburn, leading to disrupted sleep and reduced quality of life. Although PPIs are generally prescribed once daily, many patients end up taking them twice a day for adequate symptom control.
Fexuprazan is a next-generation P-CAB drug designed to overcome these limitations of PPIs. It is absorbed in an already active form and does not require an acidic environment for activation, allowing it to act immediately upon ingestion. It can also be taken regardless of meals, offering greater dosing flexibility and convenience.
Fexuprazan competitively binds to the potassium (K⁺) binding site of the proton pump, the final gateway of gastric acid secretion. By doing so, it blocks the exchange of potassium and hydrogen ions, directly inhibiting the acid secretion process at its source. In addition, Fexuprazan maintains high chemical stability even in highly acidic environments. It is not easily degraded by acid, allowing it to remain in the stomach for an extended period and deliver sustained acid suppression.
With a half-life of approximately 9 hours — the longest among P-CAB drugs — Fexuprazan provides effective acid control throughout the night with just a once-daily dose. As a result, it serves as a particularly effective treatment option for patients experiencing nighttime heartburn and sleep disturbances.
Recognizing the potential of this new class of therapy, the Indonesian Society of Gastroenterology (PGI) officially updated the 2024 GERD Treatment Guidelines to include P-CABs as a recommended treatment option alongside PPIs. This marks the first time P-CABs have been incorporated into Indonesia’s national clinical guidelines, reflecting growing confidence in their efficacy. In Japan as well, P-CABs are now recommended as a first-line treatment for severe GERD, and considered alongside PPIs for mild to moderate cases, reflecting the growing international recognition and adoption of P-CAB therapies.
◆ Fexuprazan Demonstrates Fast Symptom Relief in Indonesian Clinical Trials
Recent investigator-initiated trials in Indonesia confirmed Fexuprazan’s comparable efficacy to Esomeprazole while delivering faster symptom relief, particularly in alleviating nausea.
While patients on Esomeprazole typically reported symptom improvement after eight weeks, those treated with Fexuprazan showed significant improvement within just seven days. Additionally, within just seven days of treatment, patients receiving Fexuprazan showed significantly greater improvement in quality of life compared to the control group, along with faster relief from nighttime reflux symptoms and improved sleep quality.
Professor Ari Fahrial Syam, Chair of the Executive Board of the Indonesian Society of Gastroenterology and Principal Investigator of the study, stated, “This study confirmed that Fexuprazan alleviates heartburn and acid reflux symptoms faster than Esomeprazole. Given the rising prevalence of GERD in Indonesia, Fexuprazan, which provides symptom relief with just once-daily dosing, represents an innovative treatment option.”
Jisun Lee, Head of Clinical Development at Daewoong Pharmaceutical, stated, "Fexuprazan’s rapid symptom relief and dosing convenience position it as a valuable option to improve patients' quality of life in Indonesia. We are committed to continuously providing high-quality treatment options that contribute to the health of the Indonesian people."
Based on these positive clinical results, Daewoong Pharmaceutical is actively progressing with the regulatory approval process for Fexuprazan in Indonesia. The company also plans to expand its indications to include broader gastrointestinal conditions such as functional dyspepsia and gastritis, while strengthening collaboration with local medical societies and academic institutions.
PPI Vs. P-CAB
Illustration Description: Mechanism of Action of Fexuprazan in the Stomach
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