Author/Authors :
Maruyama, Masafumi Department of Gastroenterology - Nagano Red Cross Hospital, Nagano, Japan , Tanaka, Naoki Department of Metabolic Regulation - Shinshu University Graduate School of Medicine, Matsumoto, Japan , Kubota, Daisuke Department of Gastroenterology - Nagano Red Cross Hospital, Nagano, Japan , Miyajima, Masayuki Department of Gastroenterology - Nagano Red Cross Hospital, Nagano, Japan , Kimura, Takefumi Department of Gastroenterology - Nagano Red Cross Hospital, Nagano, Japan , Tokutake, Koujiro Department of Gastroenterology - Nagano Red Cross Hospital, Nagano, Japan , Imai, Ryujiro Department of Gastroenterology - Nagano Red Cross Hospital, Nagano, Japan , Fujisawa, Toru Department of Gastroenterology - Nagano Red Cross Hospital, Nagano, Japan , Mori, Hiromitsu Department of Gastroenterology - Nagano Red Cross Hospital, Nagano, Japan , Matsuda, Yoshiaki Department of Gastroenterology - Nagano Red Cross Hospital, Nagano, Japan , Wada, Shuichi Department of Gastroenterology - Nagano Red Cross Hospital, Nagano, Japan , Horiuchi, Akira Digestive Disease Center - Showa Inan General Hospital, Komagane, Japan , Kiyosawa, Kendo Department of Gastroenterology - Aizawa Hospital, Matsumoto, Japan
Abstract :
Background. A new agent, potassium-competitive acid blocker vonoprazan (VPZ) has potent acid-inhibitory effects and may offer advantages over conventional H. pylori eradication therapies. We aimed to compare the eradication rate between VPZ-based treatment and PPI-based one. Methods. This randomized controlled trial was designed to assign 141 patients with H. pylori-positive gastritis to VPZ group (VPZ 20 mg, amoxicillin 750 mg, and clarithromycin 200 or 400 mg twice daily for 7 days) or PPI group (rabeprazole 20 mg or lansoprazole 30 mg, amoxicillin 750 mg, and clarithromycin 200 or 400 mg twice daily for 7 days). Primary endpoints were eradication rates and adverse events. Results. Seventy of 72 patients in VPZ group and 63 of 69 patients in PPI group completed the treatment after 7 days. The eradication rate was significantly higher in VPZ group than PPI group by intention-to-treat analysis (95.8% versus 69.6%, P = 0.00003, 95% confidence interval [CI] 88.3-99.1% versus 57.3-80.1%) and per-protocol analysis (95.7% versus 71.4%, P = 0.0002, 95% CI 88.0-99.1% versus 58.7-82.1%). The incidence of adverse events was not different between the groups (26.3% in VPZ group versus 37.7% in PPI group, P = 0.15). Conclusion. VPZ-based regimen is more useful than that PPI-based regimen as a first-line H. pylori eradication therapy.
