Seven-day vonoprazan-based triple therapy as first-line treatment in comparison with extended sequential therapy.

Background And Aim: Vonoprazan as a new acid blocker has more potency and longer lasting acid suppression than proton pump inhibitors. Whether the efficacy of vonoprazan-based triple therapy is comparable with or even better than that of currently recommended first-line therapies is still unknown. Our study aims to compare the eradication rate and major adverse effects between 7-day vonoprazan-based triple therapy with high-dose amoxicillin and 14-day extended sequential therapy.

Methods: We performed a retrospective analysis from the database of C-urea breath test at Fu Jen Catholic University Hospital. All patients with a definite diagnosis of infection by rapid urease test, urea breath test, stool antigen test, or pathology report were recruited. Patients receiving first-line regimens with vonoprazan-based triple therapy or extended sequential therapy were included. The respective eradication rate determined by C-urea breath test and major adverse effects were demonstrated.

Results: Totally, 106 patients were recruited in the vonoprazan-based triple therapy group and 357 in the extended sequential therapy group. There was no significant difference in eradication rate between vonoprazan-based triple therapy with high-dose amoxicillin and extended sequential therapy (83.0 vs 88.8%,  = 0.12). Major adverse effects occurred in 13 of the extended sequential therapy group but none in the other group (0% vs 3.6%,  = 0.046).

Conclusions: Seven-day vonoprazan-based triple therapy with high-dose amoxicillin is a potential first-line anti- regimen alternative to current standard treatment, with the advantages of simplicity, short treatment duration, low pill burden, and fewer major adverse effects.