Zheyu Wang1, Fen Wang2. 1. Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaHunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, Hunan, China. 2. Department of Gastroenterology, Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, 138 Tongzi Road, Changsha, Hunan 410013, P.R. ChinaHunan Key Laboratory of Non-Resolving Inflammation and Cancer, Central South University, Changsha, Hunan, China.
Abstract
Background: As a novel drug, vonoprazan (VPZ) has been developed as a new strategy against Helicobacter pylori (H. pylori) infections. However, whether VPZ + amoxicillin (AMO) dual therapy has a clear advantage is still unclear. Objective: To review and meta-analyze the available literature investigating the efficacy and safety of H. pylori eradication in VPZ dual therapy. Design: A systematic review and meta-analysis were conducted. Data sources and methods: We performed a systematic search in the PubMed, Embase, EIsevier/Science Library, and Cochrane Library databases from 2015 to 2022. Meta-analyses were conducted to evaluate the actual cure rate and the incidence rate of adverse reactions in dual therapy and VPZ + AMO + clarithromycin (CLA) triple therapy; furthermore, eradication rates in CLA-resistant infections and different doses of antibiotics were evaluated in subgroup analysis. Results: Seven studies with 1490 patients were included in this meta-analysis. According to intention-to-treat analysis, the actual cure rates of VPZ dual and triple therapy were 82.8% and 84.6%, respectively [p = 0.29, odds ratio (OR): 0.86, 95% confidence interval (CI): 0.64-1.14]. And in the per-protocol analysis, the actual cure rates of these two therapies were 84.8% and 87.0%, respectively (p = 0.21, OR: 0.80, 95% CI: 0.57-1.13). The incidence of adverse reactions between VPZ dual and triple therapy was 26.1% versus 29.6% (p = 0.04, OR: 0.78, 95% CI: 0.61-0.99). In subgroup analysis, the eradication rates in CLA-resistant infections were dual therapy: 85.7% for VPZ versus 71.0% for triple therapy (p = 0.03, OR: 2.36, 95% CI: 1.10-5.05). And the actual cure rate of VPZ with high-dose antibiotics was lower than with low-dose antibiotics (p = 0.000 in dual therapy; p = 0.011 in triple therapy). Conclusion: A combination of VPZ and a low dose of AMO should be prioritized as a treatment option for H. pylori eradication. Registration: PROSPERO registration number CRD42022346100.
Background: As a novel drug, vonoprazan (VPZ) has been developed as a new strategy against Helicobacter pylori (H. pylori) infections. However, whether VPZ + amoxicillin (AMO) dual therapy has a clear advantage is still unclear. Objective: To review and meta-analyze the available literature investigating the efficacy and safety of H. pylori eradication in VPZ dual therapy. Design: A systematic review and meta-analysis were conducted. Data sources and methods: We performed a systematic search in the PubMed, Embase, EIsevier/Science Library, and Cochrane Library databases from 2015 to 2022. Meta-analyses were conducted to evaluate the actual cure rate and the incidence rate of adverse reactions in dual therapy and VPZ + AMO + clarithromycin (CLA) triple therapy; furthermore, eradication rates in CLA-resistant infections and different doses of antibiotics were evaluated in subgroup analysis. Results: Seven studies with 1490 patients were included in this meta-analysis. According to intention-to-treat analysis, the actual cure rates of VPZ dual and triple therapy were 82.8% and 84.6%, respectively [p = 0.29, odds ratio (OR): 0.86, 95% confidence interval (CI): 0.64-1.14]. And in the per-protocol analysis, the actual cure rates of these two therapies were 84.8% and 87.0%, respectively (p = 0.21, OR: 0.80, 95% CI: 0.57-1.13). The incidence of adverse reactions between VPZ dual and triple therapy was 26.1% versus 29.6% (p = 0.04, OR: 0.78, 95% CI: 0.61-0.99). In subgroup analysis, the eradication rates in CLA-resistant infections were dual therapy: 85.7% for VPZ versus 71.0% for triple therapy (p = 0.03, OR: 2.36, 95% CI: 1.10-5.05). And the actual cure rate of VPZ with high-dose antibiotics was lower than with low-dose antibiotics (p = 0.000 in dual therapy; p = 0.011 in triple therapy). Conclusion: A combination of VPZ and a low dose of AMO should be prioritized as a treatment option for H. pylori eradication. Registration: PROSPERO registration number CRD42022346100.
Authors: Mohd Amer Alsamman; Eric C Vecchio; Khaled Shawwa; Gabriel Acosta-Gonzales; Murray B Resnick; Steven F Moss Journal: Dig Dis Sci Date: 2019-06-11 Impact factor: 3.199
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