Tegoprazan-Amoxicillin Dual Therapy Versus Bismuth Quadruple Therapy Versus Tegoprazan-Based Quadruple Therapy for Helicobacter pylori Eradication: A Network Meta-Analysis
Abstract
Helicobacter pylori eradication remains a global clinical challenge, compounded by rising antibiotic resistance. Bismuth quadruple therapy (BQT) is the guideline-preferred first-line regimen, yet its high pill burden and adverse event profile limit real-world adherence. Tegoprazan, a novel potassium-competitive acid blocker (P-CAB), has demonstrated potent acid suppression and is being evaluated both as a dual therapy (tegoprazan-amoxicillin dual therapy (TADT)) and as a component of quadruple regimens (tegoprazan-based quadruple therapy (TBQT)). The aim of this study was to compare the efficacy, compliance, and adverse event profile of TADT, BQT, and TBQT for first-line H. pylori eradication using network meta-analysis (NMA) methodology. A systematic search of PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus was conducted from inception to March 5, 2026. Randomised controlled trials (RCTs) and observational studies comparing at least two of the three specified regimens in treatment-naive adults were eligible. Eight studies (seven RCTs and one observational) encompassing 3,513 patients were included. All three regimens achieved statistically comparable H. pylori eradication rates. The risk ratio (RR) for BQT versus TADT was 0.82 (95% confidence interval (CI): 0.53-1.28), and for TBQT versus TADT, the RR was 1.01 (95% CI: 0.63-1.61). Treatment compliance was equally high across regimens (all comparisons p > 0.05).…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 3,513 participants or records.
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