Comparison of vonoprazan and proton pump inhibitors for eradication of Helicobacter pylori.
Alternative eradication therapies for Helicobacter pylori infection are needed because of an increasing failure rate over the past decade. The aim of this study was to determine if vonoprazan, a new potassium-competitive acid blocker, showed superiority to existing proton pump inhibitors for primary eradication of H. pylori in routine clinical practice. Data for 573 patients who underwent primary H. pylori eradication therapy were retrospectively reviewed. Regimens included clarithromycin 200 mg, amoxicillin 750 mg, and an acid-suppressing drug [lansoprazole 30 mg (LAC), rabeprazole 10 mg (RAC), esomeprazole 20 mg (EAC), or vonoprazan 20 mg (VAC)] twice daily for 1 week. Eradication was successful in 73% (419/573) of patients using intention-to-treat (ITT) analysis and 76% (419/549) of patients in per-protocol (PP) analysis. The VAC group had a significantly superior eradication rate compared with the LAC and RAC groups in ITT (VAC 83%, LAC 66% and RAC 67%, p < 0.01) and PP analysis (VAC 85%, LAC 69% and RAC 70%, p < 0.01), and had a similarly high eradication rate to the EAC group (83% in ITT and 87% in PP). Although the eradication rate in the VAC and EAC groups was not significantly higher than in the LAC and RAC groups in patients with mild gastric atrophy with both ITT and PP analyses, it was significantly higher in patients with severe gastric atrophy (p < 0.01). The VAC group had a significantly higher H. pylori eradication rate than the LAC and RAC groups, and a > 80% eradication rate regardless of the degree of atrophy.
Shinozaki Medical Clinic, Utsunomiya, Japan.
Satoshi
S
Shinozaki
Department of Gastroenterology, Haga Red Cross Hospital, Moka, Japan.
Hiroaki
H
Nomoto
Department of Gastroenterology, Haga Red Cross Hospital, Moka, Japan.
Yoshie
Y
Kondo
Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Hirotsugu
H
Sakamoto
Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Yoshikazu
Y
Hayashi
Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
Hironori
H
Yamamoto
Department of Surgery, Jichi Medical University, Shimotsuke, Japan.
Alan Kawarai
AK
Lefor
Division of Gastroenterology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan. Electronic address: osawa@jichi.ac.jp.
Hiroyuki
H
Osawa
D001284:Atrophy; D060740:Disease Eradication; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000517:prevention & control*; D016480:Helicobacter pylori / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D011758:Pyrroles / Q000494:pharmacology / Q000627:therapeutic use*; D013270:Stomach / Q000187:drug effects / Q000473:pathology; D013449:Sulfonamides / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
C552956:1-(5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl)-N-methylmethanamine; D054328:Proton Pump Inhibitors; D011758:Pyrroles; D013449:Sulfonamides
Antibiotics; Gastric acid; Helicobacter pylori; Proton pump inhibitors; Treatment outcome