The efficacy and mechanism of vonoprazan-containing triple therapy in the eradication of Helicobacter pylori

Abstract

<b>Purpose:</b> Vonoprazan (VPZ) produces a strong acid-inhibitory effect, which can potentially eradicate <i>Helicobacter Pylori (H. pylori)</i>. We aimed to assess whether a 14-day VPZ-containing triple therapy was safe and effective in the Chinese population and the potential mechanism. <b>Methods:</b> Enrolled patients confirmed to be infected with <i>H. pylori</i> were randomly divided into four groups: VPZ + doxycycline + furazolidone, VPZ + doxycycline + amoxicillin, esomeprazole (EPZ) + bismuth + doxycycline + furazolidone, and EPZ + colloidal bismuth + doxycycline + amoxicillin for 14 days. The eradication rate, medication adherence, and incidence of adverse events (AEs) were evaluated. Inhibition of <i>H. pylori</i> by VPZ and EPZ <i>in vitro</i> was assessed. <i>H. pylori</i> treated with appropriate concentrations of VPZ and EPZ were sequenced by transcriptome analysis to explore the antibacterial mechanism. <b>Results:</b> A higher eradication rate were observed in VPZ-containing triple therapy. No obvious differences were observed in medication adherence or the incidence of AEs. VPZ had no direct inhibitory effect on <i>H. pylori</i>, whereas EPZ directly inhibited <i>H. pylori</i> may through downregulated genes related to the ribosome. <b>Conclusion:</b> In the Chinese population, 14-day VPZ-containing triple therapy was safe and more effective and can be used clinically as first-line <i>H. pylori</i> treatment. <b>Clinical Trial Registration:</b> ClinicalTrials.gov, identifier NCT05097846.