The Started 'Domestic Esophagitis Yak' Three-Way Battle...Who Will Be the Winner?

In the gastroesophageal reflux disease (GERD) treatment market, a new drug called potassium-competitive acid blocker (P-CAB), which improves both efficacy and convenience compared to existing drugs, is emerging as a game changer. More than half of the drugs developed worldwide have been developed domestically, signaling fierce competition both at home and abroad.

Jeil Pharmaceutical's gastroesophageal reflux disease treatment 'Jacubo'
Photo by Jeil Pharmaceutical

Jeil Pharmaceutical began selling its new GERD drug Jacubo this month under the National Health Insurance coverage. Jacubo, a P-CAB drug developed by its subsidiary Onconic Therapeutics, is the first proprietary new drug introduced by Jeil Pharmaceutical since its founding.

Drugs like Jacubo and other P-CABs overcome the drawbacks of proton pump inhibitors (PPIs), which have traditionally dominated the GERD treatment market. PPIs must be taken before meals because they need to activate before acid secretion, and it can take 3 to 5 days for their effects to manifest. Additionally, the drug components are rapidly eliminated from the body, so taking the medication at night can cause the effect to wear off during sleep, leading to acid secretion and heartburn. P-CABs block acid secretion through a more fundamental mechanism than PPIs, overcoming these limitations. They can be taken at any time regardless of meals, and their effects appear faster and last longer.

In South Korea, HK Inno.N’s K-CAB and Daewoong Pharmaceutical’s Pexuclu were developed earlier and have rapidly expanded their market presence. Although PPIs still hold a higher market share overall, K-CAB and Pexuclu have already secured the first and second positions in market share among individual products, showing rapid growth.

Since its launch in 2019, K-CAB has rapidly grown with cumulative outpatient prescription sales reaching 761.1 billion KRW as of August. Besides Korea, it is accelerating its entry into global markets such as Asia and South America, increasing its potential to become the first Korean new drug to surpass annual sales of 1 trillion KRW and become a global blockbuster. Pexuclu has also contributed to market expansion, surpassing cumulative sales of 100 billion KRW as of May since its launch in 2022.

P-CAB gastroesophageal reflux disease treatments HK inno.N's 'K-CAB' and Daewoong Pharmaceutical's 'Pexuclu' (from left)
[Photo by each company]

Globally, P-CAB drugs are also showing rapid growth. According to global market research firm BCC Research, the P-CAB treatment market, which was about 61 billion KRW in 2015 across 17 major countries, is expected to grow at an average annual rate of 25.7%, reaching 1.876 trillion KRW by 2030. With the launch of Jacubo, three out of the five commercially available P-CAB drugs worldwide will be Korean new drugs, raising expectations for global market dominance. Besides K-CAB, Pexuclu, and Jacubo, Takeda Pharmaceutical’s Takecab from Japan and Gabipharm’s Beiwen from China are also on the market.

Securing dominance in the domestic market is a top priority to establish global leadership, making domestic sales partners a key focus. HK Inno.N initially partnered with Chong Kun Dang to sell K-CAB but switched to Boryung this year. Although Chong Kun Dang played a significant role in the early growth, the change was made to improve profitability. The two companies are actively creating synergy by jointly selling Boryung’s flagship hypertension drug Kanarb along with K-CAB. Based on sales in the first half of this year, K-CAB recorded 88.9 billion KRW and Kanarb 78.3 billion KRW, showing sales growth of 67.3% and 12.6%, respectively, compared to the first half of last year.

In response, Chong Kun Dang has teamed up with Daewoong Pharmaceutical to re-enter the GERD treatment market. Pexuclu alone recorded sales of 51.3 billion KRW in the first half of this year, nearly matching last year’s total sales of 55 billion KRW. The two companies aim to increase Pexuclu’s annual sales to around 300 billion KRW by 2030. Jeil Pharmaceutical has partnered with Dong-A ST, setting a goal to achieve sales of 189.7 billion KRW over the next three years. They plan to deliver results similar to the 218.2 billion KRW sales achieved by the leading drug K-CAB during its first three years after launch.