Seven-day fexuprazan regimen matched longer rabeprazole therapy in H pylori eradication
A shorter fexuprazan-based triple therapy performed about as well as the longer rabeprazole regimen in treatment-naïve Korean patients with Helicobacter pylori infection. In a randomized single-center trial, the 7-day potassium-competitive acid blocker strategy reached eradication rates in the same range as a 14-day proton pump inhibitor comparator, while tolerability remained similar across both arms.
The comparison matters because eradication therapy has long balanced duration, acid suppression, antibiotic exposure, and the practical burden placed on patients. More potent acid control can improve the gastric environment for antibiotics, particularly amoxicillin and clarithromycin, which work best when intragastric pH is less hostile. Fexuprazan enters that conversation as a newer potassium-competitive acid blocker designed to provide sustained acid suppression, and this study examined whether its pharmacology could support a shorter regimen without losing efficacy.
Trial design and treatment arms
Investigators randomized 79 patients to one of two triple-therapy schedules. The experimental arm received fexuprazan 40 mg for 7 days with amoxicillin 1 g and clarithromycin 500 mg twice daily. The control arm received rabeprazole 20 mg for 14 days with the same antibiotic backbone. Eradication was assessed with the 13C-urea breath test, and safety outcomes were tracked throughout the study.
This was a single-center trial, and the population consisted of Korean patients with untreated infection. The design therefore addresses a focused clinical question rather than a broad multinational one, but it still provides a direct head-to-head comparison of two acid-suppression strategies paired with the same antibiotics. In practice, the question is straightforward: can a shorter course built on a newer acid blocker keep pace with a standard two-week regimen built on a conventional proton pump inhibitor?
Eradication rates stayed close in full and per-protocol analyses
The answer was yes, at least within this study sample. In the full analysis set, eradication occurred in 80.00% of patients in the fexuprazan arm (32 of 40) and 82.05% in the rabeprazole arm (32 of 39). In the per-protocol analysis, the corresponding rates were 83.78% (31 of 37) and 88.89% (32 of 36). The reported P values, P = 1.000 and P = .737, did not show a statistical separation between the regimens.
The numbers sit in a clinically familiar zone. Triple therapy outcomes are heavily influenced by antimicrobial resistance, especially clarithromycin susceptibility, and the overall study results reflect that reality. Even a more potent acid suppressant cannot fully overcome bacterial resistance patterns or the biological constraints of antibiotic exposure. What the trial does show is that a 7-day fexuprazan-based regimen can reach a similar eradication range to a 14-day rabeprazole-based course when the same antibiotics are used.
Among patients with clarithromycin-susceptible strains, eradication rates rose substantially in both groups. In the full analysis set, success reached 93.10% in the fexuprazan arm and 87.09% in the rabeprazole arm. In the per-protocol set, the rates were 96.42% and 93.10%, respectively. Those results fit the expected pharmacologic pattern: once clarithromycin resistance is removed from the equation, stronger and more sustained acid suppression can help antibiotic activity translate into high cure rates.
Safety signals were similar across regimens
Treatment-emergent adverse events were common in both groups, but the rates did not differ meaningfully. Overall adverse events occurred in 70.00% of patients in the fexuprazan group and 66.67% in the rabeprazole group, with no significant difference between arms (P = .812). Both regimens were described as well tolerated.
The adverse-event profile deserves attention because eradication therapy is often limited less by efficacy than by adherence. A shorter course can reduce pill burden, but a more intensive acid-suppressive mechanism does not automatically eliminate the gastrointestinal or medication-related effects that accompany combination therapy. Here, fexuprazan did not introduce an obvious safety penalty, and the overall tolerability profile remained close to the comparator.
Why potassium-competitive acid blockade may matter in eradication therapy
Fexuprazan belongs to a newer class of acid suppressants that block the potassium channel step required for gastric acid secretion. In theory, this produces rapid and sustained pH control, which can improve antibiotic stability and bacterial susceptibility within the stomach. For H. pylori eradication, that mechanism is not just pharmacologic elegance; it may change the treatment burden by allowing shorter therapy while preserving clinical efficacy.
The present trial offers a practical glimpse of that possibility. A 7-day regimen is easier for patients to complete than a 14-day course, especially when combined with twice-daily antibiotics. Shorter therapy also reduces the duration of antimicrobial exposure, which is attractive in any setting where stewardship matters. Still, the trial does not prove that shorter is always better, only that this specific fexuprazan-based combination matched the longer rabeprazole regimen in a narrow treatment-naïve Korean cohort.
Single-center evidence leaves important gaps
The study was limited to 79 randomized patients at one center, and that scale leaves room for uncertainty around generalizability. Resistance patterns, background adherence, and prescribing practices vary across regions, and those factors can move eradication rates in either direction. The trial also compares two acid-suppression strategies using the same antibiotics, so it cannot determine whether fexuprazan would outperform or underperform alternative modern regimens outside this setting.
Even with those constraints, the result is clinically useful. A shorter fexuprazan-based triple therapy delivered eradication efficacy comparable with a longer rabeprazole-based course, with no clear safety tradeoff. For clinicians considering acid suppression as part of H. pylori treatment, the study adds a direct head-to-head dataset showing that a potassium-competitive acid blocker can hold its own against a standard proton pump inhibitor regimen, at least in clarithromycin-containing therapy and in a treatment-naïve Korean population. Further work will need to define whether the same pattern holds in larger, more diverse cohorts and in areas where antimicrobial resistance is more entrenched.