Seven‐day vonoprazan‐based triple therapy as first‐line Helicobacter pylori 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 (13)C‐urea breath test at Fu Jen Catholic University Hospital. All patients with a definite diagnosis of Helicobacter pylori 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 (13)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%, P = 0.12). Major adverse effects occurred in 13 of the extended sequential therapy group but none in the other group (0% vs 3.6%, P = 0.046). CONCLUSIONS: Seven‐day vonoprazan‐based triple therapy with high‐dose amoxicillin is a potential first‐line anti‐Helicobacter pylori regimen alternative to current standard treatment, with the advantages of simplicity, short treatment duration, low pill burden, and fewer major adverse effects.