vonoprazan和大剂量阿莫西林双重疗法根除幽门螺旋杆菌的有效性和安全性：系统回顾和荟萃分析。

IF 4.9 2区医学 Q1 INFECTIOUS DISEASES

International Journal of Antimicrobial Agents Pub Date : 2024-09-07 DOI:10.1016/j.ijantimicag.2024.107331

Ju Zhang , Huan Zhang , Xiao-Jing Zhu , Nuo Yao , Ju-Mei Yin , Jian Liu , Han-Jun Dan , Qi-Meng Pang , Zhi-Hua Liu , Yong-Quan Shi

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引用次数: 0

摘要

背景：新型抑酸药物沃诺普拉赞为根除幽门螺杆菌提供了更多选择。因此，沃诺普拉赞和大剂量阿莫西林双重疗法是否更有效、更安全，需要进行系统分析：对截至 2024 年 5 月 16 日的 PubMed、Embase、Cochrane Library 和 Web of Science 数据库中的文献进行了全面检索。纳入了评估VHA双重疗法与其他疗法相比的幽门螺杆菌根除率、不良事件和依从性的研究。使用RevMan 5.4进行统计分析：结果：共纳入11项研究性临床试验和2项回顾性临床研究，4570个样本。VHA双重疗法具有更高的幽门螺杆菌根除率（ITT：86.0% vs 80.7%，OR=1.36，95%CI 1.07-1.73，P=0.01；PP：90.6% vs 85.7%，OR=1.42，95%CI 1.07-1.88，P=0.02）、更少的不良反应（15.4% vs 27.7%，OR=0.49，95%CI 0.35-0.68，PConclusion）：与指南推荐的疗法相比，VHA 10 天或 14 天双重疗法的疗效和安全性更佳，应优先采用。

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Efficacy and safety of vonoprazan and high-dose amoxicillin dual therapy in eradicating Helicobacter pylori: A systematic review and meta-analysis

Background

Vonoprazan is a new acid-suppressing drug that provides an additional choice for eradicating Helicobacter pylori. The effectiveness and safety of vonoprazan and high-dose amoxicillin (VHA) dual therapy requires study in a systematic analysis.

Materials and Methods

A comprehensive search of the literature from the PubMed, Embase, Cochrane Library, and Web of Science databases was conducted up to 16 May 2024. Trials comparing H. pylori eradication rates, adverse events, and compliance of VHA dual therapy with that of other therapies were included. RevMan 5.4 was used for statistical analysis.

Results

Eleven randomised controlled trials (RCTs) and two retrospective clinical studies with 4570 samples were included. VHA dual therapy had superior H. pylori eradication rates (intention-to-treat [ITT]: 86.0% vs. 80.7%; odds ratio [OR]=1.36; 95% confidence interval [CI] 1.07–1.73; P=0.01; per-protocol [PP]: 90.6% vs. 85.7%; OR=1.42; 95% CI 1.07–1.88; P=0.02), fewer adverse events (15.4% vs. 27.7%; OR=0.49; 95% CI 0.35–0.68, P<0.0001), and similar compliance (94.6% vs. 93.2%; OR=1.27; 95% CI 0.98–1.64; P=0.07) compared with other guideline therapies. According to subgroup analysis with PP data, VHA dual therapy is more effective than bismuth quadruple therapy based on proton-pump inhibitors (P-BQT) (93.5% vs. 89.3%; OR=1.76; 95% CI 1.03–3.00; P=0.04). In addition, the eradication rates for 7-day, 10-day and 14-day VHA dual therapy were 65% (95% CI 0.55–0.75), 92% (95% CI 0.91–0.94) and 93% (95% CI 0.90–0.97), respectively.

Conclusion

VHA dual therapy for 10 or 14 days showed superior efficacy and safety compared with therapies recommended by the guidelines and should be prioritised for adoption.

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来源期刊

International Journal of Antimicrobial Agents 医学-传染病学

CiteScore

21.60

自引率

0.90%

发文量

176

审稿时长

36 days

期刊介绍： The International Journal of Antimicrobial Agents is a peer-reviewed publication offering comprehensive and current reference information on the physical, pharmacological, in vitro, and clinical properties of individual antimicrobial agents, covering antiviral, antiparasitic, antibacterial, and antifungal agents. The journal not only communicates new trends and developments through authoritative review articles but also addresses the critical issue of antimicrobial resistance, both in hospital and community settings. Published content includes solicited reviews by leading experts and high-quality original research papers in the specified fields.