Vonoprazan-based dual therapy with amoxicillin or doxycycline versus bismuth-containing quadruple therapy for

Background: Bismuth-containing quadruple therapy, the standard Methods: A total of 579 Results: In the intention-to-treat (ITT), modified intention-to-treat (mITT), and per-protocol (PP) analyses, the VA regimen demonstrated non-inferiority to the VBQ regimen. The VD regimen did not meet the non-inferiority criterion in the ITT analysis (79.3% vs. 83.4%, P = 0.070 for non-inferiority), but it demonstrated non-inferiority to the VBQ regimen in both the mITT (87.4% vs. 90.4%, P = 0.018) and PP (87.7% vs. 90.1%, P = 0.012) analyses. The overall incidence of adverse events was not significantly different between the VBQ and VA groups (P = 0.313), but it was significantly lower in the VD group compared to the VBQ group (P = 0.002). No statistically significant differences in medication adherence were observed between the VBQ group and either the VA (P = 0.381) or VD (P = 0.269) group. Conclusion: Vonoprazan-low-dose amoxicillin dual therapy is a safe and simple alternative to bismuth containing quadruple therapy. Vonoprazan-doxycycline dual therapy demonstrates acceptable efficacy and may be considered for patients allergic to amoxicillin. Both align with antimicrobial stewardship principles of regimen simplification.