41 - Efficacy of 10-day VAL (Vonoprazan, Amoxicillin, and Levofloxacin) vs 14-day Standard Triple Therapy for Helicobacter pylori Eradication A Multicenter Randomized Controlled Trial

Suttigiat Sangsuwan, MD¹, Anuchit Suksamai, MD², Noppamate Preechathammawong, MD³, Sukhum Songserm, MD⁴, Krit Opuchar, MD¹, Sakkarin Chirapongsathorn, MD, MSc¹, Kachonsak Yongwatana, MD^1
1Phramongkutklao Hospital, Bangkok, Krung Thep, Thailand; ²Fort Suranari Hospital, Phramongkutklao Hospital, Bangkok, Krung Thep, Thailand; ³Fort Wachirawut Hospital, Nakhon Si Thammarat, Nakhon Si Thammarat, Thailand; ⁴Fort Somdej Phra Naresuan Maharaj Hospital, Phitsanulok, Phitsanulok, Thailand

Introduction: Helicobacter pylori (H. pylori) infection is a global concern, impacting approximately 50% of the world's population. H. pylori infection leads to gastritis, dyspepsia, peptic ulcer disease, and in severe cases, may progress to gastric cancer or MALT lymphoma. Eradication of H. pylori is recommended by global guidelines. However, the conventional regimen especially standard triple therapy may yield suboptimal outcomes and some adverse events. Vonoprazan, a potassium-competitive acid blocker, may yield a higher response rate but the data is limited.



Methods: Patients diagnosed with H. pylori infection were enrolled from December 2022 to September 2023. Patients were randomized into two groups: the 10-day VAL group (vonoprazan 20 mg twice daily, amoxicillin 1,000 mg twice daily, and levofloxacin 500 mg once daily for 10 days) and the 14-day OAC group (omeprazole 20 mg twice daily, amoxicillin 1,000 mg twice daily, and clarithromycin 500 mg twice daily for 14 days). The eradication rate was evaluated by C¹³ UBT 4 weeks after completion of treatment.

Results: The study included 280 patients, with 140 patients in each group. Vonoprazan-based therapy (10-day VAL) resulted in a significantly higher H. pylori eradication rate compared to the 14-day OAC group in both intention-to-treat analysis (91.4 % vs 80.7%, P = 0.009), and per-protocol analysis (93.4% vs 83.7%, P = 0.012) respectively. The incidence of adverse events rate was lower in the 10-day VAL group compared to the 14-day OAC group, with a bitter taste (2.1 % vs 42.9%, p < 0.001) and bloating (5% vs 12.1%, p =0.033). A body mass index (BMI) of less than 23.5 kg/m² was significantly associated with the higher success rate of H. pylori eradication with Relative Risk (RR)=2.27 (CI 1.00-5.13). In the subgroup analysis of the 14-day OAC group, a BMI of less than 23.5 kg/m² was significantly associated with the higher success rate of H. pylori eradication with RR 3.34 (CI 1.15-9.67, p =0.026). However, in the 10-day VAL group, a BMI of less than 23.5 kg/m² did not affect the H. pylori eradication rate with RR 1.10 (CI 0.28-4.30, p =0.888).

Discussion: Vonoprazan-based therapy for 10 days (10-day VAL) is more effective, well tolerated, and has a higher H. pylori eradication rate compared to standard triple therapy for 14 days (14-day OAC). Furthermore, 10-day VAL therapy is associated with fewer adverse effects, making it a preferred treatment option.



Disclosures:


Suttigiat Sangsuwan, MD¹, Anuchit Suksamai, MD², Noppamate Preechathammawong, MD³, Sukhum Songserm, MD⁴, Krit Opuchar, MD¹, Sakkarin Chirapongsathorn, MD, MSc¹, Kachonsak Yongwatana, MD¹, 41, Efficacy of 10-day VAL (Vonoprazan, Amoxicillin, and Levofloxacin) vs 14-day Standard Triple Therapy for Helicobacter pylori Eradication: A Multicenter Randomized Controlled Trial, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.