Efficacy of Vonoprazan-Based Triple Therapy for Helicobacter pylori Eradication: A Multicenter Study and a Review of the Literature

Abstract

Vonoprazan-based triple therapy was effective and safe for Helicobacter pylori eradication in real-world experience, confirmed by a multicenter study and a review of the pertinent literature.

Vonoprazan-Based Helicobacter pylori Eradication Therapy: Time to Get Kompetitive?

“…These results support the high efficacy of vonoprazan-based triple therapy without prior antibiotic sensitivity testing, even in regions where the clarithromycin resistance rate is high, such as in Japan [9]. In the study by Tanabe et al [8], however, the eradication rate in intention-to-treat (ITT) analysis was relatively low (82.7%), failing to achieve an acceptable grade in the report card system proposed by Graham et al (C85% in ITT analysis) [11]. This gap of eradication rate between ITT and PP analyses may be due to the retrospective design of the study.…”

“…These results support the high efficacy of vonoprazan-based triple therapy without prior antibiotic sensitivity testing, even in regions where the clarithromycin resistance rate is high, such as in Japan [9]. In the study by Tanabe et al [8], however, the eradication rate in intention-to-treat (ITT) analysis was …”

“…In Korea, for example, [40 randomized controlled trials (RCTs) of first-line H. pylori eradication regimens have been completed [7]; in a network metaanalysis of H. pylori eradication in Korea, where both H. pylori infection and gastric cancer are highly prevalent, alternative regimens such as sequential, hybrid, and concomitant therapies (sequential therapy: PPI and amoxicillin, twice daily for the first 5 days (or 7 days), thereafter PPI, clarithromycin, and metronidazole (or tinidazole), twice daily for the last 5 days (or 7 days); hybrid therapy: PPI and amoxicillin, twice daily for the first 5 days (or 7 days), thereafter PPI, amoxicillin, clarithromycin, and metronidazole, twice daily for the next 5 days (or 7 days); concomitant therapy: PPI, amoxicillin, clarithromycin and metronidazole, twice daily for 5-14 days) reported higher eradication rates than did conventional triple therapy [7]. Since most PPI-based regimens, including alternative regimens, failed to achieve acceptable eradication rates [7], regimens incorporating the potent potassium-competitive antisecretory drug vonoprazan rather than PPIs have been developed in an effort to improve the eradication rate [7][8][9].In this issue of Digestive Diseases and Sciences, Tanabe et al [8] reported their ''real-world'' experience regarding vonoprazan-based H. pylori eradication therapy. In their study, the eradication rates of first-line and second-line vonoprazan-based triple therapy (first-line: 20 mg of vonoprazan, 750 mg of amoxicillin, and 200 mg (or 400 mg) of clarithromycin, twice daily for 1 week; second-line: 20 mg of vonoprazan, 750 mg of amoxicillin, 250 mg of metronidazole, twice daily for 1 week) in per-protocol (PP) analysis in populations untested for antibiotic sensitivity were 94.4 and 97.1%, respectively.…”

“…In this issue of Digestive Diseases and Sciences, Tanabe et al [8] reported their ''real-world'' experience regarding vonoprazan-based H. pylori eradication therapy. In their study, the eradication rates of first-line and second-line vonoprazan-based triple therapy (first-line: 20 mg of vonoprazan, 750 mg of amoxicillin, and 200 mg (or 400 mg) of clarithromycin, twice daily for 1 week; second-line: 20 mg of vonoprazan, 750 mg of amoxicillin, 250 mg of metronidazole, twice daily for 1 week) in per-protocol (PP) analysis in populations untested for antibiotic sensitivity were 94.4 and 97.1%, respectively.…”

“…The results of the study by Tanabe et al [8] reported the beneficial effect of a vonoprazan-based second-line regimen that consisted of vonoprazan, amoxicillin, and metronidazole. The eradication rate of the second-line regimen was 90.4 and 97.1% in the ITT and PP analyses, respectively.…”