Dual Therapy Recommended Over Triple Therapy to Eradicate H pylori Infection

Dual therapy with vonoprazan and amoxicillin can increase the cure rate of H pylori infection.

Dual therapy achieved higher actual cure rates with less adverse treatment reactions compared with triple therapy in patients with Helicobacter pylori (H pylori) infection, according to study findings published in Therapeutic Advances in Gastroenterology.

Researchers conducted a systematic review and meta-analysis of literature published in PubMed, Embase, Elsevier/Science Library, and Cochrane Library databases from 2015 to 2022. The meta-analysis included 7 eligible studies with a total of 1490 patients.

Researchers compared the efficacy and safety of vonoprazan plus amoxicillin dual therapy vs vonoprazan plus amoxicillin plus clarithromycin triple therapy in the eradication of H pylori infection.

Following an intention-to-treat analysis, the dual therapy combination demonstrated an 82.8% cure rate, whereas the triple therapy combination demonstrated an 84.6% cure rate (odds ratio [OR], 0.86; 95% CI, 0.64-1.14; P =.29). Following a per-protocol analysis, actual cure rates for the dual and triple therapy combinations totaled 84.8% and 87%, respectively (OR, 0.80; 95% CI, 0.57-1.13; P =.21).

Overall, we suggest a combination of VPZ [vonoprazan] and low-dose AMO [amoxicillin] as a prioritized strategy for H. pylori eradication.

Patients with clarithromycin-resistant infections demonstrated higher cure rates in the dual therapy group compared with the triple therapy group (85.7% vs 71%; OR, 2.36; 95% CI, 1.10-5.05; P =.03).

Additionally, regardless of treatment combinations, the actual cure rate was higher among patients taking low-dose antibiotics with vonoprazan compared with those taking high-dose antibiotics with vonoprazan (dual therapy group: P =.000; triple therapy group: P =.011). The researchers defined low-dose administration as 200 mg of clarithromycin and 1500 mg of amoxicillin, while they considered 500 mg of clarithromycin and 3000 mg of amoxicillin as high-dose.

Patients in the triple therapy group experienced significantly more adverse treatment reactions than those in the dual therapy group (29.6% vs 26.1%; OR, 0.78; 95% CI, 0.61-0.99; P =.04).

“Overall, we suggest a combination of [vonoprazan] and low-dose [amoxicillin] as a prioritized strategy for H. pylori eradication,” the study authors concluded.

Limitations include the retrospective design of the study as well as actual cure rates never exceeding 90%, which may decrease promotion of dual therapy in Western countries.


Wang Z, Wang F. Efficacy and safety comparison of Helicobacter pylori eradication between vonoprazan dual therapy versus triple therapy: a systematic review and meta-analysis. Therap Adv Gastroenterol. Published online October 13, 2022. doi:10.1177/17562848221125308