Thus, therapy with vonoprazan was effective even for smoking patients; this was most likely because of strong acid suppression

Thus, therapy with vonoprazan was effective even for smoking patients; this was most likely because of strong acid suppression. (95%CI: 52.0%-72.9%), and 57.3% (95%CI: 50.4%-64.1%), respectively. The vonoprazan eradication rate was significantly higher than that of the PPIs ( 0.01). Interestingly, smoking did not impact the eradication rate in the vonoprazan group (= 0.34), whereas it decreased the rates in the PPI groups (= 0.013). The incidence of adverse events in the vonoprazan group was not different from the PPI group (= 0.054), even though vonoprazan group exhibited a wider range of adverse events. Vonoprazan-based triple therapy was highly effective as a second-line treatment, with an eradication rate similar to that of PPI-based therapy. CONCLUSION Vonoprazan might be superior to PPIs in first-line therapy, particularly for smokers. However, caution is required due to possible adverse events. ((eradication therapy has been shown to be effective for treatment of eradication therapy was expanded to include patients with infection-associated gastritis to prevent gastric cancer. However, the eradication rate with the first-line treatment has reportedly decreased due to the increase of CAM-resistant strains in recent years[5-7]. Therefore, a more effective strategy is required for CAM-resistant patients. Vonoprazan is UNC2881 usually a novel potassium-competitive acid blocker (P-CAB) and to a new class of gastric acid-suppressive brokers[8]. P-CABs, which block H+, K+ ATPase in a competitive and reversible manner, result in stronger and more sustained acid suppression than PPIs[9]. Alteration of the intragastric pH, to a higher pH with a lower percentage of time spent pH 4, is crucial in eradication therapy[10]. Therefore, P-CAB-based triple therapy should be more efficient than PPI-based therapy for eradication therapy compared to treatment with lansoprazol[11]. In this study, we evaluated the clinical effectiveness and security of vonoprazan-based eradication therapy and compared it to that of standard PPI-based therapy in clinical practice. MATERIALS AND METHODS Patients and study design This study was conducted in a single institution (Hattori Medical center). We retrospectively examined data from patients administered first- and/or second-line eradication therapy. at admission and after first- UNC2881 and second-line eradication therapy was confirmed with the 13C-urea breath test (UBT). The cut-off value was 2.5. Confirmation of eradication by UBT was performed no less than 8 wk after eradication treatment was completed. UBT-negative patients whose endoscopic findings showed gastric atrophy received an additional stool antigen UNC2881 test. Fishers exact test and the 2 2 test. Factors associated with treatment failure were assessed by logistic regression analysis. values 0.05 were considered to be statistically significant. RESULTS Patient characteristics In total, 1353 patients completed UNC2881 the first-line treatment protocol. The baseline characteristics and demographics of patients in this study were offered in Table ?Table1.1. Most patients (= 1169) were diagnosed with = 65), DU/DUs (= 105), GDU/GDUs (= 8), MALT lymphoma (= 2), and post ESD for early gastric malignancy (= 4). The patients were treated with VPZ (= 546), EPZ (= 507), RPZ (= 89), or LPZ (= 211). Demographic and other baseline characteristics for all the patients receiving the four regimens were not significantly different with TM4SF18 regard to age, sex, and upper gastrointestinal diseases. In total, 261 patients completed the second-line UNC2881 treatment protocol. Demographic and other baseline characteristics in the second-line treatment were also shown in Table ?Table11 and there were not significant differences in all of them. Table 1 Baseline and demographic characteristics of patients in this study = 546= 807= 507= 89= 211= 76= 185= 104= 24= 57(%)Male225 (41.2)318 (39.4)193 (38.1)35 (39.3)90 (42.7)30 (39.5)71 (38.4)39 (37.5)9 (39.3)23 (40.4)Female321 (58.8)489 (60.6)314 (61.9)54 (60.7)121 (57.3)46 (60.5)114 (61.6)65 (62.5)15 (60.7)34 (59.6)IndicationGU(s)32331841137601DU(s)376836824513526GDU(s)4421110000MALT lymphoma0200201001Post ESD1320110000Atrophic gastritis4726974497617266164932249 Open in a separate windows GU/GUs: Gastric ulcer and/or ulcer scar; DU/DUs: Duodenal ulcer and/or ulcer scar; GDU/GDUs: Gastroduodenal ulcer and/or ulcer scar; MALT: Mucosa-associated lymphoid tissue; ESD: Endoscopic submucosal dissection; VPZ: Vonoprazan; PPI: Proton pump inhibitor; EPZ: Esomeprazole; RPZ: Rabeprazole; LPZ: Lansoprazole. Eradication rates FAS analysis indicated that this first-line treatment eradication rate was 87.9% (95%CI: 84.9%-90.5%) in the VPZ group, 71.6% (95%CI: 67.5%-75.5%) in the EPZ group, 62.9% (95%CI: 52.0%-72.9%) in the RPZ group, and 57.3% (95%CI: 50.4%-64.1%) in the LPZ group (Physique ?(Figure1).1). The eradication rate achieved in the VPZ group was significantly higher than that in the other three groups ( Table ?Table22). Open in a separate window Physique 1 eradication rates (full analysis set) for vonoprazan, esomeprazole, rabeprazole, and lansoprazole in first-line triple therapy. The eradication rate was significantly higher in the VPZ group than that in the EPZ, RPZ, and LPZ groups (a 0.05); c 0.05 lansoprazole. VPZ 20: 20 mg VPZ, 200 mg CAM, and 750 mg AMPC twice a day for 1 wk. EPZ 20: 20 mg EPZ, 200 mg CAM, and 750 mg AMPC twice a day for 1 wk. RPZ 10: 10 mg RPZ, 200 mg CAM, and 750 mg AMPC twice a day for 1 wk. LPZ 30: 30 mg LPZ,.