Comparing potassium-competitive acid blocker-based therapies for Helicobacter pylori infection: A Bayesian network meta-analysis of 77 randomised controlled trials
Abstract
Background: Eradication rates for Helicobacter pylori (H. pylori) with proton pump inhibitor (PPI)-based therapy have declined due to rising resistance and pharmacokinetic limitations. Several potassium-competitive acid blockers (PCABs) are now approved for H. pylori eradication. However, direct comparisons among PCABs-based regimens are limited.
Aim: To evaluate the efficacy, safety and compliance of PCAB-based regimens for H. pylori eradication.
Methods: Randomised controlled trials in adults with H. pylori infection, evaluating PCAB-based dual, triple, or bismuth quadruple regimens or comparing PCAB- with PPI-based regimens, were included. The primary outcome was eradication rate; secondary outcomes were compliance and adverse events. Proportional meta-analysis and Bayesian network meta-analysis (NMA) with a random-effects model were conducted to compare efficacy and safety. Pooled estimates were expressed in odd ratio (OR) and corresponding 95% confidence intervals (CIs). Ranking used surface under the cumulative ranking curve (SUCRA). Subgroup analyses were conducted to explore potential sources of heterogeneity.
Results: Seventy-seven RCTs involving 19,950 patients were included. Vonoprazan (VPZ)-based regimens showed the highest eradication rates in proportional meta-analysis (88.15-91.94%), while tegoprazan (TPZ)- and keverprazan (KEV)-based regimens demonstrated more variable performance. NMA demonstrated a significantly higher eradication rate in patients treated…
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: 19,950 participants or records.
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