Potassium-Competitive Acid Blockers for First-Line Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis
Abstract
Background and aims: Potassium-competitive acid blockers (P-CABs) have emerged as an alternative to proton pump inhibitors (PPIs) for Helicobacter pylori eradication. However, much of the available evidence is based on comparisons with suboptimal PPI-based regimens. We conducted a systematic review and meta-analysis to compare P-CAB-based regimens with bismuth-containing PPI (B-PPI)-based quadruple therapies as first-line treatment for H pylori eradication.
Methods: A systematic search of PubMed, ScienceDirect, Cochrane, and Scopus databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials comparing P-CAB-based regimens with B-PPI-based quadruple therapies were included. Pooled risk ratios (RRs) were calculated. The primary outcome was the eradication rate; secondary outcomes were treatment compliance and subgroup analysis according to the specific P-CAB used.
Results: Twenty-five trials including 8789 patients were analyzed. In the intention-to-treat analysis, pooled eradication rates were 86.8% for P-CAB-based regimens and 83.3% for PPI-based quadruple therapy (RR: 1.04; 95% confidence interval [CI]: 1.01-1.07; P = .005). In the per-protocol analysis, no statistical significance was observed (89.4% vs 88.5%; RR: 1.02; 95% CI: 0.99-1.05; P = .17). Treatment compliance was similar between groups (92.6% vs 91.3%; RR: 1.01; 95% CI: 0.99-1.02; P = .40). In subgroup analyses, no significant…
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: 8,789 participants or records.
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