A Triple-Drug Blister-Packaged Drug with Vonoprazan Improves First-Line Eradication ofHelicobacter pyloriin Elderly Patients: A Retrospective Propensity Score-Matched Cohort Study

Background:A blister-packaged drug might be useful to enhance the eradication ofHelicobacter pylori. We investigated the effect of a blister-packaged drugfor H. pylorieradication.Methods:We treated 1,758 patients withH. pyloriinfections and evaluated the successful eradication rate in patients who underwent first-line eradication between January 2013 and May 2018. Treatments included a conventional proton pump inhibitor (PPI) blister-packaged drug containing lansoprazole or rabeprazole with clarithromycin (CAM) and amoxicillin (AC), vonoprazan (VPZ) with CAM and AC in a separate tablet, or a VPZ blister-packaged drug (VONOSAP) containing VPZ with CAM and AC, with all drugs given twice daily for 7 days.Results:Finally, we evaluated 1,263 patients (conventional PPI:n= 644, VPZ:n= 326, and VONOSAP:n= 293). The overall successful eradication rates were 71.9% in the conventional PPI group, 90.2% in the VPZ group, and 92.2% in the VONOSAP group. There was a significantly lower eradication rate in the PPI group than in the VPZ and VONOSAP (p< 0.00001,p< 0.0001) groups, but there was no significant difference between the VPZ and VONOSAP groups (p= 0.4006). We enrolled a total of 256 age- and gender-matched patients in the VPZ and VONOSAP groups, and both groups had successful eradication rates of approximately 90% (89.8 vs. 90.4%, respectively,p= 0.7641). After analyzing the subgroup of patients older than 75 years, there was a significant treatment benefit of VONOSAP but not of VPZ in elderly patients (EPs).Conclusion:Triple-drug blister-packaged drugs including VPZ may improve the first-line eradication ofH. pyloriin EPs.