Effectiveness and safety of vonoprazan-based regimens compared with those of proton pump inhibitor (PPI)–based regimens as first-line agents for Helicobacter pylori: a meta-analysis of randomized clinical trials

• Published in: European journal of clinical pharmacology 2023-02, Vol.79 (2), p.279-288
• Main Authors: Sun, Yingchao, Yue, Lei, Hu, Weiling
• Format: Article
• Language: English
• Subjects: Acids; Adverse events; Amoxicillin; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bias; Biomedical and Life Sciences; Biomedicine; Campylobacter; Clarithromycin; Clarithromycin - adverse effects; Clarithromycin - therapeutic use; Clinical outcomes; Clinical trials; Compliance; Drug dosages; Drug resistance; Drug Therapy, Combination; Eradication; Gastroenterology; Gene polymorphism; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Infections; Meta-analysis; Pharmacology; Pharmacology/Toxicology; Proton pump inhibitors; Proton Pump Inhibitors - adverse effects; Proton Pump Inhibitors - therapeutic use; Pyrroles - adverse effects; Pyrroles - therapeutic use; Randomized Controlled Trials as Topic; Statistical analysis; Treatment Outcome
• ISSN: 0031-6970; 1432-1041
• DOI: 10.1007/s00228-022-03430-y

Purpose Vonoprazan (VPZ), a reversible H + –K + ATPase inhibitor, has a relatively fast and sustained acid-suppression action that is unaffected by diet or gene polymorphisms. Several randomized controlled trials have evaluated the difference in the eradication rate of Helicobacter pylori (HP) between VPZ-based and proton pump inhibitor (PPI)–based regimens. The present review aimed to (1) evaluate the efficacy, safety, and compliance of VPZ-based regimens compared with those of PPI-based regimens as first-line treatments for HP infection and (2) perform a subgroup analysis to examine the influence of differences in clarithromycin-resistance status, treatment duration, treatment regimens, and research region on treatment outcomes. Methods We conducted a systematic literature search on PubMed, Embase, Cochrane Library, Web of Science, and ChiCTR Register. Systematic searches, study selection, data extraction, risk of bias assessment, and statistical analysis were performed according to pre-registered protocol on the PROSPERO (CRD42022336608). Results Eight studies and 2956 HP-infected patients were enrolled. Only first-line therapy and RCT study were considered. VPZ-based group had a superior eradication efficacy compared to PPI-based group by intention-to-treat (ITT) (pooled risk ratio (RR): 1.14, 95% CI: 1.08–1.21, p