S1382 Vonoprazan Dual and Triple Therapy for Helicobacter pylori Eradication

Chey, William D.; Mégraud, Françis; Laine, Loren; López, L.; Hunt, Barbara; Smith, Neila; Leifke, Eckhard; Knipfer, Nancianne; Howden, Colin W.

doi:10.14309/01.ajg.0000779060.18666.73

Cited by 7 publications

(7 citation statements)

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“…But these have failed to achieve a threshold of 90% at the doses studied. 237 Dose ranging studies and prospective comparative trials in western countries offer important new directions and the prospect of simpler, dual therapies at a time when global resistance rates are a serious challenge to the successful management of H. pylori infection. [238][239][240] Statement 10: empiric second-line and rescue therapies should be guided by local resistance patterns assessed by susceptibility testing and eradication rates in order to optimise treatment success.…”

Section: Agreement 100% Grade B2mentioning

confidence: 99%

“…The initial development and clinical experience with vonoprazan based eradication regimen has been largely limited to East Asian countries but equivalent rates of eradication to PPI based treatments have been reported in North American and European studies. But these have failed to achieve a threshold of 90% at the doses studied 237. Dose ranging studies and prospective comparative trials in western countries offer important new directions and the prospect of simpler, dual therapies at a time when global resistance rates are a serious challenge to the successful management of H. pylori infection 238–240…”

Section: Wg3: Treatmentmentioning

confidence: 99%

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Management ofHelicobacter pyloriinfection: the Maastricht VI/Florence consensus report

Malfertheiner

Mégraud

Rokkas

et al. 2022

Gut

630

842

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Helicobacter pyloriInfection is formally recognised as an infectious disease, an entity that is now included in the International Classification of Diseases 11th Revision. This in principle leads to the recommendation that all infected patients should receive treatment. In the context of the wide clinical spectrum associated with Helicobacter pylori gastritis, specific issues persist and require regular updates for optimised management.The identification of distinct clinical scenarios, proper testing and adoption of effective strategies for prevention of gastric cancer and other complications are addressed. H. pylori treatment is challenged by the continuously rising antibiotic resistance and demands for susceptibility testing with consideration of novel molecular technologies and careful selection of first line and rescue therapies. The role of H. pylori and antibiotic therapies and their impact on the gut microbiota are also considered.Progress made in the management of H. pylori infection is covered in the present sixth edition of the Maastricht/Florence 2021 Consensus Report, key aspects related to the clinical role of H. pylori infection were re-evaluated and updated. Forty-one experts from 29 countries representing a global community, examined the new data related to H. pylori infection in five working groups: (1) indications/associations, (2) diagnosis, (3) treatment, (4) prevention/gastric cancer and (5) H. pylori and the gut microbiota. The results of the individual working groups were presented for a final consensus voting that included all participants. Recommendations are provided on the basis of the best available evidence and relevance to the management of H. pylori infection in various clinical fields.

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Section: Agreement 100% Grade B2mentioning

confidence: 99%

Section: Wg3: Treatmentmentioning

confidence: 99%

Management ofHelicobacter pyloriinfection: the Maastricht VI/Florence consensus report

Malfertheiner

Mégraud

Rokkas

et al. 2022

Gut

630

842

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“…Potassium-competitive acid blockers (P-CABs), a new class of acid inhibitors, have a more potent and durable effect on acid suppression than PPIs 309,310 . Vonoprazan-based triple therapy (V-TT) with clarithromycin and amoxicillin in first-line achieved an eradication rate of 92.6% versus 75.9% with PPI-TT, and 98% in second-line in Japan 311 , which was also confirmed in western countries 312 . In network meta-analyses, V-TT ranked best among all current first-line empirical therapies, which was also confirmed after the inclusion of a trial conducted in western countries 313,314 .…”

