Vonoprazan is non-inferior to proton pump inhibitors in bismuth-containing quadruple therapy for the treatment of Helicobacter pylori infection: A propensity score matching analysis

AIM

The efficacy of vonoprazan compared with that of proton pump inhibitors in clarithromycin-based bismuth-containing quadruple therapy has not been fully demonstrated. This study aimed to evaluate the efficacy and safety of vonoprazan-based versus proton pump inhibitor-based bismuth-containing quadruple therapy.

METHODS

The records of patients in whom Helicobacter pylori was eradicated between July 1, 2018, and December 31, 2021 were retrieved retrospectively from outpatient units. Efficacy, safety, and compliance were compared between vonoprazan- and proton pump inhibitor-based bismuth-containing quadruple therapy (vonoprazan 20 mg or proton pump inhibitors [lansoprazole 30 mg or esomeprazole 20 mg], bismuth, amoxicillin 1000 mg, and clarithromycin 500 mg twice a day for 2 weeks) by 1:1 propensity score matching.

RESULTS

The eradication rates of vonoprazan- and proton pump inhibitor-based therapies were 88.8% (151/170) and 87.6% (149/170) in the intention-to-treat analysis, 94.1% (144/153) and 91.1% (144/158) in the per-protocol analysis, respectively. The non-inferiority of vonoprazan to proton pump inhibitors was confirmed in all analyses (P < 0.001). The incidence of adverse effects was 30.0% (51/170) and 27.1% (46/170) in the vonoprazan- and proton pump inhibitor-based groups, respectively Vonoprazan- and proton pump inhibitor-based therapies were well tolerated and showed good patient compliance without significant differences.

CONCLUSION

Vonoprazan-based therapy resulted in a satisfactory eradication rate and was well tolerated for Helicobacter pylori eradication. Vonoprazan is comparable to proton pump inhibitors in clarithromycin-based bismuth-containing quadruple therapy as a first-line treatment for Helicobacter pylori infection. This article is protected by copyright. All rights reserved.

Clarithromycin versus furazolidone for naïve Helicobacter pylori infected patients in a high clarithromycin resistance area

BACKGROUND AND AIM

The increase in antibiotic resistance makes the eradication of Helicobacter pylori more difficult. Considering the limitations of the application of susceptibility-guided therapy, it is important to find an effective empirical regimen. The aim of the study is to compare the efficacy, safety, and cost-effectiveness of clarithromycin-based bismuth-containing quadruple therapy (C-BQT) and furazolidone-based bismuth-containing quadruple therapy (F-BQT) in naïve H. pylori positive patients.

METHODS

This was an open-label, randomized controlled, crossover trial. The trial comprised two phases. In C-F group, patients received C-BQT in the first phase; those who were still positive for H. pylori infection after the first phase entered the second phase to receive F-BQT as rescue treatment. In F-C group, patients were treated with F-BQT firstly and rescued with C-BQT.

RESULTS

As first-line treatments, the eradication rates of C-BQT and F-BQT were 89.7% (157/175) and 92.0% (161/175) (P = 0.458) in intention-to-treat analysis and 93.4% (156/167) and 95.8% (161/168) (P = 0.327) in per-protocol analysis, respectively. The cumulative eradication rates of the C-F group and the F-C group were both 94.3% in intention-to-treat analysis (P = 1.000). Cost-effectiveness indexes of F-BQT and C-BQT were 0.54 and 1.24 in first-line treatments. Frequencies of adverse events in F-BQT and C-BQT had no differences (36.0% in C-BQT vs 32.6% in F-BQT, P = 0.499).

CONCLUSIONS

Furazolidone-based bismuth-containing quadruple therapy should be preferred for its excellent cost-effectiveness and acceptable safety.

New bismuth-containing quadruple therapy in patients infected with Helicobacter pylori: A first Italian experience in clinical practice

BACKGROUND

Rising antibiotic resistance requires the evaluation of new and effective therapies.

AIMS

To test the efficacy and safety of the new bismuth-containing quadruple therapy in patients infected with Helicobacter pylori.

MATERIAL AND METHODS

Consecutive H. pylori-positive dyspeptic patients were enrolled, either naïve or with previous failure treatment. Patients were treated with Pylera^® (three-in-one capsules containing bismuth subcitrate potassium 140 mg, metronidazole 125 mg, and tetracycline 125 mg) three capsules q.i.d. plus omeprazole 20 mg or esomeprazole 40 mg b.i.d. for 10 days. Eradication was confirmed using an urea breath test (at least 30 days after the end of treatment). Efficacy was assessed by UBT and safety by means of treatment-emergent adverse events.

RESULTS

One hundred and thirty-one patients were included in the study: 42% of patients were naïve, and 58%, with previous failure treatment. H. pylori eradication was achieved in 124 patients (94.7%, 95% confidence intervals (CIs) 89.3-97.8) in ITT population. In the PP population, the percentage was 97.6% (95%, CIs 93.3-99.2). No difference in eradication rate was found either between naïve and previously treated patients (92.7% vs 96.0%, P=.383), or smoking and nonsmoking ones, or in patients taking omeprazole or esomeprazole. Treatment-emergent adverse events occurred in 35 patients (26.7%, 95% CIs 19.9-34.9). They were mild in all cases except in four, who discontinued the study due to diarrhea (three patients) and diffuse urticarial rush (one patient).

CONCLUSIONS

Pylera^® achieved a remarkable eradication rate in clinical practice, irrespective if it was used as first treatment or as a rescue therapy. Treatment-emergent adverse events were uncommon generally mild.