Vonoprazan-based therapies versus PPI-based therapies in patients with H. pylori infection: Systematic review and meta-analyses of randomized controlled trials

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Helicobacter Pub Date : 2024-05-24 DOI:10.1111/hel.13094

Ligang Liu, Hekai Shi, Yufei Shi, Anlin Wang, Nuojin Guo, Fang Li, Milap C. Nahata

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Abstract

Background

This study aims to evaluate the efficacy and safety of vonoprazan-amoxicillin (VA), vonoprazan-amoxicillin-clarithromycin (VAC), vonoprazan-based bismuth-containing quadruple therapy (VBQT), and PPI-based triple (PAC) or quadruple therapy (PBQT) for H. pylori infection with the consideration of duration of therapy and amoxicillin dose (H: high; L: low).

Materials and Methods

PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for eligible randomized controlled trials (RCTs) up to December 15, 2023. The efficacy outcome was eradication rate, and safety outcomes included the rates of adverse events and treatment discontinuation.

Results

Twenty-seven RCTs were included. The pooled eradication rates were 82.8% for VA, 89.1% for VAC, and 91.8% for VBQT, which increased with the higher amoxicillin frequency of administration and extended duration of therapy within each regimen. There were no significant differences in eradication rate when comparing 7-VA versus 7-VAC and 14-VA versus 14-VAC. VA was at least comparable to PAC. The eradication rate did not differ significantly between 10-H-VA or 14-H-VA versus 14-PBQT. 7-L-VAC demonstrated higher eradication rate versus 7-PAC and comparable rate to 14-PAC. 14-VBQT showed higher eradication rates versus 14-PBQT. The adverse events rate was 19.3% for VA, 30.6% for VAC, and 38.4% for VBQT. VA had similar risk of adverse events versus VAC and significantly fewer adverse events compared to PBQT. The treatment discontinuation rate did not differ significantly between treatments.

Conclusions

The eradication rate of VBQT was the highest at above 90% followed by VAC and VA. VA was as effective as VAC and superior to PPI-based therapies with favorable safety, highlighting the potential of VA therapy as a promising alternative to traditional PPI-based therapies. VPZ-based triple or quadruple therapies was more effective than PPI-based therapies. Further studies are needed to establish the optimal treatment regimen especially in the western countries.

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幽门螺杆菌感染患者中基于沃诺普拉赞的疗法与基于 PPI 的疗法：随机对照试验的系统回顾和荟萃分析。

研究背景本研究旨在评估冯诺普拉唑-阿莫西林（VA）、冯诺普拉唑-阿莫西林-卡里霉素（VAC）、基于冯诺普拉唑的含铋四联疗法（VBQT）以及基于PPI的三联疗法（PAC）或四联疗法（PBQT）治疗幽门螺杆菌感染的疗效和安全性，同时考虑疗程和阿莫西林剂量（H：高；L：低）：检索了 PubMed、Embase 和 Cochrane 对照试验中央注册中心截至 2023 年 12 月 15 日的符合条件的随机对照试验 (RCT)。疗效结果为根除率，安全性结果包括不良事件发生率和治疗中止率：结果：共纳入 27 项随机对照试验。VA、VAC和VBQT的总根除率分别为82.8%、89.1%和91.8%。7-VA 与 7-VAC 和 14-VA 与 14-VAC 相比，根除率没有明显差异。VA 至少与 PAC 相当。10-H-VA 或 14-H-VA 与 14-PBQT 的根除率没有明显差异。7-L-VAC的根除率高于7-PAC，与14-PAC相当。14-VBQT 的根除率高于 14-PBQT。VA的不良事件发生率为19.3%，VAC为30.6%，VBQT为38.4%。与 VAC 相比，VA 的不良事件风险相似，而与 PBQT 相比，VA 的不良事件风险要低得多。不同治疗方法的治疗中断率没有明显差异：结论：VBQT的根除率最高，超过90%，其次是VAC和VA。VA的疗效与VAC相当，优于基于PPI的疗法，且安全性良好，这凸显了VA疗法作为传统PPI疗法替代品的潜力。基于 VPZ 的三联或四联疗法比基于 PPI 的疗法更有效。需要进一步研究以确定最佳治疗方案，尤其是在西方国家。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Helicobacter 医学-微生物学

CiteScore

8.40

自引率

9.10%

发文量

审稿时长

2 months

期刊介绍： Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.