Comparative study: Vonoprazan and proton pump inhibitors in eradication therapy.

Aim: To compare the effectiveness and safety of vonoprazan-based therapy with proton pump inhibitor (PPI)-based therapies to treat ().

Methods: We retrospectively analysed data from first-line (vonoprazan or PPI with 200 mg clarithromycin and 750 mg amoxicillin twice daily for 7 d) ( = 1353) and second-line (vonoprazan or PPI with 250 mg metronidazole and 750 mg amoxicillin twice daily for 7 d) ( = 261) eradication treatments for -positive patients with associated gastrointestinal diseases from April 2014 to December 2015 at Hattori Clinic, Japan. The primary endpoint was the eradication rate, which was assessed with a full analysis set. The secondary endpoints were adverse events and related factors.

Results: After the first-line treatments, the eradication rates for vonoprazan, esomeprazol, rabeprazole, and lansoprazole were 87.9% (95%CI: 84.9%-90.5%), 71.6% (95%CI: 67.5%-75.5%), 62.9% (95%CI: 52.0%-72.9%), and 57.3% (95%CI: 50.4%-64.1%), respectively. The vonoprazan eradication rate was significantly higher than that of the PPIs ( < 0.01). Interestingly, smoking did not affect the eradication rate in the vonoprazan group ( = 0.34), whereas it decreased the rates in the PPI groups ( = 0.013). The incidence of adverse events in the vonoprazan group was not different from the PPI group ( = 0.054), although the vonoprazan group exhibited a wider range of adverse events. Vonoprazan-based triple therapy was highly effective as a second-line treatment, with an eradication rate similar to that of PPI-based therapy.

Conclusion: Vonoprazan might be superior to PPIs in first-line therapy, particularly for smokers. However, caution is required due to possible adverse events.