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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

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Abstract

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 < 0.00001) and per-protocol analysis (pooled RR: 1.13, 95% CI: 1.07–1.20, p < 0.00001). This finding was further validated by subgroup analysis depending on treatment regimens, duration, region, and clarithromycin resistance. In addition, there was no significant difference in adverse events (p = 0.33) and compliances (p = 0.30) between the regimens.

Conclusion

The VPZ-based regimens showed a superior eradication efficacy compared to the already frequently used PPI-based regimens. Furthermore, VPZ-based therapy showed comparable tolerability and incidence of adverse events.

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Data availability

The data that support the findings of the study are available from the corresponding author on reasonable request.

Abbreviations

VPZ:

Vonoprazon

PPI:

Proton pump inhibitor

HP:

Helicobacter pylori

RCT:

Randomized clinical trial

RR:

Risk ratios

ITT:

Intention-to-treat

CI:

Confidence interval

PP:

Per-protocol analysis

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Authors and Affiliations

  1. Department of Gastroenterology, Sir Run Run Shaw Hospital, Medical School, Zhejiang University, No. 3 East Qingchun Road, Hangzhou, 310016, Zhejiang Province, China

    Yingchao Sun, Lei Yue & Weiling Hu

  2. Institute of Gastroenterology, Zhejiang University (IGZJU), Hangzhou, China

    Weiling Hu

  3. Zhejiang University Cancer Center, Hangzhou, China

    Weiling Hu

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Contributions

W. L. H. was guarantor of the article. L. Y. and Y. C. S. performed the literature search with a systematic review. Y. C. S. performed the meta-analysis and extracted the data. L. Y. and Y. C. S. wrote the manuscript. And W. L. H. designed a systematic review and edited this manuscript. All authors approved the final version of this manuscript.

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Correspondence to Weiling Hu.

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Sun, Y., Yue, L. & Hu, W. 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. Eur J Clin Pharmacol 79, 279–288 (2023). https://doi.org/10.1007/s00228-022-03430-y

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