First-Line Helicobacter pylori Eradication with Vonoprazan, Clarithromycin, and Metronidazole in Patients Allergic to Penicillin

Abstract

Aim To assess the efficacy of 7-day first-line Helicobacter pylori eradication with vonoprazan (VPZ), clarithromycin (CAM), and metronidazole (MNZ) in patients with penicillin allergy. Methods Patients with penicillin allergy, diagnosed with Helicobacter pylori infection and did not have history of Helicobacter pylori eradication, were eligible for the study. Twenty patients were prospectively treated with 20 mg VPZ twice daily, 200 or 400 mg CAM twice daily, and 250 mg MNZ twice daily for 7 days. We also collected the data from 30 patients retrospectively treated with proton pump inhibitor (PPI), CAM, and MNZ. Safety was evaluated in patients completing an adverse effect questionnaire. Results Both the intention-to-treat and per-protocol effectiveness of VPZ-based eradication were 100% (95% CI: 86.1–100%; n = 20). The eradication rates of PPI-based regimen were 83.3% (95% CI: 65.3–94.4%) in the ITT and 82.7% (95% CI: 64.2–94.2%) in the PP analyses. Abdominal fullness was more frequent in VCM compared to PCM. However, all patients with VCM regimen had taken 100% of their course of medication. Conclusion Triple therapy with VPZ, CAM, and MNZ is well tolerated and effective for eradicating Helicobacter pylori in patients allergic to penicillin. This study was registered in the UMIN Clinical Trials Registry as UMIN000016335.

Randomized trial of vonoprazan‐based versus proton‐pump inhibitor‐based third‐line triple therapy with sitafloxacin for Helicobacter pylori

“…We confirmed the superiority of the V‐AC compared with PPI/AMPC/CAM (PPI‐AC) for first‐line eradication in a multicenter prospective study, whereas no significant differences were observed between VPZ/AMPC/MNZ (V‐AM) and PPI/AMPC/MNZ (PPI‐AM) for second‐line eradication . In addition, in a retrospective study and in our prospective study, an excellent grading eradication rate with VPZ/CAM/MNZ (V‐CM) or VPZ/MNZ/STFX (V‐MS) was reported in patients allergic to penicillin. These data suggest that a VPZ‐based third‐line regiment could improve the eradication rate compared with conventional PPI‐based regimens.…”

“…28,29 The safety of the V-AS was confirmed using the same questionnaire used to demonstrate the safety of V-AC, V-AM, and V-CM. 12,14,21 These results support the superiority of VPZ-based regimens for eradicating H. pylori.…”

“…The efficacy of a VPZ‐based first‐line regimen (VPZ, AMPC, and CAM for 7 days) for CAM‐resistant H. pylori was demonstrated in a prospective study and in meta‐analyses of retrospective studies . The safety of the V‐AS was confirmed using the same questionnaire used to demonstrate the safety of V‐AC, V‐AM, and V‐CM . These results support the superiority of VPZ‐based regimens for eradicating H. pylori .…”

Treatment of Helicobacter pylori infection in 2018

“…A small study assessing regimens including vonoprazan for penicillin‐allergic patients demonstrated an eradication rate of 92.9% for patients who received clarithromycin‐metronidazole‐vonoprazan which far surpassed the 54.2% achieved by PPI‐based therapies . Triple therapy with vonoprazan, clarithromycin, and metronidazole was well tolerated and effective for eradicating H. pylori in patients allergic to penicillin …”

“…57 Triple therapy with vonoprazan, clarithromycin, and metronidazole was well tolerated and effective for eradicating H. pylori in patients allergic to penicillin. 58 Safety of new medication is always a concern. One study assessing vonoprazan triple therapy in children found adverse effects (rash/GI disturbance) in 21.1%.…”