Comparative efficacy of Helicobacter pylori eradication therapy between tegoprazan‐based concomitant and bismuth quadruple therapies: A real‐world evidence

Abstract Background and Aim Tegoprazan, a potassium‐competitive acid blocker, can be used as a substitute for proton pump inhibitors in Helicobacter pylori eradication therapy; some studies have reported improved efficacy. In Korea, where clarithromycin resistance rates are high, we aimed to compare the efficacies of tegoprazan‐based concomitant and bismuth quadruple therapies. Methods We retrospectively analyzed data from patients with H. pylori infection who received either 10‐day tegoprazan‐based concomitant therapy or 14‐day tegoprazan‐based bismuth quadruple therapy as first‐line treatment. The primary outcome was H. pylori eradication rate, with secondary outcomes including adverse events and insufficient medication rates. Results Among the 1082 patients included in the study, 620 and 462 were treated with tegoprazan‐based concomitant and bismuth quadruple therapies, respectively. Intention‐to‐treat analysis demonstrated no difference in eradication rates between the tegoprazan‐based concomitant and bismuth quadruple therapy groups (74.7% [95% confidence interval—CI, 71.1–78.0%] vs 74.7% [95% CI, 70.6–78.5%], P = 0.999). Per‐protocol analysis also showed similar eradication rates between the two groups (88.0% [95% CI, 85.0–90.6%] vs 89.7% [95% CI, 86.3–92.5%], P = 0.424). The overall adverse event rates (49.6% vs 39.2%, P = 0.001) and insufficient medication rates (4.8% vs 2.4%, P = 0.036) were higher in the bismuth quadruple therapy group than in the concomitant therapy group. Conclusions The eradication rates of tegoprazan‐based 10‐day concomitant therapy and 14‐day bismuth quadruple therapy were comparable. However, because of its shorter treatment duration, better medical adherence, and lower incidence of adverse events, tegoprazan‐based concomitant therapy may be preferable in regions with high rates of clarithromycin and metronidazole resistance.