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Hanno et al.ǀ Journal of Clinical and Translational Research 2024; 10(6): 317-324 321
Table 3. Adverse events of vonoprazan-based triple therapy versus When there is no CLA susceptibility test, vonoprazan-
conventional proton-pump inhibitor (PPI)-based triple therapy CLA triple therapy may be advised empirically. For 14 days,
Adverse effect Number of patients (%) we compared vonoprazan-AMO-CLA treatment to PPI-based
Vonoprazan Conventional therapy for naïve patients and evaluated vonoprazan,
(n=598) (%) PPI (n=586) (%) nitazoxanide, levofloxacin, and doxycycline to a comparable
Rash 6 (1.003) 7 (1.19) PPI regimen for experienced patients. Our findings were similar
Constipation 8 (1.33) 9 (1.5) to Mahrous et al., who did a similar study on Egyptian patients
Diarrhea 10 (1.6) 11 (1.8) and compared the effects of vonoprazan, although with a
Nausea and vomiting 5 (0.8) 3 (0.5) smaller number of patients, included only one center, and used
Bloating 2 (0.3) 1 (0.17) metronidazole instead of CLA in the naïve patients [39].
Our study included only adult participants and did not assess
the effect of the drug in children with H. pylori. In addition, only
Table 4. Regimen for previous Helicobacter pylori treatment (n=483) three patients over 70 years old were included; hence, further
Regimen Number of patients (%) studies are warranted to confirm the efficacy of vonoprazan
PPI+amoxicillin+clarithromycin 119 (24.64) in children and older adults, especially those with multiple
PPI+amoxicillin+quinolones 154 (31.88) medications and comorbidities.
PPI+amoxicillin+metronidazole 117 (24.22) The drug was well tolerated, with diarrhea being the most
PPI+amoxicillin+nitazoxanide+clarithromycin 93 (19.26) reported side effect. This may be linked to the use of CLA,
Abbreviation: PPI: Proton-pump inhibitor which is known to stimulate GI motility. This finding contrasts
with Furuta et al., who reported a higher incidence of diarrhea
line H. pylori eradication treatments. The vonoprazan, AMO, and other side effects with vonoprazan, potentially due to ethnic
and CLA triple treatment had eradication rates equivalent to the differences [40].
BQT and CQT and higher than the 7-day STT rate in this study. Nonetheless, this study had limitations, with the primary
We found that vonoprazan-based triple treatment had a challenge being how to effectively communicate with the large
higher eradication rate than PPI-based triple therapy as a first- number of patients and ensure their adherence and compliance
line regimen in naïve patients (91% vs. 74.6%) and as rescue to the treatment regimen.
therapy in experienced patients (89.7% vs. 78.3%) in this study.
Consistent with previous findings, vonoprazan-based triple 5. Conclusion
therapy achieved eradication rates exceeding 90%, while PPI- In both naive and experienced patients, vonoprazan-based
based triple therapy achieved rates of 80% [33]. The triple therapy treatment was statistically substantially superior to omeprazole-
that includes vonoprazan is preferable because its acid-inhibitory based therapy in eradicating H. pylori. However, the effectiveness
effect is more rapid, potent, and stable [34], and its pharmacokinetic of vonoprazan-based treatment was not significantly different
features are not affected by CYP2C19 polymorphism [23]. between naïve and experienced groups. Therefore, it appears to
Dual vonoprazan-AMO and CLA triple treatment eradication be a potentially safe and effective H. pylori treatment for our
rates may be high because the strain infecting participants was Egyptian patients, who tolerated it with few adverse effects.
not AMO resistant. Despite AMO resistance being lower than
other antibiotics, it is often overlooked in H. pylori treatments. Acknowledgments
AMO resistance rates are 38% in Africa, 14% in the Eastern The authors would like to thank all of the patients who
Mediterranean, 12% in Southeast Asia, 8% in the Americas, participated in this research, the American Journal Experts for
and 0 – 1% in Europe and the Western Pacific, though it varies copyediting this manuscript, and the Inspire Pharmaceutical
significantly in other regions [35]. Company for funding this study.
After 7 days of triple treatment, high-dose PPIs eliminated
H. pylori infection more effectively compared to conventional Funding
doses (82% vs. 74%; 95% confidence interval [CI]: 1.01 – 1.17) in
a previous meta-analysis [36]. Increased stomach pH may cause This study was funded by Inspire Pharmaceutical Company
H. pylori to re-replicate and become antibiotic-sensitive [9]. If (grant number 17501), which provided free samples during the
CLA resistance is >15%, many guidelines recommend avoiding study period without interfering with the study results.
PPI-CLA triple therapy [37]. Notably, 40% of patients in Egypt Conflict of Interest
are resistant to CLA [12].
However, PPI-CLA triple therapy is frequently employed There is a financial conflict of interest with the funder Inspire
in the absence of CLA susceptibility testing, as empirical Pharmaceutical Company.
treatment is less time-consuming and less expensive than Ethics Approval and Consent to Participate
testing. Vonoprazan-CLA triple treatment eliminated CLA
resistance more effectively than PPI-CLA triple therapy (82.0% This study was approved by Alexandria University and
vs. 40.0%; 95% CI: 3.63 – 12.86), demonstrating an acceptable was conducted in line with ethical principles. Moreover, the
eradication rate (i.e., >80%) [38]. study protocol adheres to the ethical principles outlined in the

DOI: http://doi.org/10.36922/jctr.24.00043