S3146 Real-World Clinical Study for Effectiveness and Safety of Vonoprazan-Based Dual Therapy Versus PPI-Based Triple Therapy for Helicobacter pylori Eradication

Introduction: Eradication of Helicobacter pylori remains a significant clinical challenge due to increasing antibiotic resistance, particularly to clarithromycin. Vonoprazan, a potassium-competitive acid blocker, is gaining use as an effective alternative to proton pump inhibitors for acid-related conditions and H. pylori treatment. This study assesses the effectiveness of vonoprazan-amoxicillin (VA) dual therapy versus proton pump inhibitor (PPI)-amoxicillin-clarithromycin (PAC)–based triple therapy in routine clinical practice, based on H. pylori eradication assessed by the rapid urease test (RUT). Methods: This was a single-centre, open-label, observational, real-world comparative study conducted at Kolkata Gastro Care, Dumdum, Kolkata, India, from July 2024 to March 2025. Data from 94 patients diagnosed with H. pylori infection were analyzed. Patients received either VA (vonoprazan 20 mg twice per day and amoxicillin 1 g three times per day) or PAC (PPI twice per day, amoxicillin 1 g twice per day, and clarithromycin 500 mg twice per day). Follow-up was performed at 4 weeks using RUT on the biopsy sample. Patients unresponsive to initial therapy were either switched between regimens or escalated to bismuth quadruple therapy. Adverse effects and switching patterns were observed. Results: A total of 94 patients with H. pylori infection were analyzed, with 45 initiated on VA dual therapy and 49 on PAC regimen. The mean age was 38.96 (standard deviation ± 13.18) years in VA and 43.49 (SD ± 11.34) years in PAC group. Chronic gastritis was the most frequent diagnosis across both groups (53.33% in VA, 59.18% in PAC). Post-treatment, negative RUT cases were numerically higher in VA than those in PAC regimen (95.56% vs 85.71%). Adverse effects were reported in 13.33% of patients in VA group versus 28.57% of those in PAC group. One out of three patients (66.7%) who switched from VA to PAC, while all 7 patients (14.29%) from PAC to VA, achieved a response. Third-line bismuth quadruple therapy was initiated in 2 patients from the VA group. Conclusion: This study demonstrates that VA dual therapy achieves higher eradication rates and is better tolerated than PAC regimen in patients with H. pylori infection. Additionally, the lower incidence of adverse effects in the VA group suggests improved patient tolerability. The successful eradication of H. pylori infection in patients switched from PAC to VA further supports its efficacy as a rescue therapy.