The Efficacy and Safety of Vonoprazan and Amoxicillin Dual Therapy for Helicobacter pylori Infection: A Systematic Review and Network Meta-Analysis

Abstract

The eradication of Helicobacter pylori (H. pylori) infection remains challenging due to increasing bacterial resistance. Resistance rates to clarithromycin, metronidazole, and levofloxacin were higher than 30% in the USA, making current therapies less effective. Vonoprazan triple therapy (VAC) has demonstrated similar efficacy and safety profiles compared to PPI-based triple therapy (PPI). However, the eradication rate of vonoprazan dual therapy (VA) for H. pylori infection in comparison to VAC, and PPI was poorly established. Electronic databases were searched up to 6 October 2022, to identify studies examining the safety and efficacy of VA compared to VAC and PPI. Six studies were included. For empiric therapies among treatment naïve patients, VA, VAC, and PPI did not achieve high cure rates (>90%). The comparative efficacy ranking showed VAC was the most effective therapy, followed by VA, and PPI. The results were similar for clarithromycin-resistant infections. The comparative safety ranking showed VA ranked first, whereas PPI triple therapy was the least safe regimen. These findings should guide the selection of the most effective and safe treatment and conduct additional studies to determine the place of vonoprazan dual versus triple therapies in patients with H. pylori from various countries across the world.

Vonoprazan and amoxicillin dual therapy as the first‐line treatment of Helicobacter pylori infection: A systematic review and meta‐analysis

“…In contrast to the four previous systematic reviews and meta‐analysis, 8,35–37 our study incorporates nine articles 12,24–28,34,38 . Compared with previous meta‐analysis, we made a comprehensive analysis to compare the efficacy and safety of VA dual therapy with VPZ triple or quadruple therapy.…”

“…As for the comparison between VA dual therapy and bismuth-containing quadruple therapy, no significant difference was observed as well. 12,25,26,28 The adverse events rate of VA dual therapy was lower than VPZ triple therapy and bismuth-containing quadruple therapy, which In contrast to the four previous systematic reviews and meta-analysis, 8,[35][36][37] our study incorporates nine articles. 12,[24][25][26][27][28]34,38 Compared with previous meta-analysis, we made a comprehensive analysis to compare the efficacy and safety of VA dual ther- This meta-analysis had several limitations that should be considered.…”

Treatment of Helicobacter pylori Infection in Patients with Penicillin Allergy

“…In the general population with H. pylori infection, studies have demonstrated that vonoprazan-based therapy was often more effective than PPI-based therapy [ 19 , 51 , 52 ]. In patients with penicillin allergy, Vonoprazan-Clarithromycin-Metronidazole achieved a high eradication rate of 90%, with high adherence and tolerable adverse events in treatment-naïve patients [ 20 , 30 , 32 ].…”

Vonoprazan-amoxicillin dual regimen with Saccharomyces boulardii as a rescue therapy for Helicobacter pylori: Current perspectives and implications

“…Zuberi et al ’s study reported that the vonoprazan-based regimen was superior to the PPI triple therapy regimen in eradicating H. pylori (93.5% vs 83.9%)[ 10 ]. Similarly, Liu et al ’s network meta-analysis suggested that vonoprazan-based therapies were significantly more effective in eradicating H. pylori than PPI triple therapy, with the best safety profile shown by the vonoprazan dual therapy[ 11 ]. Therefore, vonoprazan dual therapy presents as a lower-cost, simple, yet effective treatment option for H. pylori eradication.…”

“…However, several other studies, including Zojaji et al [ 18 ], did not show any significant improvement in eradication with the addition of S. boulardii; however , it was noted that the side effects, including nausea, bloating, and diarrhea, were lower. In addition, a meta-analysis by Liu et al [ 11 ] investigating S. boulardii in addition to standard triple therapy suggested that it yielded beneficial outcomes in eradication, the occurrence of adverse effects, and symptom reduction. Another meta-analysis of 18 RCTs by Zhou et al [ 19 ] demonstrated a slight pooled improvement in the eradication rate by 9% while decreasing the adverse effects by half.…”