Combinations of antibiotics and vonoprazan for the treatment of Helicobacter pylori infections—Exploratory study

Abstract

Background Vonoprazan fumarate is a novel potassium‐competitive acid blocker more effective in suppressing acid production than proton pump inhibitors (PPIs) and when combined with antibiotics has been used to eradicate Helicobacter pylori (H. pylori) infection. However, it has not yet been examined in an Australian setting. This study aimed to report on the efficacy and safety of vonoprazan‐containing antibiotic combination therapies in the eradication of H. pylori. Methods A single‐center, exploratory, clinical review of patients 18 years or over, positive for H. pylori on Urea Breath Test (UBT), and/or histopathology who underwent a 10‐day treatment of combination antibiotics plus vonoprazan between January 2017 and September 2019 was conducted. Eleven different combinations of antibiotics that included 2–5 different antibiotics predominantly amoxicillin, rifabutin, levofloxacin, furazolidone, nitazoxanide, and tetracycline were included. The eradication success was based on negative UBT results and/or histopathology results after the treatment. Descriptive statistics were summarized. Results One hundred and fifty‐three patients (Female n = 74, 48%) with a positive for H. pylori were treated with vonoprazan‐containing antibiotic combination therapy during the study period. Of the 153 patients, 48 (31%) had previously failed a PPI‐based H. pylori treatment. Follow‐up was available for 66/153 (43%) patients. In those who completed follow‐up, overall eradication was achieved in 97% (64/66) of patients. In the subgroup of patients treated for the first time, eradication was achieved in 100% (44/44). In those who had failed prior, non‐vonoprazan‐containing treatment, eradication was achieved in 91% (20/22) of patients. Conclusions Vonoprazan‐containing antibiotic therapy is an effective H. pylori eradication treatment. It is capable of achieving 100% efficacy in patients treated for the first time and even 91% efficacy in patients with previous eradication failure. Subsequent studies utilizing a factorial design will be needed to optimize each regimen as most regimens contained more than two antibiotics.

Optimization of vonoprazan‐amoxicillin dual therapy for eradicating Helicobacter pyloriinfection in China: A prospective, randomized clinical pilot study

“…In Korea, 12 H. pylori ‐positive patients received bismuth‐containing quadruple therapy with VPZ (bismuth 220 mg, clarithromycin 500 mg, amoxicillin 1000 mg, and VPZ 20 mg given twice daily) for 14 days; all were H. pylori ‐negative after treatment 20 . A single‐center, exploratory, clinical study 21 with 66 patients was conducted in Australia to evaluate the efficacy of VPZ therapy for treating H. pylori , the regimens included a number of different antibiotic combinations plus VPZ with or without bismuth for 10 days. The results showed that 97% eradication rate was achieved in the cohort of patients not lost to follow‐up.…”

The efficacy of vonoprazan combined with different dose amoxicillin on eradication of Helicobacter pylori: an open, multicenter, randomized clinical study

“…At the same time, the adverse effect of symptoms of bitterness in the mouth mainly appeared in the VAC group, which may have been caused by the side effects of clarithromycin. A study has reported that patients with VPZ-containing eradication regimens will have side effects of influenza-like symptoms such as chest pain, generalized pain, and dizziness ( 25 ). In this trial, patients with the same symptoms appeared in all 3 groups of regimens, and 2 patients in the L-VA group were discharged because of intolerable adverse effects, and influenza-like symptoms resolved after discontinuation of the drug.…”

Cost-Effectiveness of Vonoprazan-Based and Rifabutin-Based vs Other Regimens as First-Line Treatment of Helicobacter pylori Infection in the United States

“…In addition, the current estimate of resistance to regimens containing levofloxacin, metronidazole, and clarithromycin exceeds 30% in the United States (64); thus, the efficacy results used may overestimate current eradication rates with standard PPI use. However, substituting vonoprazan for PPI in various eradication regimens achieves greater efficacy with first-time treatment and results in eradication in over 90% among patients with a previous failed eradication attempt (65). Despite requiring more time and higher costs than an empirical approach, future pharmacoeconomic analyses should evaluate the impact of testing for resistance.…”