Gastric Mucosal Atrophy Might Be Associated with the Efficacy of First-Line Therapy Using Vonoprazan for <i>Helicobacter pylori</i>

Abstract

Aim: To investigate the factors related to the effect of eradication therapy with vonoprazan for Helicobacter pylori (H. pylori). Methods: We retrospectively reviewed medical records of H. pylori-positive patients who received first-line (40 mg vonoprazan/60 mg lansoprazole or 20 mg rabeprazole, 1500 mg amoxicillin, 400 mg clarithromycin, all 2/day for 7 days) (n = 4118). H. pylori eradication was assessed by the 13 C-urea breath test with success defined as a result of < 2.5‰. Using propensity score matching, successful eradication rates were compared between two groups: those receiving vonoprazan and those receiving a proton pump inhibitor. Related factors and adverse events were investigated. Results: Successful first-line eradication rates according to ITT analysis and PP analysis, respectively, were 79.8% and 91.4% for VPZ therapy. Eradication rates using propensity matched patients (n = 1053) who received first-line vonoprazan therapy were higher than in those using proton pump inhibitor (PPI) therapy (92.1% vs. 79.7% in per-protocol analysis, p < 0.0001). Multivariate analysis confirmed that gastric mucosal atrophy was associated with treatment success. Conclusions: Low-dose clarithromycin triple therapy for first-line H. pylori eradication therapy using vonoprazan was more effective than standard triple therapy with proton pump inhibitor. Gastric mucosal atrophy was associated with treatment success.

Efficacy and Tolerability of Second-Line Metronidazole Triple Therapy Using Vonoprazan for Helicobacter pylori Eradication in Japan—Comparative Study: Vonoprazan vs. Proton Pump Inhibitors

“…Katayama et al [23] reported that the eradication rate for H. pylori was 87.0% when VPZ was used as a second-line therapy (VAM) in patients for whom first-line VAC failed. In our cases, the successful first-line eradication rates according to ITT analysis and PP analysis, respectively, were 79.8% (95% CI, 77.5% -81.9%) and 91.4% (95% CI, 89.6% -92.9%) for VAC and 66.3% (95% CI, 64.6% -68.0%) and 78.9% (95% CI, 77.2% -80.5%) for PAC [14]. Among the patients who had not achieved eradication with first-line VAC the eradication rate was low with second-line VAM (75.2% in the ITT analysis, 88.1% in the PP analysis); this rate tended to be lower than that among those who previously were given first-line PAC (82.5% in the ITT analysis, 95.4% in the PP analysis).…”

“…A double-blind phase 3 study of triple therapy with VPZ (VAC) for first-line H. pylori eradication showed a high success rate of 92.6% [13]. Recently, a retrospective study with a large sample size [14], a meta-analysis [15] and prospective studies [16] [17] showed that the eradication rate of first-line VPZ (VAC) therapy was higher than that with PPI (PAC) therapy. In Japan, MNZ triple therapy is decided as second-line therapy under the National Health Insurance System.…”