Optimization of vonoprazan‐amoxicillin dual therapy for eradicating Helicobacter pyloriinfection in China: A prospective, randomized clinical pilot study

Abstract

Background Vonoprazan‐amoxicillin (VA) dual therapy has been shown to achieve acceptable cure rates for treatment of Helicobacter pylori(H. pylori) in Japan. Its effectiveness in other regions is unknown. We aimed to explore the efficacy of VA dual therapy as first‐line treatment for H. pyloriinfection in China. Methods This was a single center, prospective, randomized clinical pilot study conducted in China. Treatment naive H. pyloriinfected patients were randomized to receive either low‐ or high‐dose amoxicillin‐vonoprazan consisting of amoxicillin 1 g either b.i.d. or t.i.d plus VPZ 20 mg b.i.d for 7 or 10 days. 13C‐urea breath tests were used to access the cure rate at least 4 weeks after treatment. Results Three hundred and twenty‐three patients were assessed, and 119 subjects were randomized. The eradication rates of b.i.d. amoxicillin for 7 and 10 days, t.i.d. amoxicillin for 7 and 10 days were 66.7% (16/24), 89.2% (33/37), 81.0% (17/21), and 81.1% (30/37) (p = .191) by intention‐to‐treat analysis, respectively, and 72.7% (16/22), 89.2% (33/37), 81.0% (17/21), and 81.1% (30/37) (p = .454) by per‐protocol analysis, respectively. Conclusion Neither 7‐ or 10‐day VA dual therapy with b.i.d. or t.i.d. amoxicillin provides satisfied efficacy as the first‐line treatment for H. pyloriinfection in China. Further optimization is needed.

Amoxicillin‐vonoprazan dual therapy forHelicobacter pylorieradication: A systematic review and meta‐analysis

“…The results showed that the eradication of 7-or 10-day VA dual therapy with bid or tid amoxicillin was below 90%. 36 However, 14-day VA dual therapy showed satisfactory efficacy (eradication rate > 90%) as the first-line treatment for H. pylori infection (our unpublished data). Therefore, it was of great interest to explore the duration, dosage, and frequency of VA dual therapy in other regions.…”

“…In China, we conducted a prospective, randomized clinical pilot study to evaluate the efficacy of VA dual therapy for H. pylori eradication. The results showed that the eradication of 7‐ or 10‐day VA dual therapy with bid or tid amoxicillin was below 90% 36 . However, 14‐day VA dual therapy showed satisfactory efficacy (eradication rate > 90%) as the first‐line treatment for H. pylori infection (our unpublished data).…”

Analysis of oral microbiota alterations induced by Helicobacter pylori infection and vonoprazan‐amoxicillin dual therapy for Helicobacter pylori eradication

“…From January 9, 2021, to October 1, 2021, 119 H. pylori ‐positive patients diagnosed by histology or the 13 C‐urea breath test were enrolled from The First Affiliated Hospital of Nanchang University. The detailed inclusion criteria and exclusion criteria were described previously 19 . These patients showed dyspepsia symptoms or visited for a healthy examination and were not treated with H. pylori eradication previously, PPI and antibiotics within the previous month.…”

“…The detailed inclusion criteria and exclusion criteria were described previously. 19 These patients showed dyspepsia symptoms or visited for a healthy examination and were not treated with H. pylori eradication previously, PPI and antibiotics within the previous month. Thirteen H. pylori-negative patients (confirmed by the 13 C-urea breath test) without a history of surgery or other diseases were defined as normal controls, whose saliva samples were collected.…”

Letter: a promising Helicobacter pylori regimen ‐ vonoprazan‐based therapy

“…amoxycillin achieved >90%eradication rate in China. 8 Moreover,dualtherapyfor14 daysachievedcure ofinfectionin83.3%ofpatientswithclarithromycin-resistantstrains in the US and Europe. 9 Dual therapy might be optimised by increasing the frequency of amoxycillin from b.…”