Vonoprazan-amoxicillin treatment vs PPI-based therapy for H. pylori eradication

Although a 10-day treatment with vonoprazan-amoxicillin dual therapy did not outperform the standard 14-day proton pump inhibitor (PPI)-based therapy for the eradication of Helicobacter (H.) pylori infection, there were fewer adverse events with the vonoprazan-amoxicillin treatment, a systematic review showed.

A systematic review compared PPI-based treatment and vonoprazan-amoxicillin therapy for the eradication of H. pylori infection [1]. “This is a common bacterium that infects the gastric mucosa and has been associated with various gastrointestinal disorders,” explained Dr Mhd Albuni (TriHealth Inc, OH, USA). “Eradication rates have been decreasing in recent years due to increasing antimicrobial resistance.” Vonoprazan is a novel potassium-competitive acid blocker that may help to increase the eradication rates. The research team looked at 4 randomised-controlled trials to compare a 10-day vonoprazan-amoxicillin dual therapy with a 14-day PPI-based bismuth-containing quadruple therapy.

The researchers analysed data from 1,545 trial participants. There was no difference in H. pylori eradication rate between patients treated with vonoprazan and those treated with a PPI-based therapy (OR 1.08; 95% CI 0.51–2.31; P=0.84). However, adverse events were significantly less common in the vonoprazan group than in the PPI group (OR 0.35; 95% CI 0.25–0.49; P<0.01).

“Our study did not demonstrate that a 10-day treatment with vonoprazan-amoxicillin dual therapy leads to improved eradication rates of H. pylori infections compared with a 14-day PPI-based treatment,” concluded Dr Albuni. “Vonoprazan-based therapy may however offer a safer alternative.”

1. Albuni MK, et al. Comparison of 10-day vonoprazan-amoxicillin dual therapy vs 14-day PPI-based therapy for helicobacter pylori eradication: a meta-analysis of randomized controlled trials. Abstract Su1493, Digestive Disease Week 2025, 3–6 May 2025, San Diego, USA.

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Posted on 21 May 202521 May 2025