Different doses of vonoprazan as the first-line treatment of Helicobacter pylori infection:A pro-spective cohort study
Objective To investigate the efficacy,safety,compliance,and economic benefits of low-dose or standard-dose vonoprazan quadruple therapy for the eradication of Helicobacter pylori(Hp).Methods A total of 531 patients who were diagnosed with Hp infection in our hospital from March to August 2023 were enrolled and divided into esomeprazole(Ebid)group(oral administration of esomeprazole 20 mg twice a day),standard vonoprazan(Vbid)group(oral administration of vonoprazan 20 mg twice a day),and low-dose vonoprazan(Vqd)group(oral administration of vonoprazan 20 mg once a day),and the remai-ning three drugs of Hp quadruple therapy were the same for the three groups(oral administration of amoxicillin 1 000 mg,cla-rithromycin 500 mg,and bismuth potassium citrate 600 mg,twice a day),with a course of treatment of 14 days.All patients were examined for Hp eradication rate(based on the intention-to-treat[ITT]analysis and the per-protocol[PP]analysis),symptom improvement,adverse events,and patient compliance after 4 weeks of drug withdrawal,and a cost-effectiveness analysis was pe-rformed for the regimens in each group(including the ITT and PP analyses).Results There was a significant difference in Hp eradication rate between the three groups in the ITT and PP analyses(x2ITT=6.351,PITI＜0.05;x2PP=7.376,PPP＜0.05),and the Vbid group had a significantly better Hp eradication rate than the Ebid group(x2ITT=6.077,PITT＜0.016;x2PP=6.821,PPP＜0.016).The regimens in all three groups achieved a relatively high symptom improvement rate,with no significant difference be-tween the three groups(P＞0.05).All three groups had mild adverse events,and the Vqd group had a significantly lower incidence rate of adverse events than the Ebid group(x2=6.058,P＜0.016).There was no significant difference in compliance rate between the three groups(P＞0.05),with a compliance rate of＞95％in all three groups.The Vqd group had a lower cost-effectiveness ra-tio than the Vbid and Ebid groups in both ITT and PP analyses.Conclusion The low-dose vonoprazan quadruple regimen has comparable efficacy to the standard-dose regimen,and both regimens have better efficacy than esomeprazole quadruple regimen.The low-dose vonoprazan quadruple regimen has better safety and cost-effectiveness and thus holds promise for clinical application in Hp eradication therapy.
Proton pump inhibitorsOmeprazoleHelicobacter pyloriDisease eradicationCosts and cost analysis
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