The Multicenter Real-World Report of the Efficacies of 14-Day Esomeprazole-Based and Rabeprazole-Based High-Dose Dual Therapy in First-Line Helicobacter pylori Eradication in Taiwan

Background High-dose dual therapy (HDDT) using proton-pump inhibitors (PPI) and amoxicillin attracted attention for its simplicity and lower adverse event profile. Besides, vonoprazan is not available worldwide. This real-world study aims to compare the efficacy of esomeprazole-based and rabeprazole-based HDDT regimens and to identify clinical factors influencing outcomes. Methods A retrospective study enrolled 346 H. pylori-infected naïve patients from January 2016 to August 2023. Patients were assigned to either a 14-day esomeprazole-based HDDT (EA-14; esomeprazole 40 mg t.i.d. and amoxicillin 750 mg q.i.d. for 14 days, n=173) or a 14-day rabeprazole-based HDDT (RA-14; rabeprazole 20 mg and amoxicillin 750 mg q.i.d. for 14 days, n=173). Results Five patients from the EA-14 group and 10 from the RA-14 group were lost to follow-up, resulting in 168 and 163 patients for the per-protocol (PP) analysis, respectively. Eradication rates for the EA-14 and RA-14 groups were 90.2% and 80.9% (P=0.014) in intention-to-treat (ITT) analysis; and 92.9% and 85.9% (P=0.039) in PP analysis. Adverse event rates were similar between the two groups (11.9% vs 11.7%, P=0.944). In multiple logistic regression analysis, age≧60 was associated with eradication failure (P=0.046) and a trend of significance for smoking (P=0.060) in the EA-14 group but not in the RA-14 group. A trend of significance was also observed for eradication regimens (EA-14 vs RA-14) (P=0.071).The antibiotic resistance rates were amoxicillin (2.3%), clarithromycin (14.7%), metronidazole (40.3%), and dual resistance to clarithromycin and metronidazole (7.0%). Conclusions Esomeprazole-based HDDT achieved over 90% eradication rates but rabeprazole-based HDDT, which failed.