Company: PHAT
Filing Date: 2025-03-06
Form Type: 10-K
Source: 0000950170-25-034183
Chunk: 29

Company: Phathom Pharmaceuticals, Inc.
Filing Date: 2025-03-06
Form: 10-K
Item: Item 1
Chunk 29
---
 healthcare resource utilization were significantly lower for patients treated with vonoprazan-based triple therapy compared to a PPI-based triple therapy.  

Given the clinical and post-marketing experience in the Japanese market, we believe that vonoprazan-based treatment regimens have the potential not only to restore eradication rates to their 1990s rates in the United States and Europe but also to significantly reduce H. pylori-related healthcare costs and healthcare resource utilization. 

Current Treatment Paradigm in the United States and Europe 

The ACG recently updated its clinical practice guideline to inform the evidence-based management of patients with H. pylori infection in North America. ACG noted that substantial changes were made to these updated guidelines based on increasing rates of resistance to key antibiotics used to treat H. pylori and new research on novel antibiotics and potassium-competitive acid blockers, or PCABs. As such the use of PCABs have been incorporated into these guidelines. In treatment naive patients, dual therapy with a PCAB and amoxicillin is suggested (moderate quality evidence) for empiric, first-line treatment. In patients with unknown clarithromycin susceptibility, PCAB-clarithromycin triple therapy is suggested over PPI-clarithromycin triple therapy (moderate quality evidence). Although PCAB based therapy is not specifically mentioned as a recommendation for treatment- experienced patients with H. pylori infection, the guidelines emphasize that it can be considered in certain patients with persistent H. pylori infection. Dual PCAB therapy may be considered in patients with no penicillin allergy and with unknown antibiotic susceptibility when optimized bismuth quadruple therapy or rifabutin triple therapy is not an option or in patients with known clarithromycin or levofloxacin resistance. Triple PCAB therapy may be considered in patients with confirmed clarithromycin sensitivity. 

The use of anti-secretory agents enhances the effect of antibiotics in two ways. First, anti-secretory agents increase gastric pH, which in turn increases the stability of the antibiotics. For example, amoxicillin and clarithromycin are chemically unstable at the low pH typically found in the human stomach. Second, several antibiotics, including amoxicillin and clarithromycin, are most potent against H. pylori at the time of maximum bacterial replication, which occurs at pH 6.0 to 8.0. H. pylori is in a dormant state at lower pH values, which reduces the effectiveness of the antibiotics. 

The table below shows the minimum inhib