Vonoprazan‐Containing Triple Therapy Based on Clarithromycin Susceptibility May Be Definitive Treatment Strategy for Eradication of Helicobacter pylori

ABSTRACT Aims Helicobacter pylori (H.pylori) eradication therapy often fails to eradicate clarithromycin (CAM)‐resistant strains. Individualized therapy with proton pump inhibitors and metronidazole instead of CAM could be effective for first‐line eradication based on CAM sensitivity tests. However, on the basis of these tests, whether vonoprazan (VPZ) can be used for the eradication of H. pylori remains unknown. Therefore, this study investigated the effectiveness of VPZ‐based triple therapy for the eradication of H. pylori based on CAM sensitivity tests. Methods Of 2920 patients who underwent H. pylori culture testing, 1223 tested positive, and 771 H. pylori ‐positive patients received VPZ‐based triple therapy (VAC [VPZ 20 mg b.i.d., amoxicillin 750 mg b.i.d., CAM 200 mg or 400 mg b.i.d.; n = 631] or VAM [VPZ 20 mg b.i.d., amoxicillin 750 mg b.i.d., MNZ 250 mg b.i.d.; n = 140] therapy for 7 days based on CAM sensitivity). Results Both the VAC and VAM therapy groups were equivalent in terms of patient backgrounds. The VAM therapy‐associated eradication rate of CAM‐resistant strains was higher than the VAC therapy‐associated eradication rates of both CAM‐resistant and CAM‐sensitive strains ( p < 0.01 and p = 0.02, respectively). The incidences of adverse events associated with VAC and VAM therapies were similar. Conclusions Based on CAM susceptibility, VPZ‐based triple therapy, VAM, afforded a high eradication rate of CAM‐resistant H. pylori strains; whereas VAC was not effective for the eradication. Additionally, drug sensitivity tests are recommended when VPZ‐based triple therapy is administered.