Different doses of vonoprazan as the first-line treatment of Helicobacter pylori infection: A prospective cohort study

Abstract

Objective To investigate the efficacy, safety, compliance, and economic benefits of low-dose or standard-dose vonoprazan quadruple therapy for the eradication of Helicobacter pylori (Hp). Methods A total of 531 patients who were diagnosed with Hp infection in our hospital from March to August 2023 were enrolled and divided into esomeprazole (Ebid) group (oral administration of esomeprazole 20 mg twice a day), standard vonoprazan (Vbid) group (oral administration of vonoprazan 20 mg twice a day), and low-dose vonoprazan (Vqd) group (oral administration of vonoprazan 20 mg once a day), and the remaining three drugs of Hp quadruple therapy were the same for the three groups (oral administration of amoxicillin 1 000 mg, cla-rithromycin 500 mg, and bismuth potassium citrate 600 mg, twice a day), with a course of treatment of 14 days. All patients were examined for Hp eradication rate (based on the intention-to-treat [ITT] analysis and the per-protocol [PP] analysis), symptom improvement, adverse events, and patient compliance after 4 weeks of drug withdrawal, and a cost-effectiveness analysis was pe-rformed for the regimens in each group (including the ITT and PP analyses). Results There was a significant difference in Hp eradication rate between the three groups in the ITT and PP analyses (χ2ITT=6.351,PITT<0.05; χ2PP=7.376,PPP<0.05), and the Vbid group had a significantly better Hp eradication rate than the Ebid group (χ2ITT=6.077,PITT<0.016; χ2PP=6.821,PPP<0.016). The regimens in all three groups achieved a relatively high symptom improvement rate, with no significant difference between the three groups (P>0.05). All three groups had mild adverse events, and the Vqd group had a significantly lower incidence rate of adverse events than the Ebid group (χ2=6.058,P<0.016). There was no significant difference in compliance rate between the three groups (P>0.05), with a compliance rate of >95% in all three groups. The Vqd group had a lower cost-effectiveness ratio than the Vbid and Ebid groups in both ITT and PP analyses. Conclusion The low-dose vonoprazan quadruple regimen has comparable efficacy to the standard-dose regimen, and both regimens have better efficacy than esomeprazole quadruple regimen. The low-dose vonoprazan quadruple regimen has better safety and cost-effectiveness and thus holds promise for clinical application in Hp eradication therapy.

Keywords

• proton pump inhibitors|omeprazole|helicobacter pylori|disease eradication|costs and cost analysis