Efficacy and safety of vonoprazan‐based dual therapy and esomeprazole‐based dual therapy in eradicating primary Helicobacter pylori infection: A propensity score matching analysis

Abstract

BackgroundAccording to the Maastricht VI/Florence consensus report, potassium‐competitive acid blockers (P‐CAB) may improve Helicobacter pylori eradication treatment.Materials and methodsA total of 213 H. pylori treatment‐naive patients aged between 18 and 70 years were treated with two regimens. The two regimens are VDT: 20 mg vonoprazan twice a day and 1 g amoxicillin three times daily and EDT: 20 mg esomeprazole four times a day and 750 mg amoxicillin four times daily. 13C‐urea breath tests were used to evaluate eradication rate 4–6 weeks after treatment. Based on propensity score matching (PSM), this retrospective study analyzed the eradication rates, adverse events (AEs), compliance, and antibiotic resistance rates in VDT and EDT groups.ResultsOn intention‐to‐treat (ITT) analysis, the eradication rate in VDT group (89.0%; 95% CI 81.7–96.3) was non‐inferior to that in EDT group (87.7%; 95% CI 80.1–95.3; p = 0.796). The corresponding per‐protocol (PP) eradication rates were 94.1% (95% CI 88.4–99.8) and 92.8% (95% CI 86.7–98.9; p = 1.000), respectively. There were no significant between‐group differences with respect to compliance or incidence of AEs.ConclusionsThe efficacy and safety of 14‐day VDT and EDT were comparable. Therefore, 14‐day VDT or EDT may be recommended for the first‐line treatment of H. pylori infection.

Vonoprazan and amoxicillin dual therapy as the first‐line treatment of Helicobacter pylori infection: A systematic review and meta‐analysis

“…However, in China, the same therapy has resulted in a very low eradication rate, falling below 80%. The efficacy was improved (>90%) when the treatment duration was extended to 14 days 25–30 . It should be note that all the VA groups were treated with VPZ 20 mg bid and we found that high dose and low dose amoxicillin does not contribute significant difference to the cure rate.…”

“…In contrast to the four previous systematic reviews and meta‐analysis, 8,35–37 our study incorporates nine articles 12,24–28,34,38 . Compared with previous meta‐analysis, we made a comprehensive analysis to compare the efficacy and safety of VA dual therapy with VPZ triple or quadruple therapy.…”

Vonoprazan and amoxicillin dual therapy for 14 days as the first‐line treatment of Helicobacter pylori infection: A non‐inferiority, randomized clinical trial

“…In China, we reported that vonoprazan with normal (1 g b.i.d) or high (1 g t.i.d) dose amoxicillin for 14 days showed high efficiency (>90%) as the first‐line treatment of H. pylori infection 12 . The following clinical trials 13,14,27,28 further confirmed the high efficacy of VA for 14 days as the first‐line treatment of H. pylori infection, high dose of amoxicillin (1 g t.i.d or 750 mg q.i.d) was used. Until now, there are no studies to compare the efficacy of VA dual therapy and vonoprazan‐containing quadruple therapy for eradicating H. pylori infection.…”

Comparison of vonoprazan-based dual therapy with vonoprazan-based bismuth quadruple therapy for treatment-naive patients with Helicobacter pylori infection: A propensity score matching analysis

“…[40] Consistent with our results, VA regimens that have achieved satisfactory eradication rates in current research are typically administered for 10 to 14 days, with AMO dosages ≥ 3.0g/day, and administered 3 or 4 times daily. [24][25][26]41] A recent retrospective cohort study demonstrated that a 14-day VA regimen (VPZ 20 mg twice daily + AMO 1000 mg 3 times daily) had comparable efficacy (94.1% vs 92.8%) and safety to a 14-day PPI-based dual therapy regimen (AMO 1000 mg 3 times daily + esomeprazole 20 mg 4 times daily), [42] These findings indicated that the acid suppression strength of VPZ at 40 mg daily is equivalent to 4 times the standard dose of PPI, with a lower dosing frequency and improved convenience for patients. However, studies conducted in the United States and Europe have shown unacceptable eradication rates (<80%) for the 14-day VA regimen, which may be attributed to racial differences and higher BMI, leading to inadequate gastric acid suppression.…”