Section: Regimens With Potassium-competitive Acid Blockersmentioning

confidence: 75%

Helicobacter pylori infection

Malfertheiner

Camargo

El-Omar

et al. 2023

Nat Rev Dis Primers

254

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Helicobacter pylori infection causes chronic gastritis, which can progress to severe gastroduodenal pathologies, including peptic ulcer, gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma. H. pylori is usually transmitted in childhood and persists for life if untreated. The infection affects around half of the population in the world but prevalence varies according to location and sanitation standards. H. pylori has unique properties to colonize gastric epithelium in an acidic environment. The pathophysiology of H. pylori infection is dependent on complex bacterial virulence mechanisms and their interaction with the host immune system and environmental factors, resulting in distinct gastritis phenotypes that determine possible progression to different gastroduodenal pathologies. The causative role of H. pylori infection in gastric cancer development presents the opportunity for preventive screen-and-treat strategies. Invasive, endoscopy-based and non-invasive methods, including breath, stool and serological tests, are used in the diagnosis of H. pylori infection. Their use depends on the specific individual patient history and local availability. H. pylori treatment consists of a strong acid suppressant in various combinations with antibiotics and/or bismuth. The dramatic increase in resistance to key antibiotics used in H. pylori eradication demands antibiotic susceptibility testing, surveillance of resistance and antibiotic stewardship.

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“…The US and Europe 2022 study 22 focusing on VPZ‐based therapies with sufficient samples did not achieved clinically acceptable cure rates (only 77.2% by ITT analysis), which could be explained by the failure to attain adequate intragastric concentrations of antibiotics or to create an intragastric pH conducive to the activity of amoxicillin 23 . Moreover, a recent prospective pilot study also showed that VA dual therapy was ineffective in Thailand and the results were much similar to the US and Europe study than Japan 24 .…”

Section: Discussionmentioning

confidence: 99%

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

Du,

Hu,

Ouyang

et al. 2023

Helicobacter

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BackgroundRecent clinical trials have evaluated the efficacy of vonoprazan‐amoxicillin (VA) dual therapy as the first‐line treatment for Helicobacter pylori infection in different regions with inconsistent results reported. In this systematic review and meta‐analysis, we aimed to evaluate the efficacy of VA dual therapy compared to the currently recommended therapy for eradicating H. pylori.Materials and MethodsA comprehensive search of the PubMed, Cochrane, and Embase databases was performed using the following search terms: (“Helicobacter” OR “H. pylori” OR “Hp”) AND (“vonoprazan” OR “potassium‐competitive acid blocker” OR “P‐CAB”) AND (“amoxicillin” OR “penicillin”) AND (“dual”). The primary outcome was to evaluate the eradication rate according to intention‐to‐treat and per‐protocol analysis. The secondary outcomes were adverse events and compliance.ResultsA total of 15 studies involving 4, 568 patients were included. The pooled eradication rate of VA dual therapy was 85.0% and 90.0% by intention‐to‐treat and per‐protocol analysis, respectively. The adverse events rate and compliance of VA dual therapy were 17.5% and 96%, respectively. The efficacy of VA dual therapy was superior to proton pump inhibitors‐based triple therapy (82.0% vs. 71.4%, p < 0.01) but lower than vonoprazan‐containing quadruple therapy (83.1% vs. 93.3%, p = 0.02). 7‐day VA dual therapy showed lower eradication rates than 10‐day (χ2 = 24.09, p < 0.01) and 14‐day VA dual therapy (χ2 = 11.87, p < 0.01). The adverse events rate of VA dual therapy was lower than vonoprazan triple therapy (24.6% vs. 30.9%, p = 0.01) and bismuth‐containing quadruple therapy (20.5% vs. 47.9%, p < 0.01). No significant difference of compliance was observed between VA dual therapy and each subgroup.ConclusionVA dual therapy, a novel regimen, showed high efficacy as the first‐line treatment for H. pylori eradication, which should be optimized before application in different regions.

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S1382 Vonoprazan Dual and Triple Therapy for Helicobacter pylori Eradication

Cited by 7 publications

References 0 publications

Management ofHelicobacter pyloriinfection: the Maastricht VI/Florence consensus report

Management ofHelicobacter pyloriinfection: the Maastricht VI/Florence consensus report

Helicobacter pylori infection

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

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