From clinical efficacy to population health: Implementing vonoprazan-amoxicillin dual therapy for Helicobacter pylori control

Abstract

Helicobacter pylori (H. pylori) infection remains a significant global health challenge, necessitating effective, simple, and scalable eradication strategies. This editorial evaluates vonoprazan-amoxicillin (VPZ-AMO) dual therapy from clinical, public health, and health-economic perspectives, based on evidence from a recent large-scale, multi-center randomized controlled trial. The trial demonstrated that a 14-day VPZ-AMO dual regimen, particularly with amoxicillin administered at 0.5 g four times daily, achieves excellent eradication rates, outstanding safety, and high compliance. Given this compelling clinical profile, the regimen transcends a mere therapeutic option and emerges as a potential public health tool. Its advantages include significant cost-effectiveness compared to bismuth-containing quadruple therapy, high adherence due to dosing simplicity, and minimal transient impact on the gut microbiota. These features position it as a cornerstone candidate for large-scale screening and eradication programs aimed at reducing the burden of gastric cancer. Successful population-level implementation, however, requires addressing key challenges such as strengthening antimicrobial resistance surveillance, ensuring equitable access, and building healthcare system capacity. With scientifically grounded and proactively executed strategies, VPZ-AMO dual therapy holds substantial promise as a potential key intervention against H. pylori in high-prevalence regions over the coming decade.

Keywords: Helicobacter pylori; Vonoprazan; Amoxicillin; Dual therapy; Eradication treatment; Public health; Pharmacoeconomics; Antibiotic resistance

Core Tip: This editorial highlights vonoprazan-amoxicillin dual therapy, particularly the 0.5 g four-times-daily regimen, as a highly effective, safe, and well-tolerated strategy for Helicobacter pylori eradication, based on a recent large-scale regional trial. Its exceptional cost-effectiveness, high patient compliance, and dosing simplicity position it as a transformative candidate for large-scale public health interventions that aimed at reducing the burden of Helicobacter pylori-associated diseases, including gastric cancer. Successful implementation, however, necessitates addressing challenges such as antimicrobial resistance surveillance and ensuring equitable access to healthcare systems.