Real-world effectiveness of vonoprazan-based regimen versus rabeprazole-based dual therapy for Helicobacter pylori eradication in a high-resistance, multi-ethnic region: a multicenter study in Guizhou, China.

INTRODUCTION

While vonoprazan-amoxicillin dual therapy has achieved > 90% eradication rates for Helicobacter pylori (H. pylori) in clinical trials, its effectiveness in "real-world" regions with high primary antibiotic resistance and ethnic diversity remains under-verified. This multicenter study evaluated whether simplified vonoprazan-based regimens can overcome these regional barriers compared to standard rabeprazole-based dual therapy.

METHODS

This retrospective analysis (April 2022-November 2023) included 598 H. pylori-positive outpatients from 10 centers across 8 prefectures of Guizhou. Patients received one of four 14-day therapies: Group A (vonoprazan 20 mg b.i.d. + amoxicillin 1 g t.i.d.), Group B (vonoprazan 20 mg q.d. + amoxicillin 1 g t.i.d.), Group 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.), Group D (rabeprazole 20 mg b.i.d. + amoxicillin 1 g t.i.d.). The primary endpoint was the eradication rate, confirmed by 13C/14C urea breath tests at least 4 weeks post-treatment.

RESULTS

After excluding patients lost to follow-up and those with poor compliance, the eradication rates were 87.2% (Group A), 81.4% (Group B), 82.1% (Group C), and 71.5% (Group D). Group A achieved a significantly higher eradication rate than Group D (p < 0.001), while no other significant between-group differences were observed. However, none of the regimens reached the 90% "optimal" threshold. Notably, the once-daily (q.d.) vonoprazan regimens (Groups B and C) failed to reach the 85% clinical acceptability threshold in this specific geographic cohort. No significant association was observed between treatment success and age, sex, or ethnicity.

CONCLUSION

In the high-resistance environment of Guizhou, vonoprazan-based regimens are significantly more effective than traditional rabeprazole-based dual therapy, yet they face unique regional challenges. The failure of q.d. vonoprazan dosing and the sub-90% success rate of b.i.d. dosing suggest that in regions with extreme resistance and high ethnic diversity, standard global protocols may require further optimization.