Post Graduate Program at Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom.
World J Gastroenterol. 2024 Mar 7;30(9):1213-1223. doi: 10.3748/wjg.v30.i9.1213.
() infects over half the global population, causing gastrointestinal diseases like dyspepsia, gastritis, duodenitis, peptic ulcers, G-MALT lymphoma, and gastric adenocarcinoma. Eradicating is crucial for treating and preventing these conditions. While conventional proton pump inhibitor (PPI)-based triple therapy is effective, there's growing interest in longer acid suppression therapies. Potassium competitive acid blocker (P-CAB) triple and dual therapy are new regimens for eradication. Initially used in Asian populations, vonoprazan (VPZ) has been recently Food and Drug Administration-approved for eradication.
To assess the efficacy of regimens containing P-CABs in eradicating infection.
This study, following PRISMA 2020 guidelines, conducted a systematic review and meta-analysis by searching MEDLINE and Scopus libraries for randomized clinical trials (RCTs) or observational studies with the following command: [("" OR "H pylori") AND ("Treatment" OR "Therapy" OR "Eradication") AND ("Vonaprazan" OR "Potassium-Competitive Acid Blocker" OR "P-CAB" OR "PCAB" OR "Revaprazan" OR "Linaprazan" OR "Soraprazan" OR "Tegoprazan")]. Studies comparing the efficacy of P-CABs-based treatment to classical PPIs in eradicating were included. Exclusion criteria included case reports, case series, unpublished trials, or conference abstracts. Data variables encompassed age, diagnosis method, sample sizes, study duration, intervention and control, and eradication method were gathered by two independent reviewers. Meta-analysis was performed in R software, and forest plots were generated.
A total of 256 references were initially retrieved through the search command. Ultimately, fifteen studies (7 RCTs, 7 retrospective observational studies, and 1 comparative unique study) were included, comparing P-CAB triple therapy to PPI triple therapy. The intention-to-treat analysis involved 8049 patients, with 4471 in the P-CAB intervention group and 3578 in the PPI control group across these studies. The analysis revealed a significant difference in eradication between VPZ triple therapy and PPI triple therapy in both RCTs and observational studies [risk ratio (RR) = 1.17, 95% confidence interval (CI): 1.11-1.22, < 0.0001] and (RR = 1.13, 95%CI: 1.09-1.17, < 0.0001], respectively. However, no significant difference was found between tegoprazan (TPZ) triple therapy and PPI triple therapy in both RCTs and observational studies (RR = 1.04, 95%CI: 0.93-1.16, = 0.5) and (RR = 1.03, 95%CI: 0.97-1.10, = 0.3), respectively.
VPZ-based triple therapy outperformed conventional PPI-based triple therapy in eradicating , positioning it as a highly effective first-line regimen. Additionally, TPZ-based triple therapy was non-inferior to classical PPI triple therapy.
幽门螺杆菌（）感染了全球一半以上的人口，导致了消化不良、胃炎、十二指肠炎、消化性溃疡、胃黏膜相关淋巴组织淋巴瘤和胃腺癌等胃肠道疾病。根除是治疗和预防这些疾病的关键。虽然传统的质子泵抑制剂（PPI）三联疗法有效，但人们对更长时间的抑酸治疗越来越感兴趣。钾竞争性酸阻滞剂（P-CAB）三联和双联疗法是新的根除方案。沃诺拉赞（VPZ）最初在亚洲人群中使用，最近已被美国食品和药物管理局批准用于根除。
评估含 P-CAB 的方案根除 感染的疗效。
本研究遵循 PRISMA 2020 指南，通过搜索 MEDLINE 和 Scopus 数据库中的随机临床试验（RCT）或观察性研究，使用以下命令进行系统评价和荟萃分析：["（""或""H pylori""）和（""治疗""或""疗法""或""根除""）和（""沃诺拉赞""或""钾竞争性酸阻滞剂""或""P-CAB""或""PCAB""或""Revaprazan""或""Linaprazan""或""Soraprazan""或""Tegoprazan""）"]。纳入比较 P-CAB 为基础的治疗与经典 PPI 在根除方面疗效的研究。排除标准包括病例报告、病例系列、未发表的试验或会议摘要。两名独立评审员通过收集年龄、诊断方法、样本量、研究持续时间、干预和对照以及 根除方法等数据变量进行分析。使用 R 软件进行荟萃分析，并生成森林图。
通过搜索命令最初检索到 256 篇参考文献。最终，纳入了 15 项研究（7 项 RCT、7 项回顾性观察性研究和 1 项比较性独特研究），比较了 P-CAB 三联疗法与 PPI 三联疗法。意向治疗分析涉及 8049 名患者，其中 P-CAB 干预组 4471 名，PPI 对照组 3578 名。分析结果显示，VPZ 三联疗法与 PPI 三联疗法在 RCT 和观察性研究中均显著提高了 根除率[风险比（RR）=1.17，95%置信区间（CI）：1.11-1.22，<0.0001]和（RR=1.13，95%CI：1.09-1.17，<0.0001]。然而，在 RCT 和观察性研究中，TPZ 三联疗法与 PPI 三联疗法的 根除率无显著差异[RR=1.04，95%CI：0.93-1.16，=0.5]和（RR=1.03，95%CI：0.97-1.10，=0.3）。
VPZ 为基础的三联疗法在根除方面优于传统的 PPI 为基础的三联疗法，是一种非常有效的一线治疗方案。此外，TPZ 为基础的三联疗法与经典的 PPI 三联疗法非劣效。
