title: Comparative study: Vonoprazan and proton pump inhibitors inHelicobacter pylorieradication therapy.
abstract: OBJECTIVE
  To compare the effectiveness and safety of vonoprazan-based therapy with proton pump inhibitor (PPI)-based therapies to treatHelicobacter pylori(H. pylori).
  
  
  METHODS
  We retrospectively analysed data from first-line (vonoprazan or PPI with 200 mg clarithromycin and 750 mg amoxicillin twice daily for 7 d) (n= 1353) and second-line (vonoprazan or PPI with 250 mg metronidazole and 750 mg amoxicillin twice daily for 7 d) (n= 261) eradication treatments forH. pylori-positive patients with associated gastrointestinal diseases from April 2014 to December 2015 at Hattori Clinic, Japan. The primary endpoint was the eradication rate, which was assessed with a full analysis set. The secondary endpoints were adverse events and related factors.
  
  
  RESULTS
  After the first-line treatments, the eradication rates for vonoprazan, esomeprazol, rabeprazole, and lansoprazole were 87.9% (95%CI: 84.9%-90.5%), 71.6% (95%CI: 67.5%-75.5%), 62.9% (95%CI: 52.0%-72.9%), and 57.3% (95%CI: 50.4%-64.1%), respectively. The vonoprazan eradication rate was significantly higher than that of the PPIs (P< 0.01). Interestingly, smoking did not affect theH. pylorieradication rate in the vonoprazan group (P= 0.34), whereas it decreased the rates in the PPI groups (P= 0.013). The incidence of adverse events in the vonoprazan group was not different from the PPI group (P= 0.054), although the vonoprazan group exhibited a wider range of adverse events. Vonoprazan-based triple therapy was highly effective as a second-line treatment, with an eradication rate similar to that of PPI-based therapy.
  
  
  CONCLUSIONS
  Vonoprazan might be superior to PPIs in first-lineH. pyloritherapy, particularly for smokers. However, caution is required due to possible adverse events.
authors.affiliation: Kouichi Sakurai, Hiroko Suda, Yumi Ido, Takayuki Takeichi, Ayako Okuda, Kiwamu Hasuda, Masahiro Hattori, Hattori Clinic, Chuo-ku, Kumamoto 860-0004, Japan.
authors.forename: Kouichi
authors.initials: K
authors.lastname: Sakurai
authors.affiliation: Kouichi Sakurai, Hiroko Suda, Yumi Ido, Takayuki Takeichi, Ayako Okuda, Kiwamu Hasuda, Masahiro Hattori, Hattori Clinic, Chuo-ku, Kumamoto 860-0004, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Suda
authors.affiliation: Kouichi Sakurai, Hiroko Suda, Yumi Ido, Takayuki Takeichi, Ayako Okuda, Kiwamu Hasuda, Masahiro Hattori, Hattori Clinic, Chuo-ku, Kumamoto 860-0004, Japan.
authors.forename: Yumi
authors.initials: Y
authors.lastname: Ido
authors.affiliation: Kouichi Sakurai, Hiroko Suda, Yumi Ido, Takayuki Takeichi, Ayako Okuda, Kiwamu Hasuda, Masahiro Hattori, Hattori Clinic, Chuo-ku, Kumamoto 860-0004, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Takeichi
authors.affiliation: Kouichi Sakurai, Hiroko Suda, Yumi Ido, Takayuki Takeichi, Ayako Okuda, Kiwamu Hasuda, Masahiro Hattori, Hattori Clinic, Chuo-ku, Kumamoto 860-0004, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Okuda
authors.affiliation: Kouichi Sakurai, Hiroko Suda, Yumi Ido, Takayuki Takeichi, Ayako Okuda, Kiwamu Hasuda, Masahiro Hattori, Hattori Clinic, Chuo-ku, Kumamoto 860-0004, Japan.
authors.forename: Kiwamu
authors.initials: K
authors.lastname: Hasuda
authors.affiliation: Kouichi Sakurai, Hiroko Suda, Yumi Ido, Takayuki Takeichi, Ayako Okuda, Kiwamu Hasuda, Masahiro Hattori, Hattori Clinic, Chuo-ku, Kumamoto 860-0004, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hattori
mesh_terms: D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D017291:Clarithromycin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000008:administration & dosage; D008875:Middle Aged; D061214:Patient Safety; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D011758:Pyrroles / Q000008:administration & dosage*; D012189:Retrospective Studies; D013449:Sulfonamides / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: C552956:1-(5-(2-fluorophenyl)-1-(pyridin-3-ylsulfonyl)-1H-pyrrol-3-yl)-N-methylmethanamine; D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D011758:Pyrroles; D013449:Sulfonamides; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin
keywords: Adverse event; Eradication treatment; Helicobacter pylori; Proton pump inhibitors; Smoking; Vonoprazan