Low-dose or high-dose amoxicillin in vonoprazan-based dual therapy for Helicobacter pylori eradication? A systematic review and meta-analysis

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2024-02-05 DOI:10.1111/hel.13054

Kun-Ping Ju, Qing-Zhou Kong, Yue-Yue Li, Yan-Qing Li

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Abstract

Background

The amoxicillin dose used in dual therapy to eradicate Helicobacter pylori varies across studies and the optimal amoxicillin dose for vonoprazan-based dual therapies remains unclear. We aimed to investigate the efficacy and safety of low- and high-dose amoxicillin in vonoprazan–amoxicillin dual therapy.

Materials and Methods

A comprehensive systematic review was conducted by searching databases from inception to October 2023. All trials that evaluated the effectiveness and safety of vonoprazan–amoxicillin dual therapy for eradicating H. pylori were included. Pooled eradication rate, incidence of adverse events, relative risks, and 95% confidence intervals are presented.

Results

Eighteen studies with 12 low-dose amoxicillin (VLA) and 13 high-dose amoxicillin (VHA) arms were included. The pooled eradication rates were 82.4% and 86.8% for VLA therapy, and 86.0% and 90.9% for VHA therapy by the intention-to-treat and per-protocol analyses, respectively. In the subgroup analysis stratified by duration, the eradication rates achieved in 7 days, 10 days, and 14 days treatments with VLA and VHA dual therapies were 80.8%, 84.2%, 83.1%, and 67.3%, 88.8%, 87.5%, respectively. In the four randomized controlled trials that directly compared VLA and VHA dual therapies, the efficacy was not statistically different in the intention-to-treat (76.9% vs 81.4%, p = 0.337) and per-protocol (81.6% vs 84.0%, p = 0.166) analyses. Additionally, the incidence of adverse events (p = 0.965) and compliance (p = 0.994) were similar in both groups.

Conclusion

VLA therapy demonstrated comparable efficacy and safety to VHA therapy, along with regional differences. An appropriately extended treatment duration may be critical for therapeutic optimization of vonoprazan–amoxicillin treatment.

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在基于冯诺普拉赞的根除幽门螺杆菌双重疗法中使用小剂量阿莫西林还是大剂量阿莫西林？系统回顾和荟萃分析

背景在根除幽门螺旋杆菌的双重疗法中，不同研究采用的阿莫西林剂量各不相同，而基于冯诺普拉赞的双重疗法的最佳阿莫西林剂量仍不明确。我们旨在研究低剂量和高剂量阿莫西林在冯诺普拉赞-阿莫西林双重疗法中的疗效和安全性。材料与方法通过检索从开始到 2023 年 10 月的数据库，我们进行了一项全面的系统综述。纳入了所有评价过伏诺普拉赞-阿莫西林双重疗法根除幽门螺杆菌的有效性和安全性的试验。本文列出了汇总的根除率、不良事件发生率、相对风险和 95% 置信区间。结果共纳入了 18 项研究，其中 12 项为低剂量阿莫西林（VLA），13 项为高剂量阿莫西林（VHA）。通过意向治疗分析和按方案分析，VLA疗法的总根除率分别为82.4%和86.8%，VHA疗法的总根除率分别为86.0%和90.9%。在按疗程分层的亚组分析中，使用VLA和VHA双重疗法进行7天、10天和14天治疗的根除率分别为80.8%、84.2%和83.1%，以及67.3%、88.8%和87.5%。在直接比较VLA和VHA双重疗法的四项随机对照试验中，意向治疗分析（76.9% vs 81.4%，P = 0.337）和按方案分析（81.6% vs 84.0%，P = 0.166）的疗效无统计学差异。此外，两组的不良事件发生率（p = 0.965）和依从性（p = 0.994）相似。结论 VLA疗法的疗效和安全性与VHA疗法相当，但存在地区差异。适当延长治疗时间可能是优化冯诺普拉唑-阿莫西林治疗的关键。

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.