H. pylori eradication: Triple therapy with 1-week vonoprazan as good as with 2-week PPI

One-week vonoprazan-based triple therapy is well tolerated and has comparable efficacy as the 2-week proton pump inhibitor (PPI)-based triple therapy for first-line Helicobacter pylori eradication, according to a study.

Of the 1,097 treatment-naïve H. pylori patients in Singapore included in the study, 252 were randomized to receive either treatment regimen: (1) 7 days of amoxicillin 1 g, clarithromycin 500 mg, and vonoprazan 20 mg twice per day, or (2) 14 days of amoxicillin 1 g plus clarithromycin 500 mg plus omeprazole or esomeprazole or rabeprazole 20 mg twice a day.

Researchers compared demographics, H. pylori resistance, CYP 2C19 genotype, eradication success, and safety profiles between the two treatment groups.

A total of 244 patients (mean age 51.7 years) received vonoprazan- (n=119) or PPI-based (n=125) triple therapy. In the intention-to-treat analysis, eradication rates were 87.4 percent with vonoprazan-based triple therapy and 88.0 percent with PPI-based triple therapy. The difference was not statistically significant (−0.64, 95 percent confidence interval [CI], −8.5 to −7.2).

Per-protocol analysis yielded similar results. Eradiation rates were similar in the vonoprazan and the PPI groups (96.3 percent vs 94.0 percent), confirming the noninferiority of vonoprazan.

Treatment failure was significantly associated with clarithromycin resistance (relative risk, 11.4, 95 percent CI, 1.4–96.3; p=0.025). There were no significant differences in CYP 2C19 genotypes and adverse events between the two treatment groups.