The Current Role of Vonoprazan in Helicobacter pylori Treatment

Fallone, Carlo A

doi:10.1053/j.gastro.2022.06.076

Cited by 7 publications

(3 citation statements)

References 13 publications

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“…Although superior to the PPI-based triple therapy regimen in the overall population, the eradication rates with the vonoprazan-based regimens remained below 90% [ 14 ], a threshold which is considered a target for empirical treatment [ 48 ]. Indeed, one limitation of the PHALCON-HP trial was that the comparator regimen (i.e., lansoprazole-based triple therapy) is not considered the standard-of-care when susceptibility information is unavailable or when clarithromycin resistance has been identified, with a bismuth-based quadruple therapy regimen generally recommended in these circumstances [ 2 , 49 ]. Despite this limitation, and accepting that the trial was primarily designed to assess the impact of the acid suppression component of the regimen (i.e., vonoprazan versus the PPI lansoprazole), the superiority of the vonoprazan-based regimens over the PPI-based triple therapy regimen in the overall trial population supports the proposition that the enhanced gastric acid suppression provided by vonoprazan can improve the effectiveness of antibiotics used for H. pylori eradication [ 14 ].…”

Section: Place Of Vonoprazan In the Management Of H Pylori ...mentioning

confidence: 99%

Vonoprazan: A Review in Helicobacter pylori Infection

Shirley

2024

Drugs

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Treatment for the eradication of Helicobacter pylori infection, a leading cause of peptic ulcer disease and an important risk factor for gastric cancer and mucosa-associated lymphoid tissue lymphoma, is indicated whenever infection is identified. However, treatment success rates with current guideline-recommended proton-pump inhibitor (PPI)-based regimens remain suboptimal, with one potential factor associated with treatment failure being inadequate acid suppression. Vonoprazan (Voquezna ® ) is a first-in-class potassium-competitive acid blocker with the potential to provide potent and sustained acid suppression. Following clinical trials conducted mainly in Asia (supported by post-marketing experience from Asia) and the phase III PHALCON-HP trial conducted in the USA and Europe, vonoprazan is now approved in the USA for use in combination with amoxicillin (dual therapy) or amoxicillin and clarithromycin (triple therapy) for the treatment of H. pylori infection in adults. The vonoprazan-based dual and triple therapy regimens were generally well tolerated in PHALCON-HP. In addition, vonoprazan has advantages including a rapid onset of action and no food effect, making vonoprazan-based dual and triple therapy regimens valuable alternatives to standard PPI-based triple therapy in the treatment of H. pylori infection. Supplementary Information The online version contains supplementary material available at 10.1007/s40265-023-01991-5.

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Section: Place Of Vonoprazan In the Management Of H Pylori ...mentioning

confidence: 99%

Vonoprazan: A Review in Helicobacter pylori Infection

Shirley

2024

Drugs

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“…This could explain, at least in part, the results of pivotal H. pylori treatment studies with vonoprazan in the United States and Europe (Vonoprazan triple and dual therapy) failed to replicate the high eradication rates found in Japan. [24,25] Notably, not all regimens may be in uenced by obesity. Kao et al [26], using omeprazole, rifabutin, and amoxicillin for 14 days, suggested that this regimen may not be affected by BMI, although they acknowledged the limited number of patients with a BMI > 40 as a study limitation.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Obesity Severity and Helicobacter pylori Eradication in patients undergoing bariatric surgery: A Post hoc analysis

Laudanno,

Ahumarán,

Thomé

et al. 2024

Preprint

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Background The global prevalence of obesity is increasing and represents a major public health challenge. However, there is a paucity of data regarding Helicobacter pylori (H pylori) eradication in obese populations. Aim To examine the influence of obesity degree on H. pylori eradication in patients undergoing bariatric surgery. Methods A Post hoc analysis was conducted in a cohort of 204 adults patients (129 obese, 75 normal-weight) H. pylori positive included in two multicenter, prospective studies. Patients underwent a 14-day quadruple concomitant treatment, and H pylori eradication was assessed using the 13C-Urea Breath Test. The cohort was stratified according to Body Mass Index (BMI), and statistical analyses were performed using Chi-squared test, Kruskal-Wallis test, and Logistic regression. Results Eradication rates were significantly lower in patients with obesity compared to normal-weight individuals (68.2% vs. 88.0%, OR 0.29, 95% CI 0.13–0.63, p < 0.01). Furthermore, within the obesity group, the degree of obesity correlated with decreased eradication rates, with Class 3 (BMI 40.0-49.9) and Class 4 (BMI ≥ 50.0) obesity showing the lowest rates (67% and 51%, with an OR 0.28 and 0,15 respectively, P < 0.01). Conclusions Our results indicate that obesity significant influence H pylori eradication especially among severe obesity patients undergoing bariatric surgery. Tailored eradication strategies may be necessary to improve treatment efficacy in this population.

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“…Potassium‐competitive acid blockers (P‐CABs), such as vonoprazan (VPZ), have been used in HDDT. VPZ is a new inhibitor of gastric acid secretion with a rapid, powerful, and enduring acid‐suppressive effect independent of diet and cytochrome P450 2C19 (CYP2C19) polymorphisms 23,24 . All emerging studies have prompted an urgent need for data update.…”

Section: Introductionmentioning

confidence: 99%

High‐dose dual therapy versus bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori: A systematic review and meta‐analysis

Wang,

Kong,

et al. 2024

J of Digest Diseases

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ObjectiveTo update evidence‐based data comparing the efficacy and safety of high‐dose dual therapy (HDDT) and bismuth‐containing quadruple therapy (BQT) in eradicating Helicobacter pylori infection through meta‐analysis.MethodsMultiple databases were systematically searched for randomized controlled trials (RCTs) published up to May 18, 2023. Dichotomous data were evaluated using risk ratio (RR) and 95% confidence interval (CI). Subgroup analysis, sensitivity analysis, risk of bias assessment, and quality of evidence evaluation were performed.ResultsTwenty RCTs containing 7891 subjects were included in the analysis. There was no statistically significant difference in H. pylori eradication rate between HDDT and BQT in the intention‐to‐treat (ITT) analysis (86.31% vs 84.88%; RR 1.02, 95% CI 1.00–1.04, P = 0.12). In the per‐protocol (PP) analysis, the eradication rates for HDDT and BQT were 90.27% and 89.94%, respectively (RR 1.01, 95% CI 0.99–1.03, P = 0.44). Adverse events were significantly lower with HDDT than with BQT (RR 0.44, 95% CI 0.38–0.51, P < 0.00001). Patient adherence was significantly different between the two groups (RR 1.01, 95% CI 1.00–1.03, P = 0.02). Subgroup analysis based on antibiotic combinations within the BQT group showed a significantly higher eradication rate for HDDT than for BQT only when BQT used amoxicillin combined with clarithromycin (P = 0.0009).ConclusionsHDDT showed comparable efficacy with BQT for H. pylori eradication, with fewer adverse effects and higher compliance. Due to regional differences, antibiotic resistance rates, and combined BQT antibiotics, more studies are needed for further validation and optimization of HDDT.

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The Current Role of Vonoprazan in Helicobacter pylori Treatment

Cited by 7 publications

References 13 publications

Vonoprazan: A Review in Helicobacter pylori Infection

Vonoprazan: A Review in Helicobacter pylori Infection

Relationship between Obesity Severity and Helicobacter pylori Eradication in patients undergoing bariatric surgery: A Post hoc analysis

High‐dose dual therapy versus bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori: A systematic review and meta‐analysis

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