Vonoprazan-Tetracycline Dual Therapy Shows Noninferior H pylori Eradication
A 14-day vonoprazan-tetracycline dual regimen was noninferior to bismuth quadruple therapy as rescue treatment for Helicobacter pylori infection and was associated with fewer adverse events and better adherence, according to results from a prospective randomized controlled trial.
The open-label study enrolled 350 H pylori-positive adults with at least 1 prior eradication failure. Participants were randomized 1:1 to receive vonoprazan 20 mg twice daily plus tetracycline 500 mg 3 times daily, or bismuth quadruple therapy consisting of lansoprazole 30 mg twice daily, colloidal bismuth 150 mg 3 times daily, tetracycline 500 mg 3 times daily, and metronidazole 400 mg 3 times daily. Both regimens were given for 14 days.
In modified intention-to-treat analysis, eradication rates were 90.6% in the vonoprazan-tetracycline group and 89.3% in the bismuth quadruple therapy group, meeting the prespecified noninferiority criterion (difference, 1.2%; 95% CI, -5.7% to 8.2%; noninferiority P = .0003). Per-protocol results were similar, with eradication rates of 91.1% and 92.2%, respectively (difference, -1.1%; 95% CI, -7.8% to 5.6%; noninferiority P = .002).
Safety and tolerability favored the dual regimen. Treatment-emergent adverse events occurred in 10.9% of patients receiving vonoprazan-tetracycline compared with 45.7% of patients receiving bismuth quadruple therapy (P < .001). No patients in the dual-therapy group discontinued treatment because of adverse events, compared with 8.6% in the bismuth quadruple therapy group (P < .001). Adherence was also higher with dual therapy (96.0% vs 87.4%; P = .006).
According to the authors, vonoprazan-tetracycline dual therapy “achieved eradication rates noninferior to BQT while substantially reducing adverse events and improving adherence.” They concluded that the regimen is “an effective and well-tolerated rescue regimen for H pylori infection.”
Reference
Gao W, Li J, Yang G, et al. Vonoprazan-tetracycline dual regimen as rescue therapy for helicobacter pylori infection: randomized controlled trial. Gastroenterology. 2026;170(7):1473-1483. doi:10.1053/j.gastro.2026.01.008
