Abosheaishaa Hazem, Elsayed Hesham, Abdelhalim Omar, Haddad Islam Mohsen El, Harfoush Mohamed K, Abdallfatah Abdallfatah, Sethi Arshia, Abusuliman Mohammed, Karna Rahul, Bilal Mohammad
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai/NYC Health + Hospitals, Queens, New York, USA.
Faculty of Medicine, Tanta University, Tanta, Egypt.
Proc (Bayl Univ Med Cent). 2025 Apr 22;38(5):716-721. doi: 10.1080/08998280.2025.2491964. eCollection 2025.
infection can cause peptic ulcer disease, chronic gastritis, primary gastric lymphoma, and gastric cancer. Treatment with bismuth-based quadruple therapy is typically the first line of treatment but can be challenging due to increased pill burden and adverse effects, leading to nonadherence to therapy. Recent studies have shown that vonoprazan can be used in combination with amoxicillin as a potential treatment option. We conducted a systematic review and meta-analysis to assess the efficacy and tolerability of vonoprazan-based dual therapy as compared to bismuth-based therapy (BBT).
We conducted a comprehensive search of multiple electronic databases including PubMed, Embase, and Cochrane Library to identify randomized controlled studies assessing vonoprazan and amoxicillin (VA) in comparison to BBT for treatment in adults >18 years of age. Studies with pediatric populations, written in languages other than English, or without control groups were excluded.
Out of the 1968 citations, 9 studies including 2039 patients were included in the final analysis. There were 463 and 481 men in the VA and the BBT groups, respectively. The mean age ranged from 38.1 to 48.7 years in the VA group and from 38.6 to 46.1 in the BBT group. The VA group had an eradication rate similar to that of the BBT group (odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.26-0.40; = 0.08). The VA group had a lower incidence of total adverse events than the BBT group (OR: 0.32, 95% CI: 0.26-0.40; = 0.0001), including a reduced occurrence of nausea and vomiting (OR: 0.42, 95% CI: 0.28-0.65; = 0.0001). There was no difference in compliance between the VA and BBT groups (OR: 1.16, 95% CI: 0.76-1.76; = 0.50).
Our study showed a similar eradication rate of but a significantly lower incidence of adverse events in the VA group compared with the BBT group. Our analysis suggests that a VA-based regimen is an acceptable treatment option for patients who cannot tolerate BBT.
感染可导致消化性溃疡病、慢性胃炎、原发性胃淋巴瘤和胃癌。基于铋剂的四联疗法通常是一线治疗方法,但由于药丸负担增加和不良反应,可能具有挑战性,导致治疗依从性差。最近的研究表明,沃克奥美拉唑可以与阿莫西林联合使用作为一种潜在的治疗选择。我们进行了一项系统评价和荟萃分析,以评估基于沃克奥美拉唑的双联疗法与基于铋剂的疗法(BBT)相比的疗效和耐受性。
我们对包括PubMed、Embase和Cochrane图书馆在内的多个电子数据库进行了全面检索,以确定评估沃克奥美拉唑和阿莫西林(VA)与BBT相比用于18岁以上成年人治疗的随机对照研究。排除涉及儿科人群、非英文撰写或没有对照组的研究。
在1968条引用文献中,最终分析纳入了9项研究,共2039例患者。VA组和BBT组分别有463名和481名男性。VA组的平均年龄在38.1至48.7岁之间,BBT组在38.6至46.1岁之间。VA组的根除率与BBT组相似(优势比[OR]:0.32,95%置信区间[CI]:0.26 - 0.40;P = 0.08)。VA组的总不良事件发生率低于BBT组(OR:0.32,95% CI:0.26 - 0.40;P = 0.0001),包括恶心和呕吐的发生率降低(OR:0.42,95% CI:0.28 - 0.65;P = 0.0001)。VA组和BBT组之间的依从性没有差异(OR:1.16,95% CI:0.76 - 1.76;P = 0.50)。
我们的研究表明,VA组的根除率与BBT组相似,但不良事件发生率显著低于BBT组。我们的分析表明,对于不能耐受BBT的患者,基于VA的治疗方案是一种可接受的治疗选择。