Comparative efficacy of tegoprazan versus esomeprazole/sodium bicarbonate for the treatment of Helicobacter pylori infection

Abstract Introduction: Potassium-competitive acid blockers and proton pump inhibitors/sodium bicarbonate can rapidly increase intragastric pH. Herein, we aimed to compare the clinical outcomes of tegoprazan-based and esomeprazole/sodium bicarbonate-based triple therapies in the treatment of H. pylori infection. Methods: We retrospectively reviewed the data of patients with H. pylori infection treated with a 14-day tegoprazan-based triple therapy or 14-day esomeprazole/sodium bicarbonate-based triple therapy. The primary endpoint was the H. pylori eradication rate with first-line treatment in an intention-to-treat (ITT) analysis. Secondary endpoints included the eradication rate with first-line therapy in the per-protocol (PP) analysis and adverse events associated with eradication therapy. Results: Of the 854 included patients, 435 were treated with tegoprazan-based therapy and 419 received esomeprazole/sodium bicarbonate-based therapy. In the ITT population, no significant difference in eradication rate was detected between the tegoprazan- and esomeprazole/sodium bicarbonate-treated groups (78.6% [95% confidence interval (CI), 74.6–82.3%] vs. 81.4% [95% CI, 77.4–84.9%], P = 0.313). The PP analysis also revealed a similar eradication rate between groups (tegoprazan vs. esomeprazole/sodium bicarbonate: 85.5% [95% CI, 81.8–87.5%] vs. 87.8% [95% CI, 84.1–90.7%], P = 0.339). However, abdominal discomfort and diarrhea were more common in the esomeprazole/sodium bicarbonate group than in the tegoprazan group (abdominal discomfort: 1.1% vs. 3.8%, P = 0.012; diarrhea: 9.9% vs. 21.2%, P < 0.001). Discussion: The efficacy of the esomeprazole/sodium bicarbonate-based triple therapy for H. pylori eradication was comparable with that of the tegoprazan-based triple therapy. However, esomeprazole/sodium bicarbonate-based therapy exhibited a higher risk for abdominal discomfort and diarrhea than tegoprazan-based therapy.