Vonoprazan-Amoxicillin Dual Therapy Tested for H pylori Eradication

Dual therapy with vonoprazan and amoxicillin (VA) has a comparable effect in eradicating Helicobacter pylori as triple therapy with vonoprazan-amoxicillin-clarithromycin (VAC) and was superior to proton pump inhibitor-based triple therapy (PAC), according to a recent meta-analysis.

A team of investigators analyzed 5 randomized clinical trials found through search of PubMed, Embase, Cochrane Library, and Web of Science database from inception until November 2022 that compared VA dual therapy with other regimens for H. pylori eradication.

“Compared with the vonoprazan-amoxicillin-clarithromycin (VAC) triple therapy, the eradication rate of VA dual therapy was lower in intention-to-treat (ITT) analysis (n = 3 RCTs, RR = 0.94, 95% CI: 0.88–0.99, P = 0.03), but there was no significant difference between them in the per-protocol (PP) analysis (RR = 0.96, 95% CI: 0.91–1.01, P = 0.11),” the authors reported. “For clarithromycin-resistant H. pylori strains, the eradication rate of VA dual therapy was significantly higher than that of the VAC triple therapy (n = 2 RCTs, RR = 1.20, 95% CI: 1.03–1.39, P = 0.02). Compared with the PPI-based triple therapy (PAC), VA dual therapy had a superior eradication rate (n = 2 RCTs, ITT analysis: RR = 1.13, 95% CI: 1.04–1.23, P = 0.003; PP analysis: pooled RR = 1.14, 95% CI: 1.06–1.22, P = 0.0004).”

Compared with VAC or PAC triple therapy, VA dual therapy showed a similar incidence of total adverse events and compliance in comparison to the VAC or PAC triple therapy regimens, they noted.

“Future RCTs are needed to ascertain the optimal dosage and duration of vonoprazan and amoxicillin, and the effect of VA dual therapy compared with the mainstream regimens recommended by current guidelines,” the authors concluded.

Reference:

Zhou BG, Mei YZ, Jiang X, Zheng AJ, Ding YB. Vonoprazan-amoxicillin dual therapy for Helicobacter pylori eradication: A systematic review and meta-analysis of randomized controlled trials. Saudi J Gastroenterol.2023; ():10.4103/sjg.sjg_153_23. DOI: 10.4103/sjg.sjg_153_23