Vonoprazan-bismuth triple therapy eradicates H. pylori in up to 90.9% vs. standard care
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Key takeaways:
- A vonoprazan-amoxicillin-bismuth triple therapy achieved an H. pylori eradication rate similar to that of the standard quadruple therapy.
- Fewer adverse events were reported with triple vs. quadruple therapy.
A triple therapy of vonoprazan, amoxicillin and bismuth potassium citrate achieved an eradication rate of just over 90%, similar to that of the standard quadruple therapy, in patients with Helicobacter pylori infection, according to data.
“Eradication of H. pylori infection is necessary for the management of gastrointestinal disorders,” Jing Wen Liang, of the department of gastroenterology and hepatology at Tongji Hospital in China, and colleagues wrote in the Journal of Gastroenterology and Hepatology. “The primary treatment options are quadruple therapy or a combination of a proton pump inhibitor, bismuth or two antibiotics.
“However, the growing prevalence of H. pylori strains resistant to antibiotics and adverse effects associated with prolonged use of broad-spectrum antibiotics have made it progressively difficult to eradicate the pathogen.”
In a multicenter, randomized controlled trial, Liang and colleagues investigated the efficacy of vonoprazan, amoxicillin and bismuth triple therapy vs. China’s standard first-line quadruple therapy among 597 treatment-naïve adult patients with H. pylori infection.
Patients were randomly assigned to 14 days of vonoprazan (20 mg twice daily), amoxicillin (750 mg three times daily) and bismuth potassium citrate (600 mg with bismuth 220 mg twice daily) or esomeprazole (20 mg twice daily), clarithromycin (500 mg twice daily), amoxicillin (1 g twice daily) and bismuth potassium citrate (600 mg with bismuth 220 mg twice daily). Baseline characteristics between groups were similar.
According to intention-to-treat analysis, which included 300 patients on triple therapy and 297 on quadruple therapy, the eradication rates were 83.7% and 83.2%, respectively (HR = 0.994; 95% CI, 0.925-1.068). In the per-protocol analysis, which excluded 50 patients for incomplete follow-up or treatment discontinuation, the rates were 90.9% and 89.7% (HR = 0.986; 95% CI, 0.933-1.042).
The researchers reported that “bitter mouth” was the most common adverse event, which was more prevalent among patients who received quadruple vs. triple therapy (16.2% vs. 3.7%). Additional adverse reactions included nausea, vomiting, upper abdominal pain and fullness, allergy, constipation and diarrhea, none of which reached statistically significant differences between the groups.
“The study results suggest that the potent acid inhibition attained by the vonoprazan 20 mg BID can eradicate H. pylori with TID dosing of amoxicillin and bismuth potassium citrate,” Liang and colleagues wrote. “The important factors related to eradication success include sensitive antibiotics, good compliance and high intragastric pH.”
They continued: “Compared with PPIs, vonoprazan has a faster, stronger and longer duration of acid inhibition in clinical trials, potentially explaining the increase in H. pylori eradication.”
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