Vonoprazan is noninferior to proton pump inhibitors in bismuth‐containing quadruple therapy for the treatment of Helicobacter pylori infection: A propensity score matching analysis

Objective This study aimed to evaluate the efficacy and safety of vonoprazan (VPZ) versus proton pump inhibitor (PPI) in clarithromycin‐based bismuth‐containing quadruple therapy (C‐BQT) for the treatment of Helicobacter pylori ( H. pylori ) eradication. Methods Medical records of patients in whom H. pylori was eradicated between 1 July 2018 and 31 December 2021 were retrieved retrospectively from the Outpatient Unit of Qilu Hospital. Efficacy, safety, and compliance were compared between VPZ‐based and PPI‐based C‐BQT, containing vonoprazan 20 mg or proton pump inhibitors (lansoprazole 30 mg or esomeprazole 20 mg), bismuth 220 or 200 mg, amoxicillin 1000 mg, and clarithromycin 500 mg, twice daily for 2 weeks by 1:1 propensity score matching analysis. The trial was registed on ClinicalTrials.gov (registration no. NCT05301725). Results The H. pylori eradication rates of VPZ‐based and PPI‐based therapies were 88.8% (151/170) and 87.6% (149/170) in the intention‐to‐treat analysis, 94.1% (144/153) and 91.1% (144/158) in the per‐protocol analysis, respectively. The noninferiority of VPZ to PPI was confirmed in all analyses ( P < 0.001). The incidence of adverse events was 30.0% (51/170) and 27.1% (46/170) in the VPZ‐based and PPI‐based groups, respectively. VPZ‐based and PPI‐based therapies were well tolerated and showed good patient compliance without significant differences. Conclusions VPZ‐based therapy resulted in a satisfactory eradication rate and was well tolerated for H. pylori eradication, which are comparable to PPIs in C‐BQT as a first‐line treatment for H. pylori infection.