Vonoprazan Versus Tegoprazan-Amoxicillin Dual Therapy for Treatment-Naïve Patients With Helicobacter pylori...

Area of Science:

• Gastroenterology
• Infectious Diseases
• Pharmacology

Background:

• High-dose dual therapy (HDDT) offers non-inferior Helicobacter pylori eradication rates compared to bismuth quadruple therapy (BQT).
• Variations in potassium-competitive acid blocker (P-CAB) pharmacokinetics necessitate evaluating different P-CABs within HDDT regimens.
• This study addresses the incomplete understanding of P-CAB efficacy in HDDT for H. pylori infection.

Purpose of the Study:

• To evaluate and compare the eradication rates of vonoprazan/amoxicillin (VA) and tegoprazan/amoxicillin (TA) dual therapies.
• To assess the incidence of adverse events associated with VA and TA regimens.
• To determine the compliance rates for both treatment groups in H. pylori eradication.

Main Methods:

• A prospective, multicenter, randomized controlled trial involving treatment-naïve H. pylori patients.
• Patients were assigned to either the VA group (vonoprazan 20mg bid + amoxicillin 1g tid) or TA group (tegoprazan 50mg bid + amoxicillin 1g tid) for 14 days.
• Eradication assessed via urea breath test (UBT) 4 weeks post-treatment; adverse events and compliance were meticulously recorded.

Main Results:

• Vonoprazan/amoxicillin achieved significantly higher eradication rates (ITT: 89.3%, mITT: 94.6%, PP: 95.1%) compared to tegoprazan/amoxicillin (ITT: 76.1%, mITT: 80.8%, PP: 81.0%) (p < 0.001 for all analyses).
• Overall adverse event rates were comparable (17.2% vs. 13.8%, p=0.254), but tegoprazan/amoxicillin showed fewer gastrointestinal events (9.3% vs. 14.4%, p=0.048).
• Compliance was excellent and similar between groups (94.6% vs. 94.1%, p=0.871).

Conclusions:

• Vonoprazan/amoxicillin dual therapy demonstrates satisfactory H. pylori eradication rates and a favorable safety profile in treatment-naïve patients.
• Tegoprazan/amoxicillin dual therapy resulted in a lower incidence of gastrointestinal adverse events.
• Optimizing tegoprazan dosing frequency may be required to enhance its eradication efficacy.