Treatment of Helicobacter pylori with potassium competitive acid blockers: A systematic review and meta-analysis

ARTICLE HIGHLIGHTS

Research background

Helicobacter pylori (H. pylori) infection affects over 50% of the global population, with varying prevalence worldwide. The bacterium is linked to gastroduodenal conditions, including chronic gastritis, peptic ulcers, and gastric adenocarcinomas. Childhood infection, particularly in socioeconomically challenged environments, significantly elevates adult infection rates. Successful H. pylori eradication is crucial for mucosal healing and reducing gastric cancer incidence. However, rising antibiotic resistance and suboptimal therapeutic regimens pose challenges to eradication. Vonoprazan (VPZ), a potassium-competitive acid blocker (P-CAB), offers a promising alternative to conventional proton pump inhibitors (PPIs). With unique pharmacokinetics and diverse clinical applications, VPZ has gained Food and Drug Administration approval for H. pylori eradication therapy.

Research motivation

The increasing prevalence of H. pylori antibiotic resistance and suboptimal therapeutic outcomes necessitate innovative eradication strategies. VPZ emerges as a novel, effective alternative with distinct pharmacokinetics and versatile clinical applications. Addressing the efficacy of regimens incorporating P-CABs in H. pylori eradication is crucial. This study seeks to unravel the potential of VPZ-based therapies in overcoming challenges associated with conventional treatments, impacting future research directions in the field of H. pylori eradication.

Research objectives

The primary objective of this study is to evaluate the efficacy of regimens containing P-CABs, particularly focusing on VPZ, in eradicating H. pylori infection. The study aims to analyze key parameters, including eradication rates, adverse events, and compliance, to provide a comprehensive understanding of VPZ-based therapies. By achieving these objectives, the study contributes valuable insights into optimizing H. pylori eradication strategies, guiding future research towards more effective and tailored therapeutic approaches in gastroenterology and infectious diseases.

Research methods

This systematic review and meta-analysis followed the PRISMA 2020 guidelines and conducted a comprehensive literature search in MEDLINE and Scopus libraries. Inclusion criteria encompassed randomized clinical trials (RCTs) or observational studies comparing the efficacy of P-CABs with classical PPIs for H. pylori eradication. Exclusion criteria ruled out case reports, case series, unpublished trials, and conference abstracts. Two independent reviewers screened titles, abstracts, and full papers, extracting data on efficacy rates and relevant variables. Descriptive techniques, including frequency, means, and medians, were employed for data summarization. The meta-analysis utilized R software version 4.3.2 and the meta package.

Research results

The systematic review and meta-analysis identified 15 studies, including 7 RCTs and 7 retrospective observational studies, contributing valuable insights into the efficacy and safety of regimens containing P-CABs for H. pylori eradication. The majority of studies were conducted in Asia, particularly in Japan and South Korea, with limited representation from Western regions. The analysis, comprising 8049 patients, demonstrated that VPZ triple therapy significantly outperformed conventional PPI triple therapy, showcasing its statistical superiority in H. pylori eradication. Conversely, tegoprazan (TPZ) triple therapy was found to be non-inferior to classical PPI-based treatment. Observational studies reinforced these findings, emphasizing the superiority of VPZ triple therapy over PPI-based regimens. Additionally, second-line therapy with VPZ demonstrated non-inferiority to PPI-based second-line treatment for H. pylori eradication. Notably, all P-CAB regimens exhibited good tolerability and safety profiles, aligning with PPI treatments. These results contribute comprehensive evidence supporting the efficacy and safety of P-CABs, particularly VPZ, in H. pylori eradication therapy. Further research may explore the application of these findings in diverse populations and regions.

Research conclusions

This study advances the understanding of H. pylori eradication therapy by demonstrating the statistical superiority of VPZ-based triple therapy over conventional PPI-based regimens. The research concludes that TPZ-based triple therapy is non-inferior to PPI-based triple regimens. Notably, the study introduces the novel concept of P-CABs, specifically VPZ and TPZ, as effective alternatives in H. pylori eradication. By presenting robust evidence from 15 studies, including RCTs and observational studies, the research contributes to evolving treatment paradigms. The findings highlight VPZ’s superior efficacy and TPZ’s non-inferiority, offering clinicians valuable insights into alternative therapies amid rising antibiotic resistance. This study stands as a significant departure from conventional PPI-centric approaches and introduces P-CABs as viable options for H. pylori eradication, addressing the pressing need for alternative treatments in the face of declining PPI effectiveness.

Research perspectives

Future research should delve into the broader application of P-CAB-based triple and dual therapy beyond the predominantly studied Eastern populations. Assessing the generalizability of VPZ and TPZ efficacy to diverse demographic groups is crucial for informing global H. pylori eradication strategies. Additionally, further investigations should explore the impact of P-CABs in regions with varying genetic, dietary, and lifestyle factors, influencing gastric acidity levels. Addressing the limitations of this study, such as the limited pooled sample size and focused demographic representation, will enhance the external validity of findings. Future studies could integrate comprehensive analyses of antibiotic resistance, particularly clarithromycin resistance, to refine treatment recommendations. Economical considerations, emphasized in the study, warrant exploration through cost-effectiveness analyses in diverse healthcare settings. As the study hints at the potential affordability challenges of VPZ triple therapy in developing countries, future research could explore strategies for enhancing accessibility, such as government-subsidized generic forms. These perspectives collectively guide future research to broaden the scope, applicability, and accessibility of P-CAB-based therapies, fostering a more nuanced understanding of their role in global H. pylori eradication efforts.