Am J Gastroenterol

Vonoprazan triple, hybrid therapies best vonoprazan dual therapy for H. pylori

June 30, 2025

Study details: This multicenter, randomized, open-label trial enrolled 906 adults with H. pylori infection across six centers in Taiwan. Patients were randomized 1:1:1 to receive 14 days of vonoprazan high-dose dual therapy, vonoprazan triple therapy, or rabeprazole reverse hybrid therapy. H. pylori eradication, the primary outcome, was assessed by ¹³C-urea breath test.

Results: Eradication rates were 83.8% for vonoprazan high-dose dual therapy, 90.1% for vonoprazan triple therapy, and 89.1% for rabeprazole reverse hybrid therapy. Dual therapy was statistically inferior to both vonoprazan triple (difference: -6.3%; 95% confidence interval [CI], -11.5% to -1.1%; p=0.022) and rabeprazole reverse hybrid therapy (difference: -5.3%; 95% CI, -10.7% to 0.1%; p=0.031). Adverse event rates were similar across groups (10.3% to 15.6%). Independent predictors of eradication failure included body weight ≥60 kg, clarithromycin resistance, and poor adherence.

Clinical impact: Vonoprazan triple and rabeprazole hybrid therapies are more effective than high-dose dual therapy for first-line H. pylori eradication. Dual therapy may be less suitable in populations with higher clarithromycin resistance or adherence concerns.

Source:

Hsu PI, et al; Taiwan Acid-related Disease and Microbiota (TARD-M) Consortium. (2025, June 25). Am J Gastroenterol. Vonoprazan High-dose Dual, Vonoprazan Triple and Rabeprazole Reverse Hybrid Therapies for First-line Treatment of H. pylori Infection: A Multicenter Randomized Trial. https://pubmed.ncbi.nlm.nih.gov/40560185/