Systematic review with meta-analysis: Vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori

BackgroundVonoprazan is a novel gastric acid suppressant that is applied in Japan to treat gastric diseases including Helicobacter pylori (H.pylori) infection. This meta-analysis aimed to summarize the ability of vonoprazan to eradicate clarithromycin-susceptible and clarithromycin-resistant H.pylori strains. Materials and MethodsA systematic search was performed using PubMed, EMBASE, Web of Science, and Cochrane Library. Studies were included if they evaluated eradication rates of vonoprazan-based and conventional PPI-based triple therapies and checked for clarithromycin susceptibility of H.pylori. ResultsWe identified 5 studies including a total of 1599 patients containing data regarding H.pylori with clarithromycin susceptibility. Among those infected with clarithromycin-susceptible H.pylori, eradication rates for vonoprazan-based and conventional PPI-based therapies did not significantly differ in either the randomized (RCT; pooled eradication rates, 95.4% vs 92.8%; pooled odds ratio [OR], 1.63; 95% confidence intervals [CI], 0.74-3.61; P=.225) and nonrandomized (NRCT; pooled eradication rates, 92.9% vs 86.2%; OR, 4.58; 95% CI, 0.67-31.45; P=.122) controlled trials. However, vonoprazan-based triple therapy was significantly superiority to PPI-based therapy for patients with clarithromycin-resistant strains in both RCT (pooled eradication rates, 82.0% vs 40.0%; OR, 6.83; 95% CI, 3.63-12.86; P<.0001) and NRCT (pooled eradication rates, 80.8% vs 41.8%; OR, 4.98; 95% CI, 2.47-10.03; P<.0001). ConclusionsVonoprazan-based and conventional PPI-based therapies are similarly effective for the eradication of clarithromycin-susceptible H.pylori strains. Vonoprazan is superior to conventional PPI-based therapy for the eradication of clarithromycin-resistant H.pylori strains. However, clarithromycin was misused because the combination of vonoprazan and amoxicillin cures approximately 80% of infections without clarithromycin.