Jiang Yutong, Zhang Rongrong, Fang Yuxuan, Zhao Ruixia, Fu Yu, Ren Pingping, Zhan Qingqing, Shao Mingyi
The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China.
The First Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China.
Therap Adv Gastroenterol. 2024 May 14;17:17562848241241223. doi: 10.1177/17562848241241223. eCollection 2024.
The efficacy and safety of potassium-competitive acid blockers (P-CABs) in the eradication of (Hp) remains controversial when compared with proton pump inhibitors (PPIs).
The current study set out to compare the differences in the eradication rate and adverse reactions between eradication regimens based on P-CAB or PPI drugs and the differences between the vonoprazan-based and the tegoprazan-based regimens to explore the efficacy and safety of different Hp eradication regimens.
Databases including PubMed, EMBASE, Cochrane Library, and WOS were searched from the inception of these databases up to July 2023, and eligible randomized controlled trials (RCTs) were included. The outcome measures were the eradication rate and the incidence of adverse reactions of different regimens in treating Hp. The results were estimated as relative risk (RR) and its 95% confidence interval (CI), and R 4.2.1 software was used to perform the network meta-analysis (NMA).
A total of 20 studies were included in the analysis, involving 5815 patients with Hp. In terms of eradication rate, the 2-week vonoprazan-based triple regimen (V-Tri-2w) was the best, which was superior to the 2-week PPI-based quadruple regimen [P-Qua-2w, RR = 0.9, 95% CI: (0.85-0.95)] and the 1-week tegoprazan-based triple regimen [T-Tri-1w, RR = 0.79, 95% CI: (0.64-0.97)]; the 2-week tegoprazan-based quadruple regimen (T-Qua-2w) was superior to the 1-week PPI-based triple regimen [P-Tri-1w, RR = 0.82, 95% CI: (0.67-0.99)], and there was no difference between the remaining tegoprazan-based regimens and the PPI-based or vonoprazan-based regimens. In terms of the incidence of adverse reactions, the 2-week vonoprazan-based binary regimen (V-Bi-2w) was lower than that of the 2-week PPI-based quadruple regimen [P-Qua-2w, RR = 1.98, 95% CI: (1.57-2.52)]; there was no significant difference between 1 and 2 weeks for each regimen, such as the vonoprazan-based triple regimen [RR = 1.11, 95% CI: (0.82-1.52)].
In the eradication treatment of Hp, the efficacy and safety of vonoprazan-based regimens are generally better than those of PPI-based regimens. Among them, the V-Tri-2w regimen has the highest eradication rate and may be the preferred choice for Hp eradication.
与质子泵抑制剂（PPI）相比，钾离子竞争性酸阻滞剂（P-CAB）根除幽门螺杆菌（Hp）的疗效和安全性仍存在争议。
本研究旨在比较基于P-CAB或PPI药物的根除方案在根除率和不良反应方面的差异，以及沃克帕唑和替戈帕唑方案之间的差异，以探讨不同Hp根除方案的疗效和安全性。
检索了包括PubMed、EMBASE、Cochrane图书馆和WOS在内的数据库，检索时间从这些数据库建立至2023年7月，纳入符合条件的随机对照试验（RCT）。结局指标为不同方案治疗Hp的根除率和不良反应发生率。结果以相对风险（RR）及其95%置信区间（CI）进行估计，并使用R 4.2.1软件进行网络荟萃分析（NMA）。
共纳入20项研究，涉及5815例Hp患者。在根除率方面，2周的基于沃克帕唑的三联方案（V-Tri-2w）最佳，优于2周的基于PPI的四联方案[P-Qua-2w，RR = 0.9，95%CI：（0.85 - 0.95）]和1周的基于替戈帕唑的三联方案[T-Tri-1w，RR = 0.79，95%CI：（0.64 - 0.97）]；2周的基于替戈帕唑的四联方案（T-Qua-2w）优于1周的基于PPI的三联方案[P-Tri-1w，RR = 0.82，95%CI：（0.67 - 0.99）]，其余基于替戈帕唑的方案与基于PPI或沃克帕唑的方案之间无差异。在不良反应发生率方面，2周的基于沃克帕唑的二联方案（V-Bi-2w）低于2周的基于PPI的四联方案[P-Qua-2w，RR = 1.98，95%CI：（1.57 - 2.52）]；各方案1周和2周之间无显著差异，如基于沃克帕唑的三联方案[RR = 1.11，95%CI：（0.82 - 1.52）]。
在Hp根除治疗中，基于沃克帕唑的方案的疗效和安全性总体上优于基于PPI的方案。其中，V-Tri-2w方案根除率最高，可能是Hp根除的首选方案。
