Vonoprazan Versus Tegoprazan–Amoxicillin Dual Therapy for Treatment‐Naïve Patients With Helicobacter pylori Infection: A Prospective, Multicenter, Open‐Label, Randomized Controlled Study

BACKGROUND: High-dose dual therapy (HDDT) has been shown to achieve eradication rates non-inferior to the bismuth quadruple therapy (BQT) in treatment-naïve patients of Helicobacter pylori (H. pylori) infection, with advantages including greater convenience and fewer adverse events. However, the efficacy of different potassium-competitive acid blockers (P-CABs) in HDDT regimens remains incompletely defined due to variations in their pharmacokinetic properties. Therefore, this study aims to evaluate the eradication rates, incidence of adverse events, and compliance of the dual regimens of vonoprazan/tegoprazan combined with amoxicillin in patients with treatment-naïve H. pylori infection. METHOD: This prospective, multicenter, open-label, randomized controlled clinical trial enrolled newly diagnosed patients with H. pylori infection from six centers in China. All subjects were randomly assigned to the VA group (vonoprazan 20 mg bid+amoxicillin 1 g tid, 14 days) or the TA group (tegoprazan 50 mg bid+amoxicillin 1 g tid, 14 days). The basic information and clinical data of the patients were collected via electronic questionnaires, WeChat, or telephone follow-ups. H. pylori eradication was assessed 4 weeks post-treatment using the urea breath test (UBT). The adverse events and compliance were meticulously recorded throughout the treatment period. RESULT: Between June 2024 and May 2025, 710 patients were randomly assigned, and 653 subjects were included. In the intention-to-treat (ITT) analysis, the eradication rates were 89.3% in the VA group and 76.1% in the TA group, respectively (p < 0.001). The modified intention-to-treat (mITT) analysis showed rates of 94.6% and 80.8%, respectively (p < 0.001), and the per-protocol (PP) analysis yielded 95.1% and 81.0%, respectively (p < 0.001). Although the overall incidence of adverse event rates was comparable between groups (17.2% vs. 13.8%, p = 0.254), gastrointestinal adverse events were less frequent with TA therapy (9.3% vs. 14.4%, p = 0.048). Compliance was excellent and comparable in both groups (94.6% vs. 94.1%, respectively, p = 0.871). None of the factors analyzed significantly influenced eradication rates. CONCLUSION: Vonoprazan/amoxicillin dual therapy achieved satisfactory H. pylori eradication rates with a favorable safety profile in treatment-naïve patients. Tegoprazan/amoxicillin dual therapy was associated with fewer gastrointestinal adverse event incidences, while optimizing tegoprazan dosing frequency may be necessary to improve the eradication. TRIAL REGISTRATION: Chictr.org.cn ChiCTR2400082371.