Efficacy and safety comparison of <i>Helicobacter pylori</i> eradication between vonoprazan dual therapy <i>versus</i> triple therapy: a systematic review and meta-analysis

Wang, Zheyu; Wang, Fen Wei

doi:10.1177/17562848221125308

Cited by 14 publications

(27 citation statements)

References 35 publications

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“…The efficacy was improved (>90%) when the treatment duration was extended to 14 days. [25][26][27][28][29][30] It should be note that all the VA groups were treated with VPZ 20 mg bid and we found that high dose and low dose amoxicillin does not contribute significant difference to the cure rate. Possibly, a universally effective regimen will emerge, but it will likely require higher doses of VPZ such as 30 or 40 mg bid or tid in some regions.…”

Section: F I G U R Ementioning

confidence: 56%

“…Similar observations also pertain to VPZ triple therapy comparisons. As for the comparison between VA dual therapy and bismuth‐containing quadruple therapy, no significant difference was observed as well 12,25,26,28 …”

Section: Discussionmentioning

confidence: 98%

“…In contrast to the four previous systematic reviews and meta‐analysis, 8,35–37 our study incorporates nine articles 12,24–28,34,38 . Compared with previous meta‐analysis, we made a comprehensive analysis to compare the efficacy and safety of VA dual therapy with VPZ triple or quadruple therapy.…”

Section: Discussionmentioning

confidence: 99%

“…As for the comparison between VA dual therapy and bismuth-containing quadruple therapy, no significant difference was observed as well. 12,25,26,28 The adverse events rate of VA dual therapy was lower than VPZ triple therapy and bismuth-containing quadruple therapy, which In contrast to the four previous systematic reviews and meta-analysis, 8,[35][36][37] our study incorporates nine articles. 12,[24][25][26][27][28]34,38 Compared with previous meta-analysis, we made a comprehensive analysis to compare the efficacy and safety of VA dual ther- This meta-analysis had several limitations that should be considered.…”

Section: F I G U R Ementioning

confidence: 94%

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Vonoprazan and amoxicillin dual therapy as the first‐line treatment of Helicobacter pylori infection: A systematic review and meta‐analysis

Du,

Hu,

Ouyang

et al. 2023

Helicobacter

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BackgroundRecent clinical trials have evaluated the efficacy of vonoprazan‐amoxicillin (VA) dual therapy as the first‐line treatment for Helicobacter pylori infection in different regions with inconsistent results reported. In this systematic review and meta‐analysis, we aimed to evaluate the efficacy of VA dual therapy compared to the currently recommended therapy for eradicating H. pylori.Materials and MethodsA comprehensive search of the PubMed, Cochrane, and Embase databases was performed using the following search terms: (“Helicobacter” OR “H. pylori” OR “Hp”) AND (“vonoprazan” OR “potassium‐competitive acid blocker” OR “P‐CAB”) AND (“amoxicillin” OR “penicillin”) AND (“dual”). The primary outcome was to evaluate the eradication rate according to intention‐to‐treat and per‐protocol analysis. The secondary outcomes were adverse events and compliance.ResultsA total of 15 studies involving 4, 568 patients were included. The pooled eradication rate of VA dual therapy was 85.0% and 90.0% by intention‐to‐treat and per‐protocol analysis, respectively. The adverse events rate and compliance of VA dual therapy were 17.5% and 96%, respectively. The efficacy of VA dual therapy was superior to proton pump inhibitors‐based triple therapy (82.0% vs. 71.4%, p < 0.01) but lower than vonoprazan‐containing quadruple therapy (83.1% vs. 93.3%, p = 0.02). 7‐day VA dual therapy showed lower eradication rates than 10‐day (χ2 = 24.09, p < 0.01) and 14‐day VA dual therapy (χ2 = 11.87, p < 0.01). The adverse events rate of VA dual therapy was lower than vonoprazan triple therapy (24.6% vs. 30.9%, p = 0.01) and bismuth‐containing quadruple therapy (20.5% vs. 47.9%, p < 0.01). No significant difference of compliance was observed between VA dual therapy and each subgroup.ConclusionVA dual therapy, a novel regimen, showed high efficacy as the first‐line treatment for H. pylori eradication, which should be optimized before application in different regions.

