Vonoprazan Triple and Dual Therapy for Helicobacter pylori Infection in the United States and Europe: Randomized Clinical Trial

• Published in: Gastroenterology (New York, N.Y. 1943) Vol. 163; no. 3; pp. 608 - 619
• Main Authors: Chey, William D., Mégraud, Francis, Laine, Loren, López, Luis J., Hunt, Barbara J., Howden, Colin W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2022
• Subjects: Adult; Amoxicillin - adverse effects; Anti-Bacterial Agents - adverse effects; Antimicrobial Resistance; Clarithromycin - adverse effects; Drug Therapy, Combination; Helicobacter Infections - diagnosis; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Lansoprazole - adverse effects; PPI; Proton Pump Inhibitors - adverse effects; Pyrroles; Sulfonamides; Treatment Outcome; United States - epidemiology; Vonoprazan; United States; COVID-19; PP; PPp; Vonoprazan; FDA; TEAE; Helicobacter pylori; Antimicrobial Resistance; CI; UBT; PPI
• ISSN: 0016-5085; 1528-0012; 1528-0012
• DOI: 10.1053/j.gastro.2022.05.055

Novel, effective treatments for Helicobacter pylori infection are needed. This study evaluated the efficacy of vonoprazan, a potassium-competitive acid blocker, vs standard treatment on H pylori eradication in the United States and Europe. In a randomized, controlled, phase 3 trial, treatment-naïve adults with H pylori infection were randomized 1:1:1 to open-label vonoprazan dual therapy (20 mg vonoprazan twice daily; 1 g amoxicillin 3 times daily), or double-blind triple therapy twice a day (vonoprazan 20 mg or lansoprazole 30 mg; amoxicillin 1 g; clarithromycin 500 mg) for 14 days. The primary outcome was noninferiority in eradication rates in patients without clarithromycin- and amoxicillin-resistant strains (noninferiority margin = 10%). Secondary outcomes assessed superiority in eradication rates in clarithromycin-resistant infections, and in all patients. A total of 1046 patients were randomized. Primary outcome eradication rates (nonresistant strains): vonoprazan triple therapy 84.7%, dual therapy 78.5%, vs lansoprazole triple therapy 78.8% (both noninferior; difference 5.9%; 95% confidence interval [CI], −0.8 to 12.6; P < .001; difference –0.3%; 95% CI, −7.4 to 6.8; P = .007, respectively). Eradication rates in clarithromycin-resistant infections: vonoprazan triple therapy 65.8%, dual therapy 69.6%, vs lansoprazole triple therapy 31.9% (both superior; difference 33.9%; 95% CI, 17.7–48.1; P < .001; difference 37.7%; 95% CI, 20.5–52.6; P < .001, respectively). In all patients, vonoprazan triple and dual therapy were superior to lansoprazole triple therapy (80.8% and 77.2%, respectively, vs 68.5%, difference 12.3%; 95% CI, 5.7–18.8; P < .001; difference 8.7%; 95% CI, 1.9–15.4; P = .013). Overall frequency of treatment-emergent adverse events was similar between vonoprazan and lansoprazole regimens (P > .05). Both vonoprazan-based regimens were superior to proton pump inhibitor–based triple therapy in clarithromycin-resistant strains and in the overall study population. ClinicalTrials.gov; NCT04167670. [Display omitted] Vonoprazan, a new type of stomach acid blocker, improves eradication of Helicobacter pylori infection compared with a proton pump inhibitor acid blocker.