Vonoprazan-based bismuth quadruple therapy for first-line Helicobacter pylori eradication: A real-world, retrospective study

The rising prevalence of drug-resistant Helicobacter pylori (H. pylori) strains necessitates the development of more effective treatment approaches for eradication, such as bismuth quadruple therapy (BQT). We aimed to evaluate the efficacy and safety of vonoprazan (VPZ)-based BQT as a first-line regimen for H. pylori eradication. We conducted a retrospective analysis of consecutive treatment-naïve patients with H. pylori infection who received VPZ-based BQT between March 2022 and September 2023. Patients received a 14-day BQT regimen consisting of VPZ (20 mg), bismuth potassium citrate (240 mg), amoxicillin (1.0 g), and clarithromycin (500 mg) twice daily. Demographics, eradication rates, compliance, and adverse events (AEs) were assessed. 231 patients were included in the study, with 87 males (37.7%) and an average age of 40.84 ± 10.72 years old. The eradication rates for the intention-to-treat, modified intention-to-treat, and per-protocol analyses were 92.2% (213/231; 95% confidence interval [CI] 88.7-95.7%), 97.3% (213/219; 95% CI 95.1-99.4%), and 99.1% (210/212; 95% CI 97.7-100.0%), respectively. Patient compliance with the treatment was 97.0% (224/231). The incidence of AEs was 22.1% (51/231). Most AEs were mild and tolerable. Poor compliance was found to be an independent factor predicting treatment failure. This study demonstrated that the 14-day VPZ-based BQT as a first-line treatment regimen was highly effective and safe for eradicating H. pylori in a Chinese setting, with excellent patient compliance.