Amoxicillin-vonoprazan dual therapy for Helicobacter pylori eradication: A systematic review and meta-analysis

Background and Aim The efficacy and safety of amoxicillin-vonoprazan (VA) dual therapy remained unclear. Methods This systematic review was conducted in accordance with the PRISMA 2009 guidelines. A systematic search of the Pubmed, Embase, and Cochrane database was conducted using the combination of Helicobacter pylori or H. pylori or Hp, amoxicillin or penicillin, and Vonoprazan or TAK-438 or Takecab or (potassium AND competitive) or potassium-competitive. The initial and secondary outcome of this meta-analysis was to evaluate the efficacy and safety of VA dual therapy. Results Three studies and 668 H. pylori infected patients were included in this meta-analysis. The crude eradication rate of VA dual therapy was 87.5% and 89.6% by ITT and PP analysis, respectively. No significant differences were observed regarding the VA dual therapy and vonoprazan-amoxicillin-clarithromycin (VAC) triple therapy according to ITT (RR = 0.99, 95% CI, 0.93-1.05, P = 0.65) and PP (RR = 0.99, 95% CI, 0.94-1.05, P = 0.82) analysis. The side effect of VA dual therapy was 19.1% (95% CI, 5.9-32.4), which was lower than that of VAC triple therapy but there was no statistical significance (RR = 0.75, 95% CI, 0.59-1.06, P = 0.12). Conclusion VA dual therapy shows acceptable efficacy, good safety and avoid unnecessary antibiotic use in the first-line treatment for H. pylori infection. However, its application in other regions need to be further explored.

Automated summary

This study systematically evaluated the efficacy and safety of amoxicillin-vonoprazan dual therapy for H. pylori infection. The results showed that this therapy had comparable eradication rates to other therapies and a lower rate of side effects.