Fourteen-Day Vonoprazan-Minocycline vs Vonoprazan-Amoxicillin Dual Therapy for Primary Helicobacter pylori Infection:...

The therapeutic strategies available to eradicate Helicobacter pylori infection in individuals allergic to penicillin remain constrained, and regimens containing minocycline are considered potential alternative options. The primary objective of this study was to evaluate whether the efficacy of 14-day vonoprazan-minocycline (VM) dual therapy was noninferior to vonoprazan-amoxicillin (VA) dual therapy as an initial therapy against H. pylori infection.

We conducted a retrospective analysis on adult patients infected with H. pylori who had received either of these 2 regimens. To reduce selection bias and confounding factors, we used nearest neighbor caliper matching with a 0.1 caliper distance to identify eligible patients.

In both overall and as-treated analyses, the 95% confidence intervals for the difference in eradication rates all surpassed the predefined noninferiority margin of -0.1. These results confirmed that the VM group is noninferior to the VA group (all 1-sided P < 0.025). In the VM cohort, the eradication rate among penicillin-allergic patients was comparable with that of nonallergic patients in both the overall and as-treated analyses. Besides, the VM and VA groups exhibited comparable safety profiles, with adverse event incidences of 32% and 42%, respectively. In addition, the VM dual group demonstrated better compliance than the VA dual group (99.2% vs 93.2%, P = 0.02).

This retrospective propensity score matching analysis demonstrated noninferior efficacy of VM therapy compared with VA therapy, with equivalent safety and favorable treatment adherence, suggesting VM therapy may serve as a potential alternative option for penicillin-allergic patients.