Impact of body size on first‐line Helicobacter pylori eradication success using vonoprazan and amoxicillin dual therapy

Abstract

Background As a first‐line therapy for Helicobacter pylori, dual therapy with vonoprazan and amoxicillin (VA‐dual) provides an eradication rate similar to that of vonoprazan‐based triple therapy. As the factors associated with the eradication rate of H. pylori with VA‐dual are unknown,we investigated them in this study. Materials and Methods Overall, 163 patients diagnosed with H. pylori infection received VA‐dual (vonoprazan 20 mg twice daily and amoxicillin 750 mg twice daily for 7 d). The association between successful H. pylori eradication and the following patient clinical factors was analyzed: sex, age, height, weight, body surface area (BSA), body mass index (BMI), history of early gastric carcinoma and peptic ulcer, comorbidity of cirrhosis, alcohol consumption habit, smoking habit, common use of proton pump inhibitors, and concomitant use of drugs that are substratesof cytochrome P450 (CYP) 3A4. The association between post‐eradication adverse events and clinical factors was analyzed retrospectively. Results Successful H. pylori eradication was associated with a lower BSA (eradication rate: 90.8% in patients with BSA <1.723 vs. 79.6% in those with BSA ≥1.723; p = 0.045). The incidence of adverse events was higher in women than in men (adverse events: 40.0% in women vs. 19.4% in men; p = 0.004). Conclusions Successful H. pylori eradication with VA‐dual was associated with the small body size of patients. This therapy may have to be adjusted per body size.

Rabeprazole plus amoxicillin dual therapy is equally effective to bismuth‐containing quadruple therapy for Helicobacter pylori eradication in central China: A single‐center, prospective, open‐label, randomized‐controlled trial

“…Our results also reveal that higher eradication rates in patients with a low BSA level in both BDT and RADT groups. A previous study on vonoprazan‐based dual therapy 36 showed that H . pylori eradication success was associated with a low BSA level and smaller body size, which was consistent with the current results.…”

Impact of smoking on the eradication of Helicobacter pylori

“…7,11,[14][15][16]18,19,22,26,27,[29][30][31][32][33][35][36][37][38][39][42][43][44][45][46][47][48] VPZ was included in the eradication regimen in 4 studies. 11,[16][17][18] In 7 studies, the duration of H. pylori treatment was 14 days. 10,14,19,21,22,24,35 In 12 studies, all the participants had peptic ulcer.…”

“…10,14,19,21,22,24,35 In 12 studies, all the participants had peptic ulcer. 10,15,20,[23][24][25]28,32,34,37,39,46 Eleven studies 11,14,15,17,20,24,30,34,38,40,48 provided information about the current smoking status of the patients. In 5 studies 15,24,25,33,40 Reported odds ratios and 95% confidence intervals were used if available from the literature and calculated when unavailable.…”

“…Thus, the inhibition of acid secretion by VPZ was stable, and the differences between individuals were negligible. 17 Moreover, the potent gastric acid suppression induced by VPZ might conceal the effect of smoking. 16 Hence, it can be suggested that when VPZ is used to treat H. pylori infection, smoking does not affect the eradication rate.…”

The Ideal <b><i>Helicobacter pylori</i></b> Treatment for the Present and the Future

“…One study in which the dual therapy consisted of 20 mg vonoprazan twice daily and 500 mg amoxicillin 3 times daily for 7 days as the first-line treatment provided a higher eradication rate of 93% [37]. Another study reported that smaller patient body size, including lower body mass index and lower body surface area, was associated with higher eradication success of the vonoprazan-amoxicillin dual therapy [38]. These study results suggest that vonoprazan-amoxicillin dual therapy with proper adjustment of amoxicillin dose based on patient body size is expected to be the ideal treatment in the future for minimizing both H. pylori antibiotic resistance development and posttreatment gut microbiota dysbiosis while also providing sufficient H. pylori eradication.…”