Efficacy and Safety of Polaprezinc-Based Therapy versus the Standard Triple Therapy for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Helicobacter pylori (H. pylori) is the most prevalent etiology of gastritis worldwide. H. pylori management depends mainly on antibiotics, especially the triple therapy formed of clarithromycin, amoxicillin, and proton pump inhibitors. Lately, many antibiotic-resistant strains have emerged, leading to a decrease in the eradication rates of H. pylori. Polaprezinc (PZN), a mucosal protective zinc-L-carnosine complex, may be a non-antibiotic agent to treat H. pylori without the risk of resistance. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of a PZN-based regimen for the eradication of H. pylori. This study used a systematic review and meta-analysis synthesizing randomized controlled trials (RCTs) from WOS, SCOPUS, EMBASE, PubMed, and Google Scholar until 25 July 2022. We used the odds ratio (OR) for dichotomous outcomes presented with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: CRD42022349231. We included 3 trials with a total of 396 participants who were randomized to either PZN plus triple therapy (n = 199) or triple therapy alone (control) (n = 197). Pooled OR found a statistical difference favoring the PZN arm in the intention to treat and per protocol H. pylori eradication rates (OR: 2.01 with 95% CI [1.27, 3.21], p = 0.003) and (OR: 2.65 with 95% CI [1.55, 4.54], p = 0.0004), respectively. We found no statistical difference between the two groups regarding the total adverse events (OR: 1.06 with 95% CI [0.55, 2.06], p = 0.85). PZN, when added to the triple therapy, yielded a better effect concerning the eradication rates of H. pylori with no difference in adverse event rates, and thus can be considered a valuable adjuvant for the management of H. pylori. However, the evidence is still scarce, and larger trials are needed to confirm or refute our findings.

A review for non-antibiotic treatment of Helicobacter pylori: new insight

“…Several investigations have demonstrated that anti-helicobacter drugs such as levofloxacin have higher bacterial toxicity when combined with Resveratrol and its derivatives ( Bouarab Chibane et al, 2019 ; Di Lodovico et al, 2019 ; Di Fermo et al, 2020 ). Polaprezinc (PZN) or zinc carnosine (L-carnosine) are zinc chelate compounds that protect the digestive mucosa ( Mahmoud et al, 2022 ). This antioxidant compound is particularly efficient in protecting against H. pylori and promoting ulcer healing, and unlike other antibiotics, it does not cause drug resistance ( Teng et al, 2020 ; Ibrahim et al, 2022 ; Mahmoud et al, 2022 ).…”

“…Polaprezinc (PZN) or zinc carnosine (L-carnosine) are zinc chelate compounds that protect the digestive mucosa ( Mahmoud et al, 2022 ). This antioxidant compound is particularly efficient in protecting against H. pylori and promoting ulcer healing, and unlike other antibiotics, it does not cause drug resistance ( Teng et al, 2020 ; Ibrahim et al, 2022 ; Mahmoud et al, 2022 ). PZN has been shown in several trials to be useful in reducing apoptosis and inflammation, healing skin and stomach wounds, and preserving tight junctions ( Furihata et al, 2020 ; Ibrahim et al, 2022 ).…”

“…PZN has been shown in several trials to be useful in reducing apoptosis and inflammation, healing skin and stomach wounds, and preserving tight junctions ( Furihata et al, 2020 ; Ibrahim et al, 2022 ). Hence, this substance may be introduced later in the H. pylori treatment protocol ( Kawahara et al, 2018 ; Mahmoud et al, 2022 ). Palmatine (Pal) is a herbal combination derived from Coptidis Rhizoma that may relieve or diminish chronic atrophic gastritis (CAG) caused by H. pylori .…”

“…PZN has been shown in several trials to be useful in reducing apoptosis and inflammation, healing skin and stomach wounds, and preserving tight junctions (Furihata et al, 2020;Ibrahim et al, 2022). Hence, this substance may be introduced later in the H. pylori treatment protocol (Kawahara et al, 2018;Mahmoud et al, 2022) CXCL-16;Chen et al, 2020). Silibinin, derived from milk thistle seeds, possesses potent anti-Helicobacter and anti-gastric tumor cell properties (Bittencourt et al, 2020).…”

Effect of Concomitant Use of Polaprezinc and Vonoprazan-Based Triple Therapy for Helicobacter pylori Eradication

“…In 1995, Kuwayama was the first to report the effectiveness of polaprezinc in eradicating H. pylori [20]. Subsequently, the efficacy of polaprezinc as an add-on to triple therapy comprising lansoprazole, amoxicillin (AMX), and CAM was reported [21,22]. These reports described eradication therapy using PPIs.…”