Comparative efficacy and pharmacological heterogeneity of individual potassium-competitive acid blockers: A systematic review and network meta-analysis

Figure 3 Forest plot of individual potassium-competitive acid blockers (vonoprazan, tegoprazan, keverprazan) vs proton pump inhibitor for clarithromycin-resistant Helicobacter pylori eradication. Each row represents a randomized controlled trial, with squares indicating point estimates of odds ratio (OR) and horizontal lines representing 95%CIs. Diamond at the bottom shows the pooled effect estimate. Five studies reported clarithromycin resistance subgroup data. High-acid dissociation constant; potassium-competitive acid blockers (vonoprazan, keverprazan) and low-acid dissociation constant tegoprazan achieved pooled OR = 3.32 (95%CI: 1.79-6.16) compared with proton pump inhibitors (PPIs). Vonoprazan-based regimens (3 arms) achieved 65.8%-82.0% eradication in clarithromycin-resistant infections vs 31.9%-40.0% with PPIs. Keverprazan showed 83.5% vs 77.0% with a not significant OR of 1.51 (95%CI: 0.83-2.76), likely attenuated by the high baseline eradication rate in the Chinese PPI arm. Tegoprazan showed 47.8% vs 35.5% (OR = 1.67, not significant). Heterogeneity was substantial (I² = 72.3%, P = 0.006), reflecting geographic and methodological differences. P-CAB: Potassium-competitive acid blocker; PPI: Proton pump inhibitor.