Comparative study: Vonoprazan and proton pump inhibitors in Helicobacter pylori eradication therapy.
AIM
To compare the effectiveness and safety of vonoprazan-based therapy with proton pump inhibitor (PPI)-based therapies to treat Helicobacter 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 for H. 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 the H. pylori eradication 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.


CONCLUSION
Vonoprazan might be superior to PPIs in first-line H. pylori therapy, particularly for smokers. However, caution is required due to possible adverse events.
['Sakurai|Kouichi|K|', 'Suda|Hiroko|H|', 'Ido|Yumi|Y|', 'Takeichi|Takayuki|T|', 'Okuda|Ayako|A|', 'Hasuda|Kiwamu|K|', 'Hattori|Masahiro|M|']
D000368:Aged D000658:Amoxicillin D000900:Anti-Bacterial Agents D017291:Clarithromycin D004359:Drug Therapy, Combination D005260:Female D016481:Helicobacter Infections D016480:Helicobacter pylori D006801:Humans D008297:Male D008795:Metronidazole D008875:Middle Aged D061214:Patient Safety D054328:Proton Pump Inhibitors D011758:Pyrroles D012189:Retrospective Studies D013449:Sulfonamides D016896:Treatment Outcome
Vonoprazan Proton pump inhibitors Helicobacter pylori Eradication treatment Adverse event Smoking