Vonoprazan-based regimens show higher H. pylori eradication rates than rabeprazole dual therapy in Chinese cohort

This retrospective analysis evaluated the real-world effectiveness of vonoprazan-based regimens versus rabeprazole-based dual therapy for Helicobacter pylori eradication. The study included 598 H. pylori-positive outpatients from 10 centers across 8 prefectures in Guizhou, China, a region noted for high primary antibiotic resistance and ethnic diversity. Patients received one of four regimens: three vonoprazan-based groups (A: vonoprazan 20 mg b.i.d. + amoxicillin 1 g t.i.d.; B: vonoprazan 20 mg q.d. + amoxicillin 1 g t.i.d.; C: vonoprazan 20 mg q.d. + amoxicillin 1 g b.i.d. + furazolidone 100 mg b.i.d. + colloidal bismuth pectin 100 mg t.i.d.) or a comparator (D: rabeprazole 20 mg b.i.d. + amoxicillin 1 g t.i.d.). Eradication was assessed at least 4 weeks post-treatment.

The primary outcome was eradication rate. Group A (vonoprazan b.i.d. + amoxicillin t.i.d.) achieved the highest rate at 87.2%, which was significantly higher than Group D's 71.5%. Group B (vonoprazan q.d. + amoxicillin t.i.d.) and Group C (quadruple therapy) showed rates of 81.4% and 82.1%, respectively. The study reported that Group A's rate was significantly higher than Group D's (p < 0.05 implied). Safety and tolerability data, including adverse events and discontinuations, were not reported.

Key limitations include the retrospective design, which limits causal inference, and the specific regional context of high antibiotic resistance and ethnic diversity in Guizhou, China, which may affect generalizability. Funding and conflicts of interest were not reported. For practice, this analysis suggests vonoprazan-based regimens, particularly with b.i.d. dosing, may offer higher eradication rates than traditional rabeprazole-based dual therapy in challenging, high-resistance environments. However, the sub-90% success rate and lack of safety data, combined with the observational nature of the evidence, indicate these protocols require further optimization and prospective validation before broad clinical adoption.