The efficacy and safety of vonoprazan-based high-dose dual therapy for eradication of Helicobacter pylori: A systematic review and meta-analysis

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-04-08 DOI:10.1016/j.jiph.2025.102768

Ming-ming Zhang , Mei-ding Wang , Shi-yu Yang , Jia-qiang Hu , Bao-qiang Zhu , Yuan-kui Wei , Chang-lan Zhang , En-wu Long

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Abstract

In order to evaluate the effectiveness and safety of high-dose dual therapy with vonoprazan for eradicating Helicobacter pylori, we searched seven electronic databases from the establishment of the database to March 2025, collecting randomized controlled clinical trials (RCTs) comparing high-dose dual therapy with vonoprazan to high-dose dual therapy with PPI and quadruple therapy with bismuth, including 13 RCTs with 4023 patients. The primary outcome is the eradication rate determined based on intention to treat analysis and protocol analysis, while secondary outcomes include incidence of adverse events and compliance. According to ITT analysis and PP treatment analysis, the eradication rates of VA therapy were 88.81 % and 93.56 %, respectively. The incidence of adverse reactions was significantly lower (14.56 % vs 26.00 %, RR=0.57, 95 % CI: 0.48–0.67, p < 0.0001), and compliance was better (96.29 % vs 93.56 %, RR=1.03, 95 % CI: 1.01–1.05, p = 0.003), making it a reliable alternative therapy.

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为了评估大剂量双联疗法与伏诺普拉赞根除幽门螺杆菌的有效性和安全性，我们检索了从数据库建立到2025年3月的7个电子数据库，收集了将大剂量双联疗法与大剂量双联疗法、PPI疗法和四联疗法与铋剂疗法进行比较的随机对照临床试验（RCT），其中包括13项RCT，共4023名患者。主要结果是根据意向治疗分析和方案分析确定的根除率，次要结果包括不良事件发生率和依从性。根据 ITT 分析和 PP 治疗分析，VA 治疗的根除率分别为 88.81% 和 93.56%。不良反应发生率明显降低（14.56 % vs 26.00 %，RR=0.57，95 % CI：0.48-0.67，p < 0.0001），依从性更好（96.29 % vs 93.56 %，RR=1.03，95 % CI：1.01-1.05，p = 0.003），是一种可靠的替代疗法。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.