Vonoprazan–amoxicillin dual therapy improves 14-day eradication and reduces adverse events in patients with Helicobacter pylori infection: an updated landmark systematic review and meta-analysis of 11 randomized trials with subgroup analysis
Abstract
Background Vonoprazan, a potassium-competitive acid blocker (P-CAB), may enhance Helicobacter pylori (H.pylori) eradication in combination with amoxicillin.With increasing drug resistance, dual therapy is a potential alternative to standard triple and quadruple regimens.This systematic review and meta-analysis evaluated the efficacy and safety of vonoprazan dual therapy (VDT) as first-line treatment for H. pylori infection.Methods A comprehensive systematic search on PubMed, Embase, Scopus and Cochrane Library identified 11 randomized controlled trials (RCTs) involving 2877 patients (1439 VDT; 1438 control), comparing VDT with standard triple therapy, quadruple therapy or individualized treatment regimens for H. pylori eradication, up to March 2025.Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method for dichotomous outcomes.Random or fixed-effects models were applied based on heterogeneity, assessed using the Higgins I 2 statistic.A P-value <0.05 was considered statistically significant.Results VDT significantly improved eradication rates compared to standard therapy (RR 1.06, 95%CI 1.00-1.12;P<0.0001), driven primarily by 14-day regimens (RR 1.08, 95%CI 1.01-1.15;P=0.0001); no benefit was seen for 7-day regimens (RR 0.97, 95%CI 0.91-1.04;P=0.30), with low heterogeneity (8.6%).There was no significant difference in drug compliance (RR 1.02, 95%CI 0.99-1.05;P=0.03), with moderate heterogeneity (50.3%).VDT demonstrated…
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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: 2,877 participants or records.
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