Meta-analysis of Helicobacter pylori eradication therapy using vonoprazan as an acid suppressor compared with bismuth quadruple therapy

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2024-03-05 DOI:10.1111/hel.13059

Hui Yang, Miao Zhang, Gang Ma, Jiaqi Yang, Kemei Wang, Shuangshuang Jiang, Jiaqiang Dong, Ying Han

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引用次数: 0

Abstract

Background

Vonoprazan, a novel acid suppressant, has recently emerged as a regimen for eradicating Helicobacter pylori. However, uncertainties exist about the effectiveness and safety of VPZ-based regimens compared with those of bismuth-based quadruple therapy in eradicating H. pylori. The present meta-analysis was performed to compare the effectiveness and safety of vonoprazan-based regimens with those of bismuth quadruple therapy in eradicating H. pylori.

Materials and Methods

All randomized controlled trials and non-randomized controlled trials comparing the vonoprazan-based therapy with the bismuth quadruple therapy were included in this meta-analysis. Information was also extracted by two evaluators, and if heterogeneity existed, a random-effects model was used to calculate the combined relative ratio and 95% confidence interval; otherwise, a fixed-effects model was used. And subgroup analyses were performed to explore the sources of heterogeneity.

Results

A total of 10 studies, comprising 2587 patients were included in the meta-analysis. The results showed that the combined eradication rate of patients treated with the vonoprazan-based regimen was significantly higher than that of patients treated with bismuth quadruple therapy, in both intention-to-treat and per-protocol analyses, and the differences were statistically significant. Among the intention-to-treat analyses results: (90.28% vs. 83.64% [odds ratio (OR) = 1.85, 95% confidence interval (CI) (1.27, 2.70), p = 0.001]); in the per-protocol analyses: (94.80% vs. 89.88%, [OR = 2.25, 95% CI (1.37, 3.69), p = 0.001]). The occurrence of adverse events was significantly lower in patients treated with vonoprazan-based regimens than in those treated with bismuth quadruple therapy, (14.50% vs. 25.89%, [OR = 0.49, 95% CI (0.32, 0.75), p = 0.001]).

Conclusions

For eradicating H. pylori, vonoprazan-based regimens are remarkably advantageous over bismuth quadruple therapy. Furthermore, vonoprazan-based regimens exhibit a lower rate of adverse events than bismuth quadruple therapy.

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使用vonoprazan作为抑酸剂的幽门螺杆菌根除疗法与铋剂四联疗法的元分析比较。

背景：沃诺普拉赞是一种新型抑酸剂，最近已成为根除幽门螺杆菌的一种疗法。然而，与基于铋剂的四联疗法相比，基于 VPZ 的疗法在根除幽门螺杆菌方面的有效性和安全性还存在不确定性。本荟萃分析旨在比较基于醋氯吡嗪的治疗方案与基于铋剂的四联疗法在根除幽门螺杆菌方面的有效性和安全性：本次荟萃分析纳入了所有比较以伏诺普拉赞为基础的疗法和四联铋剂疗法的随机对照试验和非随机对照试验。如果存在异质性，则采用随机效应模型计算合并相对比和95%置信区间；反之，则采用固定效应模型。并进行了亚组分析，以探讨异质性的来源：荟萃分析共纳入了10项研究，2587名患者。结果表明，在意向治疗分析和按方案分析中，接受以vonoprazan为基础的方案治疗的患者的综合根除率明显高于接受四联铋剂治疗的患者，且差异具有统计学意义。在意向治疗分析结果中：（90.28% 对 83.64% [比值比 (OR) = 1.85，95% 置信区间 (CI) (1.27, 2.70)，p = 0.001]）；在按协议分析结果中：（94.80% 对 89.88%，[比值比 (OR) = 2.25，95% 置信区间 (CI) (1.37, 3.69)，p = 0.001]）。采用vonoprazan治疗方案的患者不良反应发生率明显低于采用铋剂四联疗法的患者（14.50% vs. 25.89%，[OR = 0.49，95% CI (0.32，0.75)，p = 0.001]）：结论：在根除幽门螺杆菌方面，以vonoprazan为基础的治疗方案比四联铋剂疗法具有明显优势。此外，与四联铋剂疗法相比，以伏诺普拉赞为基础的疗法的不良反应发生率更低。

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.