1. Efficacy and safety of vonoprazan and high-dose amoxicillin dual therapy in eradicating Helicobacter pylori: A systematic review and meta-analysis.
- Author
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Zhang J, Zhang H, Zhu XJ, Yao N, Yin JM, Liu J, Dan HJ, Pang QM, Liu ZH, and Shi YQ
- Subjects
- Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Sulfonamides administration & dosage, Sulfonamides adverse effects, Sulfonamides therapeutic use, Helicobacter Infections drug therapy, Amoxicillin administration & dosage, Amoxicillin therapeutic use, Pyrroles administration & dosage, Pyrroles therapeutic use, Pyrroles adverse effects, Helicobacter pylori drug effects, Drug Therapy, Combination, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Anti-Bacterial Agents adverse effects, Proton Pump Inhibitors administration & dosage, Proton Pump Inhibitors therapeutic use, Proton Pump Inhibitors adverse effects
- Abstract
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., Competing Interests: Declarations Funding: This work was supported by grants from Shaanxi Health Scientific Research Innovation Team Project (No. 2024TD-06) and Shaanxi Key Research & Development Project (No. 2023-ZDLSF-35). Competing Interests: None. Ethical Approval: Not required. Sequence Information: Not applicable., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2024
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