Comparative Efficacy and Safety of Potassium-Competitive Acid Blockers and Proton Pump Inhibitors for First-Line Helicobacter pylori Eradication Therapy: A Systematic Review and Network Meta-Analysis

IF 4.3 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Helicobacter Pub Date : 2024-11-07 DOI:10.1111/hel.13150

Mengling Ouyang, Shupeng Zou, Qian Cheng, Xuan Shi, Minghui Sun

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引用次数: 0

Abstract

Background

Given the increasing antibiotic resistance and the inadequate acid-suppressing effects of proton pump inhibitors (PPIs), it is crucial to continuously optimize existing Helicobacter pylori (H. pylori) treatment regimens. This study aimed to evaluate the clinical efficacy and safety of novel potassium-competitive acid blocker (P-CAB)-based eradication regimens compared with traditional PPI-based regimens for the initial treatment of H. pylori.

Materials and Methods

We conducted a systematic review and network meta-analysis, searching seven electronic databases for randomized controlled trials (RCTs) evaluating initial P-CAB-based H. pylori eradication therapy. The primary outcome was the H. pylori eradication rate. Secondary outcomes included adverse events and patient compliance. We synthesized the effect sizes of the trials using odds ratios (OR) and 95% confidence intervals (95% CI).

Results

A total of 54 RCTs involving 15,320 patients (74.9% male, mean age 30.2 years) were included in this study. In the intention-to-treat (ITT) analysis, VPZ-HD-dual, VPZ-triple, and VPZ-quadruple regimens demonstrated significantly higher eradication rates than PPI-triple, PPI-quadruple, and VPZ-dual regimens. Similar trends were observed in the per-protocol (PP) analysis. Subgroup analysis indicated that poor patient compliance significantly reduced eradication rates. Resistance to clarithromycin and metronidazole significantly weakened the eradication effects of PPI-triple, TPZ-triple, and VPZ-triple regimens. Additionally, the eradication rates for 7-day regimens were significantly lower than those for 14-day or 10-day regimens, but there was no significant difference between the eradication rates of 10-day and 14-day regimens. Notably, the risk of adverse events with VPZ-HD-dual was significantly lower than with VPZ-quadruple.

Conclusion

Vonoprazan combined with high-dose amoxicillin dual therapy not only provides satisfactory eradication rates but also exhibits lower adverse event rates and good patient compliance, indicating its potential as a promising regimen for further promotion.

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钾竞争性酸阻滞剂和质子泵抑制剂在一线根除幽门螺旋杆菌疗法中的疗效和安全性比较：系统综述与网络元分析》。

背景：鉴于抗生素耐药性的增加和质子泵抑制剂（PPI）抑酸效果的不足，不断优化现有的幽门螺旋杆菌（H. pylori）治疗方案至关重要。本研究旨在评估基于钾竞争性酸阻滞剂（P-CAB）的新型根除方案与基于传统 PPI 的方案相比，在初始治疗幽门螺杆菌时的临床疗效和安全性：我们进行了一项系统综述和网络荟萃分析，在七个电子数据库中搜索了评估基于 P-CAB 的幽门螺杆菌初始根除疗法的随机对照试验 (RCT)。主要结果是幽门螺杆菌根除率。次要结果包括不良事件和患者依从性。我们使用几率比（OR）和 95% 置信区间（95% CI）对试验的效应大小进行了综合分析：本研究共纳入了 54 项 RCT，涉及 15,320 名患者（74.9% 为男性，平均年龄为 30.2 岁）。在意向治疗（ITT）分析中，VPZ-HD-二联疗法、VPZ-三联疗法和VPZ-四联疗法的根除率明显高于PPI-三联疗法、PPI-四联疗法和VPZ-二联疗法。在按方案（PP）分析中也观察到了类似的趋势。亚组分析表明，患者依从性差会显著降低根除率。对克拉霉素和甲硝唑的耐药性大大削弱了PPI-三联疗法、TPZ-三联疗法和VPZ-三联疗法的根除效果。此外，7 天治疗方案的根除率明显低于 14 天或 10 天治疗方案，但 10 天和 14 天治疗方案的根除率没有明显差异。值得注意的是，VPZ-HD-双联疗法的不良反应风险明显低于VPZ-四联疗法：结论：沃诺普拉赞联合大剂量阿莫西林双重疗法不仅能提供令人满意的根除率，而且不良反应发生率较低，患者依从性良好，这表明该疗法具有进一步推广的潜力。

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.