Ten-Day Vonoprazan-Amoxicillin Dual Therapy as a First-Line Treatment of Helicobacter pylori Infection Compared With Bismuth-Containing Quadruple Therapy : Official journal of the American College of Gastroenterology | ACG

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ARTICLE: STOMACH

Ten-Day Vonoprazan-Amoxicillin Dual Therapy as a First-Line Treatment of Helicobacter pylori Infection Compared With Bismuth-Containing Quadruple Therapy

Qian, Hai-Sheng MD1,2,*; Li, Wen-Jie MD1,2,*; Dang, Yi-Ni MD, PhD1,2,*; Li, Lu-Rong MD1,2; Xu, Xiao-Bing MD1,2; Yuan, Lin MD1,2; Zhang, Wei-Feng MD1,2; Yang, Zhen MD1,2; Gao, Xin MD1,2; Zhang, Min MD, PhD1,2; Li, Xuan MD, PhD1,2; Zhang, Guo-Xin MD, PhD1,2

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The American Journal of Gastroenterology 118(4):p 627-634, April 2023. | DOI: 10.14309/ajg.0000000000002086

Abstract

INTRODUCTION: 

No study has investigated the efficacy and safety of vonoprazan-amoxicillin dual therapy compared with bismuth quadruple therapy (B-quadruple). This study aimed to evaluate the efficacy and safety of 10-day vonoprazan-amoxicillin dual therapy as a first-line treatment of Helicobacter pylori infection compared with B-quadruple and to explore the optimal dosage of amoxicillin in the dual therapy.

METHODS: 

A total of 375 treatment-naive, H. pylori-infected subjects were randomly assigned in a 1:1:1 ratio into 3 regimen groups including VHA-dual (vonoprazan 20 mg twice/day + amoxicillin 750 mg 4 times/day), VA-dual (vonoprazan 20 mg + amoxicillin 1,000 mg twice/day), and B-quadruple (esomeprazole 20 mg + bismuth 200 mg + amoxicillin 1,000 mg + clarithromycin 500 mg twice/day). Eradication rates, adverse events (AEs), and compliance were compared between 3 groups.

RESULTS: 

The eradication rates of B-quadruple, VHA-dual, and VA-dual were 90.9%, 93.4%, and 85.1%, respectively, by per-protocol analysis; 89.4%, 92.7%, and 84.4%, respectively, by modified intention-to-treat analysis; 88.0%, 91.2%, and 82.4%, respectively, by intention-to-treat analysis. The efficacy of the VHA-dual group was not inferior to the B-quadruple group (P < 0.001), but VA-dual did not reach a noninferiority margin of −10%. The AEs rates of the B-quadruple group were significantly higher than those of the VHA-dual (P = 0.012) and VA-dual (P = 0.001) groups. There was no significant difference in medication compliance among 3 treatment groups (P = 0.995).

CONCLUSIONS: 

The 10-day VHA-dual therapy provided satisfactory eradication rates of >90%, lower AEs rates, and similar adherence compared with B-quadruple therapy as a first-line therapy for H. pylori infection. However, the efficacy of VA-dual therapy was not acceptable.

Abstract
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