Abstract
Aim: To investigate the efficacy and tolerability of second-line metronidazole triple therapy with vonoprazan (VPZ) for Helicobacter pylori (H. pylori). Methods: We retrospectively reviewed medical records of patients who experienced clarithromycin triple therapy failure and were treated with second-line (20 mg VPZ (n = 274)/30 mg lansoprazole (n = 323) or 10 mg rabeprazole (n = 141) twice daily, 750 mg amoxicillin twice daily, 250 mg metronidazole twice daily for 7 days) eradication therapies. Successful eradication rates were compared between two groups: those receiving VPZ and those receiving a proton pump inhibitor (PPI). Adverse events were also investigated. Results: Successful second-line eradication rates according to ITT analysis and PP analysis, respectively, were 79.9% and 92.4% for VPZ therapy and 83.6% and 93.3% for PPI therapy. There were no significant differences between treatment groups. The eradication rates in those who had received first-line VPZ therapy previously according to ITT and PP analysis were 75.2% and 88.1%, respectively; in contrast, values were 82.5% and 95.4%, respectively, for those who had received first-line PPI therapy previously. In second-line therapy, the overall adverse event rate for VPZ therapy was the same as for PPI therapy. Conclusions: The efficacy and tolerability of metronidazole-containing second-line triple therapy with VPZ or a PPI were equivalent.
Highlights
We retrospectively reviewed medical records of patients who experienced clarithromycin triple therapy failure and were treated with secondline (20 mg VPZ (n = 274)/30 mg lansoprazole (n = 323) or 10 mg rabeprazole (n = 141) twice daily, 750 mg amoxicillin twice daily, 250 mg metronidazole twice daily for 7 days) eradication therapies
Successful second-line eradication rates according to ITT analysis and PP analysis, respectively, were 79.9% and 92.4% for VPZ therapy and 83.6% and 93.3% for pump inhibitor (PPI) therapy
Helicobacter pylori (H. pylori) in humans is commonly associated with gastroduodenal diseases, such as chronic gastritis, peptic ulcer diseases, mucosal-associated lymphoid tissue lymphoma (MALT lymphoma), and gastric neoplasms [1] [2]
Summary
Helicobacter pylori (H. pylori) in humans is commonly associated with gastroduodenal diseases, such as chronic gastritis, peptic ulcer diseases, mucosal-associated lymphoid tissue lymphoma (MALT lymphoma), and gastric neoplasms [1] [2]. The standard triple therapy for H. pylori eradication is amoxicillin (AMPC), clarithromycin (CAM) and a proton pump inhibitor (PPI) twice a day for 1 week [6]. The H. pylori eradication rate for standard triple therapy is currently less than 80% in most parts of the world [7] [8]. A double-blind phase 3 study of triple therapy with VPZ (VAC) for first-line H. pylori eradication showed a high success rate of 92.6% [13]. The aim of this study was to evaluate the efficacy and tolerability of 7-day MNZ triple therapy with VPZ in comparison to PPI-based triple therapy for second-line therapy
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