Esophagus to Small Intestine

Am J Gastroenterol. 2023;118(4):627−34

Qian HS, Li WJ, Dang YN, Li LR, Xu XB, Yuan L, Zhang WF, Yang Z, Gao X, Zhang M, Li X, Zhang GX

Ten-day vonoprazan-amoxicillin dual therapy as a first-line treatment of Helicobacter pylori infection compared with bismuth-containing quadruple therapy

Introduction: No study has investigated the efficacy and safety of vonoprazan-amoxicillin dual therapy compared with bismuth quadruple thera-py (B-quadruple). This study aimed to evaluate the efficacy and safety of 10-day vonoprazan-amoxicillin dual therapy as a first-line treatment of Helicobacter pylori infection compared with B-quadruple and to explore the optimal dosage of amoxicillin in the dual therapy.
Methods: A total of 375 treatment-naive, H. pylori-infected subjects were randomly assigned in a 1:1:1 ratio into 3 regimen groups including VHA-dual (vonoprazan 20 mg twice/day + amoxicillin 750 mg 4 times/day), VA-dual (vonoprazan 20 mg + amoxicillin 1000 mg twice/day), and B-quadruple (esomeprazole 20 mg + bismuth 200 mg + amoxicillin 1000 mg + clarithromycin 500 mg twice/day). Eradication rates, adverse events (AEs), and compliance were compared between 3 groups.
Results: The eradication rates of B-quadruple, VHA-dual, and VA-dual were 90.9%, 93.4%, and 85.1%, respectively, by per-protocol analysis; 89.4%, 92.7%, and 84.4%, respectively, by modified intention-to-treat analysis; 88.0%, 91.2%, and 82.4%, respectively, by intention-to-treat analysis. The efficacy of the VHA-dual group was not inferior to the B-quadruple group (p < 0.001), but VA-dual did not reach a non-inferiority margin of -10%. The AE rates of the B-quadruple group were significantly higher than those of the VHA-dual (p = 0.012) and VA-dual (p = 0.001) groups. There was no significant difference in medication compliance among 3 treatment groups (p = 0.995).

Conclusions: The 10-day VHA-dual therapy provided satisfactory eradication rates of > 90%, lower adverse event rates, and similar adherence compared with B-quadruple therapy as a first-line therapy for Helicobacter pylori infection. However, the efficacy of VA-dual therapy was not acceptable.

Dr. G.-X. Zhang or Dr. X. Li, Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China,
E-Mail: guoxinz@njmu.edu.cn or E-Mail: lixuan20091225@163.com

DOI: 10.14309/ajg.0000000000002086

Back to overview

this could be of interest:

Esophagus to Small Intestine

Empirical rescue treatment of Helicobacter pylori infection in third and subsequent lines: 8-year experience in 2144 patients from the European Registry on H. pylori management (Hp-EuReg)

Gut. 2023;72:1054−72

Burgos-Santamaría D, Nyssen OP, Gasbarrini A, Vaira D, Pérez-Aisa Á, Rodrigo L, Pellicano R, Keco-Huerga A, Pabón-Carrasco M, Cas-tro-Fernandez M, Boltin D, Barrio J, Phull P, Kupcinskas J, Jonaitis L, Ortiz-Polo I, Tepes B, Lucendo AJ, Huguet JM, Areia M, Brglez Jurecic N, Den-kovski M, Bujanda L, Ramos-San Román J, Cuadrado-Lavín A, Gomez-Camarero J, Jiménez Moreno MA, Lanas A, Martinez-Dominguez SJ, Alfaro E, Marcos-Pinto R, Milivojevic V, Rokkas T, Leja M, Smith S, Tonkić A, Buzás GM, Doulberis M, Venerito M, Lerang F, Bordin DS, Lamy V, Capelle LG, Marlicz W, Dobru D, Gridnyev O, Puig I, Mégraud F, O’Morain C, Gisbert JP; Hp-EuReg Investigators

Go to article

Esophagus to Small Intestine

Efficacy and safety of gluten peptide-based antigen-specific immunotherapy (Nexvax2) in adults with celiac disease after bolus exposure to gluten (RESET CeD): An interim analysis of a terminated randomized, double-blind, place-bo-controlled phase 2 study

Lancet Gastroenterol Hepatol. 2023;8(5):446−57