Second‑line triple therapy in failures with vonoprazan‑based triple therapy for eradication of Helicobacter pylori

Le résumé fourni par la source

Gastric acid inhibition during treatment is important for the eradication of Helicobacter pylori (H. pylori) infection. A novel potassium‑competitive acid blocker, vonoprazan (VPZ), has been demonstrated to achieve high eradication rates; however, the efficacy of second‑line treatment in failures of VPZ‑based triple therapy has not been well studied. The aim of the current study was to determine the efficacy of VPZ in a first‑line regimen for H. pylori eradication, and the efficacy of a second‑line regimen using metronidazole (MTZ) in failures with the first‑line regimen. Of 580 subjects enrolled in the study, 524 patients completed first‑line treatment (275 patients who received VPZ and 249 patients who received LPZ). First‑line regimens consisted of a combination of clarithromycin (CAM) 200 or 400 mg twice a day, amoxicillin (AMPC) 750 mg twice a day, and either LPZ 30 mg or VPZ 20 mg twice a day, administered orally for 7 days. CAM and VPZ/LPZ were replaced with metronidazole (MTZ) 250 mg and rabeprazole 10 mg in the second‑line regimens. The eradication of H. pylori was assessed by the H. pylori stool antigen test. The overall first‑line eradication rate with VPZ was significantly higher than that with LPZ [91.0% (250/275) vs. 84.7% (211/249), respectively, P=0.030]. The dose of CAM (400 vs. 800 mg) did not affect the eradication rate in either the VPZ or LPZ regimens. The overall eradication rates of the second‑line regimens with MTZ did not differ significantly between the VPZ‑failure and LPZ‑failure groups [87.0% (20/23) vs. 87.9% (29/33), respectively, P=0.700]. Therefore, VPZ was significantly more effective than LPZ for first‑line treatment. In patients with failure of first‑line eradication therapy, successful results of second‑line eradication therapy did not differ between the VPZ‑ and LPZ‑failure groups. In conclusion, VPZ‑based triple therapy should be recommended for eradication of H. pylori.

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