Belén Martínez Benito, Olga P. Nyssen, Javier P. Gisbert
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Heterogeneity was evaluated by subgrouping.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Seventy-seven studies (24 randomized clinical trials) evaluated 44,162 patients (22,297 receiving VPZ and 21,865 PPIs). Overall VPZ efficacy was 88% (95% CI = 87%–90%): 86%, 88%, and 94% for dual/triple/quadruple-VPZ-containing therapies. VPZ efficacy was 87% (86%–89%) in first-line and 90% (87%–93%) in rescue therapy. VPZ performed better than PPIs in treatment-naïve patients (87% vs. 70%; RD = 0.13, 95% CI = 0.11–0.15) and when using triple regimens. No significant differences were observed in rescue and quadruple therapies. In patients with clarithromycin-resistant infection, VPZ-based therapies demonstrated an 81% efficacy (76%–85%), surpassing PPIs (76% vs. 40%; RD = 0.33, 95% CI = 0.24–0.43). For clarithromycin-susceptible strains, VPZ efficacy was 92% (89%–95%), similar to PPIs. VPZ adverse events rate was 19% (16%–21%), comparable to PPI-based regimens (18% vs. 13%, respectively; RD = 0.00, 95% CI = −0.01 to 0.02, <i>p</i> = 0.57).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The efficacy of VPZ-based regimens was over 85% in all treatment combinations. In treatment-naïve and clarithromycin-resistant patients, VPZ performed better than PPIs. In rescue therapy, in clarithromycin-susceptible patients or when quadruple regimens were prescribed, this advantage was not confirmed. 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引用次数: 0
摘要
背景：幽门螺杆菌（H. pylori）根除疗法包括一种或多种抗生素和一种质子泵抑制剂（PPI），其疗效近来有所下降。与 PPIs 相比，钾竞争性胃酸阻滞剂 Vonoprazan（VPZ）能提供更强的胃酸抑制作用。我们进行了一项荟萃分析，评估了 VPZ 在根除幽门螺杆菌疗法中的有效性和安全性：我们在 PubMed、Embase 和 Cochrane 图书馆中检索了截至 2023 年 6 月的研究。通过意向治疗分析评估疗效。通过荟萃分析风险差异（RD）合并数据。通过分组对异质性进行评估：77项研究（24项随机临床试验）评估了44,162名患者（22,297人接受VPZ治疗，21,865人接受PPIs治疗）。VPZ的总体疗效为88%（95% CI = 87%-90%）：含 VPZ 的双重/三重/四重疗法的疗效分别为 86%、88% 和 94%。VPZ在一线治疗中的有效率为87%（86%-89%），在抢救治疗中的有效率为90%（87%-93%）。VPZ 在治疗新患者（87% 对 70%；RD = 0.13，95% CI = 0.11-0.15）和使用三联疗法时的疗效优于 PPIs。在抢救疗法和四联疗法中未观察到明显差异。在克拉霉素耐药感染患者中，VPZ疗法的有效率为81%（76%-85%），超过了PPIs疗法（76% vs. 40%；RD = 0.33，95% CI = 0.24-0.43）。对于克拉霉素易感菌株，VPZ 的有效率为 92%（89%-95%），与 PPIs 相似。VPZ的不良反应率为19%（16%-21%），与基于PPI的治疗方案相当（分别为18% vs. 13%；RD = 0.00，95% CI = -0.01 to 0.02，p = 0.57）：结论：以VPZ为基础的治疗方案在所有治疗组合中的有效率均超过85%。结论：在所有治疗组合中，以 VPZ 为基础的治疗方案的有效率超过 85%。在治疗无效和对克拉霉素耐药的患者中，VPZ 的疗效优于 PPIs。在抢救治疗、对克拉霉素敏感的患者或使用四联疗法时，这一优势并未得到证实。两种方案的耐受性相似。
Efficacy and Safety of Vonoprazan in Dual/Triple/Quadruple Regimens Both in First-Line and Rescue Therapy for Helicobacter pylori Eradication: A Systematic Review With Meta-Analysis
Background
The efficacy of Helicobacter pylori (H. pylori) eradication therapies encompassing one or more antibiotics and a proton pump inhibitor (PPI) has lately decreased. Vonoprazan (VPZ), a potassium-competitive acid blocker, provides higher gastric acid suppression than PPIs. We performed a meta-analysis evaluating the efficacy and safety of VPZ in H. pylori eradication therapies.
Methods
Studies were searched in PubMed, Embase, and the Cochrane Library up to June 2023. Efficacy was evaluated by intention-to-treat analysis. Data were combined by meta-analyzing risk differences (RD). Heterogeneity was evaluated by subgrouping.
Results
Seventy-seven studies (24 randomized clinical trials) evaluated 44,162 patients (22,297 receiving VPZ and 21,865 PPIs). Overall VPZ efficacy was 88% (95% CI = 87%–90%): 86%, 88%, and 94% for dual/triple/quadruple-VPZ-containing therapies. VPZ efficacy was 87% (86%–89%) in first-line and 90% (87%–93%) in rescue therapy. VPZ performed better than PPIs in treatment-naïve patients (87% vs. 70%; RD = 0.13, 95% CI = 0.11–0.15) and when using triple regimens. No significant differences were observed in rescue and quadruple therapies. In patients with clarithromycin-resistant infection, VPZ-based therapies demonstrated an 81% efficacy (76%–85%), surpassing PPIs (76% vs. 40%; RD = 0.33, 95% CI = 0.24–0.43). For clarithromycin-susceptible strains, VPZ efficacy was 92% (89%–95%), similar to PPIs. VPZ adverse events rate was 19% (16%–21%), comparable to PPI-based regimens (18% vs. 13%, respectively; RD = 0.00, 95% CI = −0.01 to 0.02, p = 0.57).
Conclusions
The efficacy of VPZ-based regimens was over 85% in all treatment combinations. In treatment-naïve and clarithromycin-resistant patients, VPZ performed better than PPIs. In rescue therapy, in clarithromycin-susceptible patients or when quadruple regimens were prescribed, this advantage was not confirmed. Tolerability was similar in both regimens.
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.
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