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Section: F I G U R Ementioning

confidence: 56%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: F I G U R Ementioning

confidence: 94%

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Vonoprazan and amoxicillin dual therapy as the first‐line treatment of Helicobacter pylori infection: A systematic review and meta‐analysis

Du,

Hu,

Ouyang

et al. 2023

Helicobacter

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“…Therefore, before starting vonoprazan triple therapy, the local resistance rate to clarithromycin should be referenced, especially in the US, where the resistance rate exceeds 30%. Ouyang et al showed that vonoprazan dual therapy had comparable efficacy and safety profiles compared with vonoprazan triple therapy [56]. However, several journal abstracts instead of original articles were included in their meta-analysis, which could have led to potential bias.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Vonoprazan and Amoxicillin Dual Therapy for Helicobacter pylori Infection: A Systematic Review and Network Meta-Analysis

Liu

Shi

et al. 2023

Antibiotics

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The eradication of Helicobacter pylori (H. pylori) infection remains challenging due to increasing bacterial resistance. Resistance rates to clarithromycin, metronidazole, and levofloxacin were higher than 30% in the USA, making current therapies less effective. Vonoprazan triple therapy (VAC) has demonstrated similar efficacy and safety profiles compared to PPI-based triple therapy (PPI). However, the eradication rate of vonoprazan dual therapy (VA) for H. pylori infection in comparison to VAC, and PPI was poorly established. Electronic databases were searched up to 6 October 2022, to identify studies examining the safety and efficacy of VA compared to VAC and PPI. Six studies were included. For empiric therapies among treatment naïve patients, VA, VAC, and PPI did not achieve high cure rates (>90%). The comparative efficacy ranking showed VAC was the most effective therapy, followed by VA, and PPI. The results were similar for clarithromycin-resistant infections. The comparative safety ranking showed VA ranked first, whereas PPI triple therapy was the least safe regimen. These findings should guide the selection of the most effective and safe treatment and conduct additional studies to determine the place of vonoprazan dual versus triple therapies in patients with H. pylori from various countries across the world.

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Potassium-competitive Acid Blockers: Current Clinical Use and Future Developments

Scarpignato,

Hunt

2024

Curr Gastroenterol Rep

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Purpose of the Review Acid suppression with proton pump inhibitors (PPIs) represents the standard of care in the treatment of acid-related diseases. However, despite their effectiveness, PPIs display some intrinsic limitations, which underlie the unmet clinical needs that have been identified over the past decades. The aims of this review are to summarize the current status and future development of the new class of antisecretory drugs (potassium-competitive acid blockers, P-CABs) that have recently been introduced into medical practice. Recent Findings Over the past decades, clinical needs unmet by the current acid suppressants have been recognized, especially in the management of patients with GERD, Helicobacter pylori infection and NSAID-related peptic ulcer. The failure to address these needs is mainly due to their inability to achieve a consistent acid suppression in all patients and, particularly, to control nighttime acidity. It was then realized that an extended duration of acid suppression would exert additional benefits. The available data with P-CABs show that they are able to address these unmet clinical needs. Summary Four different P-CABs (vonoprazan, tegoprazan, fexuprazan and keverprazan) are currently available. However, only two of them are approved outside Asia. Vonoprazan is available in North, Central and South America while tegoprazan is marketed only in Latin American countries. Two other compounds (namely linazapran glurate and zestaprazan) are presently under clinical development. While clinical trials on GERD have been performed with all P-CABs, only vonoprazan and tegoprazan have been investigated as components of Helicobacter pylori eradication regimens. The available data show that—in the above two clinical indications—P-CABs provide similar or better efficacy in comparison with PPIs. Their safety in the short-term overlaps that of PPIs, but data from long-term treatment are needed.

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Efficacy and safety comparison of Helicobacter pylori eradication between vonoprazan dual therapy versus triple therapy: a systematic review and meta-analysis

Cited by 14 publications

References 35 publications

Vonoprazan and amoxicillin dual therapy as the first‐line treatment of Helicobacter pylori infection: A systematic review and meta‐analysis

Vonoprazan and amoxicillin dual therapy as the first‐line treatment of Helicobacter pylori infection: A systematic review and meta‐analysis

The Efficacy and Safety of Vonoprazan and Amoxicillin Dual Therapy for Helicobacter pylori Infection: A Systematic Review and Network Meta-Analysis

Potassium-competitive Acid Blockers: Current Clinical Use and Future Developments

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