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Background: Vonoprazan‐containing Helicobacter pylori eradication is reliably effective in Japan. Its effectiveness in other countries remains unclear. Here, we examined vonoprazan‐H. pylori therapies in Thailand. Materials and Methods: This was pilot study of four different vonoprazan containing therapies. Subjects were randomized to: 14‐day dual therapy (500 mg amoxicillin q.i.d. plus 20 mg vonoprazan b.i.d.), 14‐day triple therapy (amoxicillin 1 g b.i.d., slow release clarithromycin‐MR, 1 g daily plus vonoprazan 20 mg b.i.d.), 7‐day high‐dose vonoprazan triple therapy (amoxicillin 1 g b.i.d., clarithromycin‐MR 1 g daily and 60 mg vonoprazan once daily), and 14‐day vonoprazan triple therapy plus bismuth (amoxicillin 1 g b.i.d., clarithromycin‐MR 1 g daily, vonoprazan 20 mg b.i.d., and bismuth subsalicylate 1048 mg b.i.d.). Eradication was confirmed 4 weeks after therapy. Antimicrobial susceptibility and CYP3A4/5 genotyping were performed. Results: One hundred H. pylori‐infected patients (mean age 54.3 ± 13 years, 51% men) were randomized. All were CYP3A4 extensive metabolizers. Cure rates with both 14‐day vonoprazan dual therapy and 14‐day triple therapy were low: 66.7%; 95% CI = 43–85% (14/21), and 59.3%; 95% CI = 39–78%) (16/27), respectively. In contrast, 7‐day high‐dose vonoprazan triple therapy and 14‐day vonoprazan triple plus bismuth proved effective 92.3%; 95% CI = 75%–99% (24/26) and 96.2%; 95% CI = 80%–100% (25/26), respectively. Conclusion: Both 14‐day vonoprazan dual and triple therapy were ineffective for H. pylori eradication in Thailand. Higher dosage of vonoprazan, and/or the addition of bismuth may be required to achieve high H. pylori eradication rates. High‐dose vonoprazan triple therapy and vonoprazan triple therapy adding bismuth might be used as first‐line treatments in some regions with high efficacy irrespective of CYP3A4/5 genotype and clarithromycin resistance. [ABSTRACT FROM AUTHOR]

Objective: Helicobacter pylori (H. pylori) infection is one of the leading causes of gastrointestinal diseases such as dyspepsia, peptic ulcers. Thailand has a 45.9% prevalence of the infection and an increasing rate of resistance to clarithromycin, leading to standard treatments being less successful. Vonoprazan represents a novel drug offering a new treatment regimen. Although vonoprazan has been available in Thailand since 2019, its cost-effectiveness has not been studied previously. Materials and Methods: This study analysed the cost-effectiveness of vonoprazan-based triple therapy compared with PPI-based therapy, in treating clarithromycin resistant H. pylori, by using the markov model from a societal perspective. Results: The total cost of vonoprazan-based triple therapy, levofloxacin-PPI based triple therapy and concomitant- PPI therapy were 784,932.08 baht, 783,863.65 baht and 783,874.55 baht respectively. The quality-adjusted life years (QALYs) of vonoprazan-based triple therapy, levofloxacin-PPI based triple therapy and concomitant-PPI therapy were 25.1118 years, 25.1147 years and 25.1054 years respectively. The cost-effectiveness ratio (CER) of vonoprazanbased triple therapy, levofloxacin-PPI based triple therapy and concomitant-PPI therapy were 31,257.50 baht/QALYs, 31,211.35 baht/QALYs and 31,223.34 baht per QALYs respectively. Conclusion: Therefore, levofloxacin-PPI based triple therapy was found to be the most cost-effective regimen and the dominant strategy compared with concomitant-PPI or vonoprazan-based triple therapy. It provided higher QALYs and lower treatment costs. Levofloxacin-PPI based triple therapy should be the first choice of an alternative strategy in treating clarithromycin-resistant H. pylori. The results of this study can be used by policymakers to help inform their decisions. [ABSTRACT FROM AUTHOR]