Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2017; 23(4): 668-675
Published online Jan 28, 2017. doi: 10.3748/wjg.v23.i4.668
Comparative study: Vonoprazan and proton pump inhibitors in Helicobacter pylori eradication therapy
Kouichi Sakurai, Hiroko Suda, Yumi Ido, Takayuki Takeichi, Ayako Okuda, Kiwamu Hasuda, Masahiro Hattori
Kouichi Sakurai, Hiroko Suda, Yumi Ido, Takayuki Takeichi, Ayako Okuda, Kiwamu Hasuda, Masahiro Hattori, Hattori Clinic, Chuo-ku, Kumamoto 860-0004, Japan
Author contributions: Sakurai K performed the research and wrote the paper; all of the authors designed the experiments and contributed to data collection. Sakurai K and Suda H contributed to the analysis; all of the authors read and approval the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Hattori Clinic’s Ethical Committee.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: Authors declare no conflict of interest related to this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kouichi Sakurai, MD, Hattori Clinic, Kumamoto, 2-12-35 Shin-machi, Chuo-ku, Kumamoto 860-0004, Japan. sakuraiko@jcom.zaq.ne.jp
Telephone: +81-96-3252300 Fax: +81-96-3524778
Received: September 14, 2016
Peer-review started: September 15, 2016
First decision: October 10, 2016
Revised: October 26, 2016
Accepted: November 15, 2016
Article in press: November 16, 2016
Published online: January 28, 2017
Abstract
AIM

To compare the effectiveness and safety of vonoprazan-based therapy with proton pump inhibitor (PPI)-based therapies to treat Helicobacter pylori (H. pylori).

METHODS

We retrospectively analysed data from first-line (vonoprazan or PPI with 200 mg clarithromycin and 750 mg amoxicillin twice daily for 7 d) (n = 1353) and second-line (vonoprazan or PPI with 250 mg metronidazole and 750 mg amoxicillin twice daily for 7 d) (n = 261) eradication treatments for H. pylori -positive patients with associated gastrointestinal diseases from April 2014 to December 2015 at Hattori Clinic, Japan. The primary endpoint was the eradication rate, which was assessed with a full analysis set. The secondary endpoints were adverse events and related factors.

RESULTS

After the first-line treatments, the eradication rates for vonoprazan, esomeprazol, rabeprazole, and lansoprazole were 87.9% (95%CI: 84.9%-90.5%), 71.6% (95%CI: 67.5%-75.5%), 62.9% (95%CI: 52.0%-72.9%), and 57.3% (95%CI: 50.4%-64.1%), respectively. The vonoprazan eradication rate was significantly higher than that of the PPIs (P < 0.01). Interestingly, smoking did not affect the H. pylori eradication rate in the vonoprazan group (P = 0.34), whereas it decreased the rates in the PPI groups (P = 0.013). The incidence of adverse events in the vonoprazan group was not different from the PPI group (P = 0.054), although the vonoprazan group exhibited a wider range of adverse events. Vonoprazan-based triple therapy was highly effective as a second-line treatment, with an eradication rate similar to that of PPI-based therapy.

CONCLUSION

Vonoprazan might be superior to PPIs in first-line H. pylori therapy, particularly for smokers. However, caution is required due to possible adverse events.

Keywords: Helicobacter pylori, Eradication treatment, Vonoprazan, Proton pump inhibitors, Adverse event, Smoking

Core tip: Because the Helicobacter pylori (H. pylori) eradication rate of conventional proton pump inhibitor (PPI)-based treatment has decreased because clarithromycin-resistant strains have appeared in recent years, a new treatment strategy is required. Vonoprazan is a novel potassium -competitive acid blocker that has strong, long-lasting effects, but few studies have investigated its efficacy against H. pylori. We compared vonoprazan-based therapy and PPI-based therapy as first-line and second-line treatments. Vonoprazan-based therapy was superior to PPI-based therapy, particularly for smokers, but adverse events (AEs) due to vonoprazan occurred more frequently. Vonoprazan-based therapy is a potentially efficacious treatment, but it should be used with caution due to possible AEs.