Vonoprazan, a Novel Potassium-Competitive Acid Blocker, Should Be Used for the Helicobacter pylori Eradication Therapy as First Choice: A Large Sample Study of Vonoprazan in Real World Compared with Our Randomized Control Trial Using Second-Generation Proton Pump Inhibitors for Helicobacter pylori Eradication Therapy

Abstract

Background/Aims: Phase III study demonstrated that vonoprazan-based Helicobacter pylori eradication therapy achieved higher eradication rate compared with lansoprazole. However, there is no study that evaluated the efficacy of vonoprazan in a large sample in real world. We investigated the eradication rate and safety of vonoprazan-based eradication therapy compared with our randomized control trial using second-generation proton pump inhibitor (PPIs). Methods: (First study) A total of 147 patients who have H. pylori infection were randomly assigned to receive either, esomeprazole (EPZ) group and rabeprazole (RPZ) group. (Second study) 1,688 patients who have H. pylori infection underwent primary eradication with triple therapy involving vonoprazan. In both studies, triple therapy with amoxicillin, clarithromycin, and PPI or vonoprazan was performed, and eradication effect was assessed by an urea breath test. Results: (First study) Eradication rate was 77.5% in the EPZ group and 68.4% in the RPZ group; no significant difference was observed between the 2 groups. (Second study) The successful primary eradication rate was 90.8%. There was no severe adverse effect. Conclusions: The eradication rate of vonoprazan-based triple therapy was remarkably higher compared with second-generation PPIs-based triple therapy in real world. Vonoprazan is very likely to become the first option for future eradication therapy.

The safety and effectiveness of vonoprazan-basedHelicobacter pylorieradication therapy; a prospective post-marketing surveillance

“…These results were similar to the Japanese phase III study in which eradication rates of the first-and second-line eradication therapies were 92.6% (300/324) and 98.0% (49/50), respectively [10]. Our results were also similar to the results of post-marketing research that investigated first-line eradication therapy with vonoprazan/AMPC/CAM and reported eradication rates of around 90% [14][15][16][17].…”

Efficacy of Vonoprazan for <i>Helicobacter pylori</i> Eradication

“…There are a few studies concerning the adverse events of second-line eradication therapy with vonoprazan (21,24,29,31,36). These studies showed that adverse events occurred in 0-30% of patients receiving VAM-containing regimens, with diarrhea being the main adverse effect.…”

“…Second, we must consider the various patterns of antibiotic resistance of H. pylori among regions. The Japanese studies described above investigated roughly the same eradication regimens: vonoprazan 20 mg + amoxicillin 750 mg + clarithromycin 200/400 mg or metronidazole 250 mg, twice (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38). In Japan, the rate of clarithromycin resistance of H. pylori is more than 30%, whereas that of metronidazole resistance is less than 5% (55).…”

Smoking and Drinking Did Not Increase the Failure of Therapeutic Helicobacter pylori Eradication by Vonoprazan, Clarithromycin, and Amoxicillin

“…P-CAB inhibits H + , K + -ATPase-mediated gastric acid secretion, and vonoprazan suppresses gastric acid secretion more potently than PPIs [22][23][24]. There have been many studies indicating that H. pylori eradication with triple therapy including vonoprazan is more efficient compared with eradication using PPIs [25][26][27][28][29][30][31][32][33][34][35][36]. However, these studies did not clearly demonstrate that lifestyle-related factors, including smoking and drinking, had any influence on eradication rates following triple therapy incorporating vonoprazan.…”