Vonoprazan-Based Regimen Is More Useful than PPI-Based One as a First-Line Helicobacter pylori Eradication: A Randomized Controlled Trial

• Published in: Canadian journal of gastroenterology & hepatology Vol. 2017; no. 2017; pp. 1 - 7
• Main Authors: Matsuda, Yoshiaki, Wada, Shuichi, Horiuchi, Akira, Kiyosawa, Kendo, Fujisawa, Toru, Imai, Ryujiro, Tokutake, Koujiro, Kimura, Takefumi, Miyajima, Masayuki, Kubota, Daisuke, Tanaka, Naoki, Maruyama, Masafumi, Mori, Hiromitsu
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01.01.2017; Hindawi; Hindawi Limited; John Wiley & Sons, Inc; Wiley
• Subjects: Acids; Adult; Aged; Aged, 80 and over; Amoxicillin - therapeutic use; Antacids; Anti-Bacterial Agents - therapeutic use; Antibiotics; Clarithromycin - therapeutic use; Clinical Study; Clinical trials; Comparative analysis; Drug therapy; Drug Therapy, Combination; Female; Gastric cancer; Gastroenterology; Helicobacter infections; Helicobacter Infections - drug therapy; Helicobacter pylori - drug effects; Hospitals; Humans; Japan; Lansoprazole - therapeutic use; Male; Metabolism; Middle Aged; Potassium; Proton pump inhibitors; Proton Pump Inhibitors - therapeutic use; Pyrroles - therapeutic use; Rabeprazole - therapeutic use; Single-Blind Method; Sulfonamides - therapeutic use; Treatment Outcome; Ulcers
• ISSN: 2291-2789; 2291-2797
• DOI: 10.1155/2017/4385161

Background. A new agent, potassium-competitive acid blocker vonoprazan (VPZ) has potent acid-inhibitory effects and may offer advantages over conventional H. pylori eradication therapies. We aimed to compare the eradication rate between VPZ-based treatment and PPI-based one. Methods. This randomized controlled trial was designed to assign 141 patients with H. pylori-positive gastritis to VPZ group (VPZ 20 mg, amoxicillin 750 mg, and clarithromycin 200 or 400 mg twice daily for 7 days) or PPI group (rabeprazole 20 mg or lansoprazole 30 mg, amoxicillin 750 mg, and clarithromycin 200 or 400 mg twice daily for 7 days). Primary endpoints were eradication rates and adverse events. Results. Seventy of 72 patients in VPZ group and 63 of 69 patients in PPI group completed the treatment after 7 days. The eradication rate was significantly higher in VPZ group than PPI group by intention-to-treat analysis (95.8% versus 69.6%, P=0.00003, 95% confidence interval [CI] 88.3-99.1% versus 57.3-80.1%) and per-protocol analysis (95.7% versus 71.4%, P=0.0002, 95% CI 88.0-99.1% versus 58.7-82.1%). The incidence of adverse events was not different between the groups (26.3% in VPZ group versus 37.7% in PPI group, P=0.15). Conclusion. VPZ-based regimen is more useful than that PPI-based regimen as a first-line H. pylori eradication therapy.