USFDA nod to two Vonoprazan therapies for H. pylori infection eradication

Helicobacter pylori is a bacterial pathogen estimated to affect nearly 115 million people in the U.S., and over the last few decades, eradication rates have dropped to below 80%. If left untreated, H. pylori infection can lead to serious complications, such as peptic ulcer disease and non-cardia gastric cancer. Acid suppressant therapy has long been established as a backbone for H. pylori treatment regimens to enhance antibiotic effectiveness. It was hypothesized that a more potent acid suppressant agent such as vonoprazan may help improve eradication rates of current regimens.

"As a practicing physician, I am excited about the potential of two novel first-line H. pylori treatment options," said William D. Chey, M.D., AGAF, FACG, FACP, Professor of Medicine and Chief of Gastroenterology & Hepatology at the University of Michigan. "I believe the added flexibility of having two additional effective therapies, including a dual therapy option that does not contain clarithromycin, offers the potential to improve clinical outcomes in patients with H. pylori infection."

These approvals were based on safety and efficacy data from the Phase 3 PHALCON-HP trial, the largest U.S. registrational trial ever conducted in H. pylori, randomizing 1,046 patients. In the modified intent-to-treat population, both VOQUEZNA treatment regimens demonstrated non-inferiority to lansoprazole triple therapy in patients without a clarithromycin or amoxicillin resistant strain of H. pylori at baseline. The H. pylori eradication rate was 84.7% with VOQUEZNA TRIPLE PAK compared to 78.8% with lansoprazole triple therapy [95% CI: -0.8, 12.6] and 78.5% for VOQUEZNA DUAL PAK compared to 78.8% with lansoprazole triple therapy [95% CI: -7.4, 6.8]. VOQUEZNA TRIPLE PAK and DUAL PAK demonstrated superior eradication rates compared to PPI-based triple therapy (lansoprazole with amoxicillin and clarithromycin) among all patients, including in patients with clarithromycin resistant strains of H. pylori. The H. pylori eradication rate with VOQUEZNA TRIPLE PAK was 80.8% versus 68.5% with lansoprazole triple therapy in the overall study population [95% CI: 5.7, 18.8] and in patients who had a clarithromycin-resistant strain of H. pylori, 65.8% vs. 31.9%, respectively [95% CI: 17.7, 48.1]. H. pylori eradication rates for VOQUEZNA DUAL PAK were 77.2% versus 68.5% with lansoprazole triple therapy in the overall study population [95% CI: 1.9, 15.4] and in patients who had a clarithromycin-resistant strain of H. pylori, 69.6% vs. 31.9%, respectively [95% CI: 20.5, 52.6].

VOQUEZNA TRIPLE and DUAL PAKs are expected to be available in the U.S. in the third quarter of 2022 and marketed exclusively by Phathom Pharmaceuticals, Inc.