Amoxicillin high-dose dual therapy for Helicobacter pylori primary eradication: Proton pump inhibitor and potassium-competitive acid blocker, which’s better?
BACKGROUND Effective acid suppression significantly enhances the eradication rate of Helicobacter pylori (H. pylori ). AIM To assess the efficacy and safety of high-dose dual therapy (HDDT) utilizing various highly potent antisecretory medications, thereby providing additional clinical guidance for...
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Published in | World journal of gastroenterology : WJG Vol. 31; no. 13; p. 100863 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Baishideng Publishing Group Inc
07.04.2025
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Subjects | |
Online Access | Get full text |
ISSN | 1007-9327 2219-2840 2219-2840 |
DOI | 10.3748/wjg.v31.i13.100863 |
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Summary: | BACKGROUND
Effective acid suppression significantly enhances the eradication rate of Helicobacter pylori (H. pylori ).
AIM
To assess the efficacy and safety of high-dose dual therapy (HDDT) utilizing various highly potent antisecretory medications, thereby providing additional clinical guidance for H. pylori eradication.
METHODS
The study population comprised untreated H. pylori patients from three medical centers in central China. From February 10, 2024 to March 31, 2024, 439 subjects were randomly allocated to either the esomeprazole-amoxicillin (EA) or esomeprazole-amoxicillin-clarithromycin-bismuth (B-quadruple) group. Subsequently, from April 1, 2024 to May 10, 2024, 367 subjects were randomly assigned to either the vonoprazan-amoxicillin (VA) or vonoprazan-amoxicillin-clarithromycin (VAC) group. The study recorded treatment efficacy, adverse events, compliance, symptom alleviation, and associated costs.
RESULTS
EA-dual demonstrated non-inferiority to B-quadruple regimen in modified intention-to-treat (mITT) and per-protocol (PP) analyses (P < 0.025). However, the eradication rate of EA was lower than that of the B-quadruple group (70.59% vs 83.49%, 92.86% vs 98.38%, 93.94% vs 98.38%, intention-to-treat (ITT), mITT, PP respectively, P < 0.05). In ITT, mITT, and PP analyses, VA-dual was non-inferior to VAC treatment (84.15% vs 83.15%, 96.25% vs 92.73%, 96.75% vs 93.75%, P < 0.025). No significant differences were observed in adverse events, compliance, and symptom relief between groups. VA exhibited the lowest cost. Antibiotic use within 2 years, poor compliance, and suburban residence were associated with reduced eradication efficacy (P < 0.05).
CONCLUSION
The HDDT based on vonoprazan demonstrated non-inferiority to the VAC triple regimen, suggesting its potential as a recommended first-line treatment for H. pylori eradication. While B-quadruple therapy showed better eradication rate than EA therapy, the latter proved non-inferior in mITT and PP analyses. Notably, antibiotic use within the preceding two years, adherence to treatment protocols, and patient residence emerged as critical factors influencing eradication success. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Supported by the National Natural Science Foundation of China, No. 82270594; the National Natural Science Foundation for Youths of China, No. 82103151; the Outstanding Youth Foundation of Hunan Province, No. 2022JJ20092; and the Wisdom Accumulation and Talent Cultivation Project of Third Xiangya Hospital of Central South University, No. YX202103. Corresponding author: Fen Wang, MD, PhD, Professor, Department of Gastroenterology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Changsha 410013, Hunan Province, China. wfen-judy@csu.edu.cn Author contributions: Yang XE contributed to investigation, formal analysis, and writing the original draft; Wang F, Zhang SJ, and Liu Y made conceptualization, methodology, writing, reviewing and editing the article, and supervision; Yao SY, Zhang SX, Liu XM, and Liang LX contributed to methodology, formal analysis, and writing, reviewing and editing the article; Wang F is the corresponding author of the article. All authors have read and agreed to the published version of the manuscript. |
ISSN: | 1007-9327 2219-2840 2219-2840 |
DOI: | 10.3748/wjg.v31.i13.100863 |