Prospective Study of Vonoprazan-Based First-Line Triple Therapy with Amoxicillin and Metronidazole for Clarithromycin-Resistant Helicobacter pylori

Aim: This was a prospective, multicenter, single-arm intervention, against historical controls, study of the efficacy vonoprazan-based 7-day triple regimen with metronidazole (VPZ-AMPC-MNZ) as first-line therapy for eradicating clarithromycin-resistant Helicobacter pylori (H. pylori). Methods: We enrolled 35 patients positive H. pylori, assessed by culture, without history eradication. These were prospectively eradicated VPZ-AMPC-MNZ. As we also 98 from our prior prospective studies, who achieved eradication including clarithromycin (VPZ-AMPC-CAM). A preplanned analysis performed superiority controls (VPZ-AMPC-MNZ compared to VPZ-AMPC-CAM). In each regimen, vonoprazan used at 20 mg bid, amoxicillin 750 250 and 200 or 400 bid 7 days. outcome using 13C-urea breath test stool antigen test. evaluated safety patient questionnaires. Results: The intention-to-treat (ITT) per-protocol (PP) rates VPZ-AMPC-MNZ both 100% (95% confidence interval CI) 90.0–100%, n = 35). VPZ-AMPC-CAM 76.5% CI 66.9–84.5%, 98) in ITT 77.3% 67.7–85.2%, 97) PP analysis. rate significantly higher than that (p 0.00052) 0.00095) analyses. Conclusions: findings suggest superior pylori. standard Japan.