The Efficacy of Potassium Competitive Acid Blocker-based First-line Triple Therapy on Helicobacter pylori Eradication as Compared to Proton Pump Inhibitor-based Treatment: A Systematic Review and Meta-analysis

Abstract

Although randomized controlled trials (RCTs) comparing potassium competitive acid blockers (PCABs) and proton-pump inhibitors (PPIs) have been previously conducted, systematic reviews are lacking. In this systematic review and meta-analysis, we searched the CENTRAL, EMBASE, MEDLINE, KMBASE, and KoreaMed databases for relevant RCTs up to October 3, 2020. We assessed the Helicobacter pylori eradication rate of PCAB-based first-line triple therapy and compared it with that of PPI-based therapy. In all five of the included studies comprising a total of 1542 patients, the intervention used was vonoprazan (VPZ)-based therapy, and there were no studies on tegoprazan (TPZ)-based therapy. The pooled risk ratios (RRs) for the eradication rate of VPZ-based therapy as compared to those of PPI-based therapies was 1.17 (95% confidence interval (CI): 1.10–1.26, P<0.00001 for overall effect, I2=41%, P=0.15 for heterogeneity). The RR of VPZ-based therapy compared to that of PPI-based for clarithromycin (CAM)-resistant strains was 1.29 (95% CI: 1.12– 1.48, P<0.0003 for overall effect, I2=0%, P=0.78 for heterogeneity). VPZ-based first-line triple therapy shows a significant H. pylori eradication rate compared to that of the PPI-based. Notably, VPZ-based therapy shows a better eradication rate than that PPI-based therapy, even in patients with CAM-resistant strains.