AUTHOR=Zhang Zinan , Liu Fen , Ai Feiyan , Chen Xiong , Liu Rui , Zhang Chao , Fang Ning , Fu Tian , Wang Xiaoyan , Tang Anliu 

TITLE=The efficacy and mechanism of vonoprazan-containing triple therapy in the eradication of Helicobacter pylori

JOURNAL=Frontiers in Pharmacology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2023.1143969

DOI=10.3389/fphar.2023.1143969

ISSN=1663-9812

ABSTRACT=<p><bold>Purpose:</bold> Vonoprazan (VPZ) produces a strong acid-inhibitory effect, which can potentially eradicate <italic>Helicobacter Pylori (H. pylori)</italic>. We aimed to assess whether a 14-day VPZ-containing triple therapy was safe and effective in the Chinese population and the potential mechanism.</p><p><bold>Methods:</bold> Enrolled patients confirmed to be infected with <italic>H. pylori</italic> were randomly divided into four groups: VPZ + doxycycline + furazolidone, VPZ + doxycycline + amoxicillin, esomeprazole (EPZ) + bismuth + doxycycline + furazolidone, and EPZ + colloidal bismuth + doxycycline + amoxicillin for 14 days. The eradication rate, medication adherence, and incidence of adverse events (AEs) were evaluated. Inhibition of <italic>H. pylori</italic> by VPZ and EPZ <italic>in vitro</italic> was assessed. <italic>H. pylori</italic> treated with appropriate concentrations of VPZ and EPZ were sequenced by transcriptome analysis to explore the antibacterial mechanism.</p><p><bold>Results:</bold> A higher eradication rate were observed in VPZ-containing triple therapy. No obvious differences were observed in medication adherence or the incidence of AEs. VPZ had no direct inhibitory effect on <italic>H. pylori</italic>, whereas EPZ directly inhibited <italic>H. pylori</italic> may through downregulated genes related to the ribosome.</p><p><bold>Conclusion:</bold> In the Chinese population, 14-day VPZ-containing triple therapy was safe and more effective and can be used clinically as first-line <italic>H. pylori</italic> treatment.</p><p><bold>Clinical Trial Registration:</bold><ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, identifier NCT05097846</p>