Decoding The Clinical Effectiveness of Vonoprazan in Helicobacter pylori Eradication!

Helicobacter pylori (H. pylori) infects over 50% of the world population and around 60% of the Indian population.^1,2 The bacterium causes a lifetime risk of approximately 17% for peptic ulcers and up to 22% for gastric cancer in infected patients.³ For several decades, proton pump inhibitor (PPI)-based therapies have dominated the H. pylori treatment landscape. However, the eradication rates of PPI-based regimens have gradually decreased due to insufficient acid suppression and widespread antibiotic resistance leading to a pressing need to optimize therapy.^3,4

Vonoprazan is a reversible H⁺-K⁺ ATPase inhibitor with a relatively fast and sustained acid suppression unaffected by diet or gene polymorphisms.³ The drug has turned out to be the preferred choice for H. pylori eradication therapy.⁵

A randomized controlled trial (RCT) compared vonoprazan-based dual and triple therapies to lansoprazole-based triple therapy for H. pylori infection in 1046 treatment-naïve patients.⁴ For the total patient population, vonoprazan-based dual and triple therapies reported eradication rates of 77.2% (p=0.013) and 80.8% (p<0.001), compared to only 68.5% with lansoprazole-based therapy.⁴ Moreover, for patients with clarithromycin resistance, vonoprazan-based dual and triple therapies showed H. pylori eradication rates of 69.6% (p<0.001) and 65.8% (p<0.001) compared to only 31.9% with lansoprazole-based therapy.⁴

Further, a systematic review and meta-analysis involving 8 RCTs compared vonoprazan- and PPI-based therapies for H. pylori eradication.³ In the intention-to-treat analysis, the pooled H. pylori eradication rates were 83.5% and 72.6% in vonoprazan- and PPI-based treatments, respectively with a significantly higher cure advantage with vonoprazan- than PPI-based group and pooled risk ratio (PRR) of 1.14, p<0.00001.³ In the per-protocol analysis, the pooled H. pylori eradication rates were 87.1% and 76.4% by vonoprazan- and PPI-based therapy, respectively.³ Here as well, the vonoprazan-based group had a superior eradication efficacy to the PPI-based group with PRR=1.12, p=0.0003.³

Conclusion

To summarize, the available evidence suggests that vonoprazan should be considered the drug of choice for the treatment of H. pylori, given its advantage of better eradication rates than PPI-based regimens.

References: ▼

1. Mégraud F, Graham DY, Howden CW, et al. Rates of antimicrobial resistance in Helicobacter pylori isolates from clinical trial patients across the US and Europe. Am J Gastroenterol. 2023;118(2):269–275.
2. Chen YC, Malfertheiner P, Yu HT, et al. Global prevalence of Helicobacter pylori infection and incidence of gastric cancer between 1980 and 2022. Gastroenterology. 2024;166(4):605–619.
3. Sun Y, Yue L, Hu W. Effectiveness and safety of vonoprazan-based regimens compared with those of proton pump inhibitor (PPI)-based regimens as first-line agents for Helicobacter pylori: A meta-analysis of randomized clinical trials. Eur J Clin Pharmacol. 2023;79(2):279–288.
4. Chey WD, Mégraud F, Laine L, et al. Vonoprazan triple and dual therapy for Helicobacter pylori infection in the United States and Europe: Randomized clinical trial. Gastroenterology. 2022;163(3):608–619.
5. Shinozaki S, Osawa H, Hayashi Y, et al. Long-term vonoprazan therapy is effective for controlling symptomatic proton pump inhibitor-resistant gastroesophageal reflux disease. Biomed Rep. 2021;14(3):32.

LMRC Code:GGI-CO-A1-AQS-300041558-APPEMC-A25-0936 DOI of 28/1/2025 and DOE of 28/4/2025

Disclaimer: For the use of a registered medical practitioner, hospital, or laboratory only.

The images are for illustrative representation only and do not depict actual medical products, procedures, or outcomes. Refer to official medical guidance and product information for accurate details.

All content including: text, images, audio, or other formats were created for medical educational purposes only. Offerings for continuing education are clearly identified and the appropriate target audience is identified. This communication is restricted for the use of HCPs and must not be shared in public domain. The opinions expressed in this video are solely the views of the speaker. The presentation may contain off label usage of drug(s) aimed at educational purpose only. Dr. Reddy’s Laboratories Ltd including but not limited its Affiliates strictly does not recommend any off label usage of its marketing products. Prior to treatment kindly refer to the latest prescribing information approved by the local authorities. No part of this content may be used, reproduced, transmitted or stored in any form without the written permission of Dr. Reddy’s.

Vono-Always on Duty

Vono 20-Always on Duty

Gastroenterology

Gastro

Gastro Intestinal

No result found. Choose another option for better results.

Decoding The Clinical Effectiveness of Vonoprazan in Helicobacter pylori Eradication!

Related Articles

Login to continue