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

Du, Ren‐Chun; Hu, Yu‐Xin; Ouyang, Yaobin; Ling, Li‐Xiang; Xu, Jing‐Yuan; Sa, Rina; Liu, Xiao‐Shun; Hong, Jun‐Bo; Zhu, Yin; Lu, Nong‐Hua; Hu, Yi

doi:10.1111/hel.13039

Cited by 8 publications

(2 citation statements)

References 47 publications

(123 reference statements)

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“…Body size (body surface area and BMI) reduces the effectiveness of P-CABs, whereas the presence and severity of corpus gastritis improve treatment outcomes [66]. Overall, highly effective dual therapy requires excellent control of gastric pH, suggesting that optimization will often be required for different populations (i.e., one size may not fit all) [35,46,53,[67][68][69][70][71][72][73][74][75][76].…”

Section: The Future Of H Pylori Therapy: Vonoprazan Dual Therapymentioning

confidence: 99%

Crises in Antimicrobial Stewardship: Misuse of Clarithromycin for Helicobacter pylori Therapy

Graham

2024

Pharmacoepidemiology

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Helicobacter pylori is a class I carcinogen that infects more than 100 million individuals in the United States. Antimicrobial therapy for H. pylori has typically been prescribed empirically rather than based on susceptibility testing. Until recently, therapeutic recommendations have generally ignored the principles of antibiotic stewardship. A combination of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin (triple therapy) remains popular despite increasing clarithromycin resistance and poor cure rates. Concomitant therapy (a PPI, amoxicillin, clarithromycin, and metronidazole) is recommended and widely used despite all patients receiving at least one unneeded antibiotic. In 2020, the Food and Drug Administration approved vonoprazan, amoxicillin, and clarithromycin triple therapy, which administers unneeded clarithromycin to >90% of patients (i.e., ~6 tons of unneeded clarithromycin/million treatments). In the late 1980s, the infectious disease community functionally transferred responsibility for the management of H. pylori to gastroenterology, which has managed the infection as another common gastrointestinal disease such as constipation. In 2022, both traditional and noninvasive molecular-based susceptibility testing for H. pylori became available in the United States. In order to reduce and prevent antibiotic misuse, the infectious disease community should reclaim responsibility for the management of this important infectious disease.

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Section: The Future Of H Pylori Therapy: Vonoprazan Dual Therapymentioning

confidence: 99%

Crises in Antimicrobial Stewardship: Misuse of Clarithromycin for Helicobacter pylori Therapy

Graham

2024

Pharmacoepidemiology

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“…associated with higher H. pylori eradication rates in amoxicillincontaining dual therapy. 9 Inspired by the enhanced efficacy observed in AMX-containing dual therapy, it was hypothesised that tetracycline's antimicrobial effect might be more stable and exhibit better bioavailability in the gastric cavity under the higher intragastric pH value produced by vonoprazan. The results of this study demonstrated that the efficacy of VT dual therapy was non-inferior to that of classical BQT, as determined by ITT, mITT and PP analyses.…”

Section: Helicobacter Pylorimentioning

confidence: 99%

Simplified Helicobacter pylori therapy for patients with penicillin allergy: a randomised controlled trial of vonoprazan-tetracycline dual therapy

Gao,

Liu,

Wang

et al. 2024

Gut

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Background and aimsThis study aimed to evaluate the efficacy and safety of vonoprazan and tetracycline (VT) dual therapy as first-line treatment forHelicobacter pyloriinfection in patients with penicillin allergy.MethodsIn this randomised controlled trial, treatment-naïve adults withH. pyloriinfection and penicillin allergy were randomised 1:1 to receive either open-label VT dual therapy (vonoprazan 20 mg two times per day+tetracycline 500 mg three times a day) or bismuth quadruple therapy (BQT; lansoprazole 30 mg two times per day+colloidal bismuth 150 mg three times a day+tetracycline 500 mg three times a day+metronidazole 400 mg three times a day) for 14 days. The primary outcome was non-inferiority in eradication rates in the VT dual group compared with the BQT group. Secondary outcomes included assessing adverse effects.Results300 patients were randomised. The eradication rates in the VT group and the BQT group were: 92.0% (138/150, 95% CI 86.1% to 95.6%) and 89.3% (134/150, 95% CI 83.0% to 93.6%) in intention-to-treat analysis (difference 2.7%; 95% CI −4.6% to 10.0%; non-inferiority p=0.000); 94.5% (138/146, 95% CI 89.1% to 97.4%) and 93.1% (134/144, 95% CI 87.3% to 96.4%) in modiﬁed intention-to-treat analysis (difference 1.5%; 95% CI −4.9% to 8.0%; non-inferiority p=0.001); 95.1% (135/142, 95% CI 89.7% to 97.8%) and 97.7% (128/131, 95% CI 92.9% to 99.4%) in per-protocol analysis (difference 2.6%; 95% CI −2.9% to 8.3%; non-inferiority p=0.000). The treatment-emergent adverse events (TEAEs) were significantly lower in the VT group (14.0% vs 48.0%, p=0.000), with fewer treatment discontinuations due to TEAEs (2.0% vs 8.7%, p=0.010).ConclusionsVT dual therapy demonstrated efficacy and safety as a first-line treatment forH. pyloriinfection in the penicillin-allergic population, with comparable efficacy and a lower incidence of TEAEs compared with traditional BQT.Trial registration numberChiCTR2300074693.

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Potassium-competitive Acid Blockers: Current Clinical Use and Future Developments

Scarpignato,

Hunt

2024

Curr Gastroenterol Rep

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Purpose of the Review Acid suppression with proton pump inhibitors (PPIs) represents the standard of care in the treatment of acid-related diseases. However, despite their effectiveness, PPIs display some intrinsic limitations, which underlie the unmet clinical needs that have been identified over the past decades. The aims of this review are to summarize the current status and future development of the new class of antisecretory drugs (potassium-competitive acid blockers, P-CABs) that have recently been introduced into medical practice. Recent Findings Over the past decades, clinical needs unmet by the current acid suppressants have been recognized, especially in the management of patients with GERD, Helicobacter pylori infection and NSAID-related peptic ulcer. The failure to address these needs is mainly due to their inability to achieve a consistent acid suppression in all patients and, particularly, to control nighttime acidity. It was then realized that an extended duration of acid suppression would exert additional benefits. The available data with P-CABs show that they are able to address these unmet clinical needs. Summary Four different P-CABs (vonoprazan, tegoprazan, fexuprazan and keverprazan) are currently available. However, only two of them are approved outside Asia. Vonoprazan is available in North, Central and South America while tegoprazan is marketed only in Latin American countries. Two other compounds (namely linazapran glurate and zestaprazan) are presently under clinical development. While clinical trials on GERD have been performed with all P-CABs, only vonoprazan and tegoprazan have been investigated as components of Helicobacter pylori eradication regimens. The available data show that—in the above two clinical indications—P-CABs provide similar or better efficacy in comparison with PPIs. Their safety in the short-term overlaps that of PPIs, but data from long-term treatment are needed.

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

Cited by 8 publications

References 47 publications

Crises in Antimicrobial Stewardship: Misuse of Clarithromycin for Helicobacter pylori Therapy

Crises in Antimicrobial Stewardship: Misuse of Clarithromycin for Helicobacter pylori Therapy

Simplified Helicobacter pylori therapy for patients with penicillin allergy: a randomised controlled trial of vonoprazan-tetracycline dual therapy

Potassium-competitive Acid Blockers: Current Clinical Use and Future Developments

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