Vonoprazan and proton pump inhibitors: Which is superior for Helicobacter pylori eradication?

Table 1 Summary of selected studies comparing vonoprazan and proton pump inhibitors in Helicobacter pylori eradication

Ref.	No. patients	Country of study	VPZ regimen	PPI regimen	Eradication rate (ITT%)		Eradication rate (PP%)		Notes
					VPZ	PPI	VPZ	PPI
Miao et al[26], 2023	44	China	VPZ 20 mg + bismuth 220 mg + CLR 500 mg + AMO 1000 mg BID for 14 days	ESO 20 mg + bismuth 220 mg + CLR 500 mg + AMO 1000 mg BID for 14 days	20/22 (90)	17/22 (77)	20/20 (100)	17/18 (94.4)	-
Chen et al[27], 2024	300	China	Berberine 500 mg + AMO 1000 mg + VPZ 20 mg BID for 14 days, VPZ 20 mg + AMO 1000 mg + CLR 500 mg + colloidal bismuth tartrate 220 mg BID for 14 days	RAB 10 mg + AMO 1000 mg + CLR 500 mg + colloidal bismuth tartrate 220 mg BID for 14 days	77/100 (77)	69/100 (69)	77/89 (86.5)	69/88 (78)	-
Bunchorntavakul and Buranathawornsom[28], 2021	122	Thailand	VPZ 20 mg + AMO 1000 mg + CLR 500 mg BID for 7 days	OME 20 mg + AMO 1000 mg + CLR 500 mg BID for 14 days	59/61 (96)	54/61 (88)	59/60 (98.3)	54/58 (93.1)	-
Ang et al[29], 2022	244	Singapore	AMO 1000 mg + CLR 500 mg + VPZ 20 mg BID for 7 days	AMO 1000 mg + CLR 500 mg + OME or ESO or RAB 20 mg BID for 14 days	104/119 (87)	110/125 (88)	104/108 (96)	110/117 (94)	-
Chey et al[21], 2022	1046	United States and Europe	VPZ 20 mg BID + AMO 1000 mg TID for 14 days VPZ 20 mg + AMO 1000 mg + CLR 500 mg BID for 14 days	LAN 30 mg + AMO 1000 mg + CLR 500 mg BID for 14 days	262/222 (84.7)	201/255 (78.8)	198/219 (90)	174/212 (82)	-
Sue et al[30], 2018	147	Japan	VPZ 20 mg + AMO 750 mg + CLR 200 or 400 mg BID for 7 days	LAN 30 mg, RAB 10 mg, or ESO 20 mg BID + AMO 750 mg BID + CLR 200 or 400 mg BID for 7 days	48/55 (87.2)	39/51 (76.4)	48/54 (88.8)	39/45 (86.6)	-
Murakami et al[19], 2016	650	Japan	VPZ 20 mg + AMO 750 mg + CLR 200 or 400 mg BID for 7 days	LAN 30 mg + AMO 750 mg + CLR 200 or 400 mg BID for 7 days	300/329 (91)	242/321 (75)	300/324 (92)	242/320 (75)	Total adverse events (VPZ/PPIs) 34%/41.1%
Maruyama et al[31], 2017	141	Japan	VPZ 20 mg + AMO 750 mg + CLR 200 or 400 mg BID for 7 days	RAB 20 mg or LAN 30 mg + AMO 750 mg + CLR 200 or 400 mg BID for 7 days	68/72 (94)	48/69 (69)	68/70 (97)	48/63 (76)	Total adverse events (VPZ/PPIs) 26.4%/37.7%
Lu et al[32], 2023	234	China	VPZ 20 mg daily + AMO 1000 mg + furazolidone 100 mg + colloidal bismuth 200 mg each BID for 10 days VPZ 20 mg daily + AMO 1000 mg + furazolidone 100 mg + colloidal bismuth 200 mg each BID for 14 days	ESO 20 mg + AMO 1000 mg + furazolidone 100 mg + colloidal bismuth 200 mg BID for 14 days	149/156 (95.5)	73/78 (93.5)	149/151 (98.67)	73/74 (98.64)	-
Huh et al[33], 2022	30	Korea	VPZ 20 mg + bismuth 220 mg + CLR 500 mg + AMO 1000 mg BID for 14 days	LAN 30 mg + bismuth 220 mg + CLR 500 mg + AMO 1000 mg BID for 14 days	12/15 (80)	14/15 (93)	12/12 (100)	14/14 (100)	-
Huang et al[34], 2023	120	China	VPZ 20 mg + AMO 1000 mg BID + bismuth potassium 0.6 g BID for 14 days VPZ 20 mg + AMO 1000 mg + furazolidone 100 mg + bismuth potassium citrate 0.6 g BID for 14 days	ESO 20 mg + AMO 1000 mg + furazolidone 100 mg + bismuth potassium 0.6 g BID for 14 days	39/40 (97)	32/40 (80)	39/40 (97.5)	32/40 (80)	-
Hou et al[35], 2022	533	China mainland, South Korea, and Taiwan	VPZ 20 mg + AMO 1000 mg + CLR 500 mg + bismuth 600 mg for 14 days, then VPZ 20 mg QD for 14 days	LAN 30 mg BID, AMO 1000 mg BID, CLA 500 mg BID, bismuth 600 mg BID for 14 days, then LAN 30 mg QD for 14 days	-	-	193/211 (91)	177/204 (86.7)	-
Hojo et al[36], 2020			7 days VPZ 20 mg bid AMO 750 mg bid MTZ 250 mg bid	7 days RAB 10 mg bid AMO 750 mg bid MTZ 250 mg bid	17/23 (73.9)	19/23 (82.6)	17/19 (89.5)	19/22 (86.4)	Total adverse events (VPZ/PPIs) 47.8%/40%

VPZ: Vonoprazan; PPI: Proton pump inhibitor; ITT: Intention to treat; PP: Per protocol; AMO: Amoxicillin; BID: Twice daily; CLR: Clarithromycin; ESO: Esomeprazole; LAN: Lansoprazole; OME: Omeprazole; QD: Once daily; RAB: Rabeprazole; TID: Three times daily; MTZ: Metronidazole.