Abstract：
BACKGROUND: This study aims to evaluate the efficacy and safety of vonoprazan-amoxicillin (VA), vonoprazan-amoxicillin-clarithromycin (VAC), vonoprazan-based bismuth-containing quadruple therapy (VBQT), and PPI-based triple (PAC) or quadruple therapy (PBQT) for H. pylori infection with the consideration of duration of therapy and amoxicillin dose (H: high; L: low).
METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for eligible randomized controlled trials (RCTs) up to December 15, 2023. The efficacy outcome was eradication rate, and safety outcomes included the rates of adverse events and treatment discontinuation.
RESULTS: Twenty-seven RCTs were included. The pooled eradication rates were 82.8% for VA, 89.1% for VAC, and 91.8% for VBQT, which increased with the higher amoxicillin frequency of administration and extended duration of therapy within each regimen. There were no significant differences in eradication rate when comparing 7-VA versus 7-VAC and 14-VA versus 14-VAC. VA was at least comparable to PAC. The eradication rate did not differ significantly between 10-H-VA or 14-H-VA versus 14-PBQT. 7-L-VAC demonstrated higher eradication rate versus 7-PAC and comparable rate to 14-PAC. 14-VBQT showed higher eradication rates versus 14-PBQT. The adverse events rate was 19.3% for VA, 30.6% for VAC, and 38.4% for VBQT. VA had similar risk of adverse events versus VAC and significantly fewer adverse events compared to PBQT. The treatment discontinuation rate did not differ significantly between treatments.
CONCLUSIONS: The eradication rate of VBQT was the highest at above 90% followed by VAC and VA. VA was as effective as VAC and superior to PPI-based therapies with favorable safety, highlighting the potential of VA therapy as a promising alternative to traditional PPI-based therapies. VPZ-based triple or quadruple therapies was more effective than PPI-based therapies. Further studies are needed to establish the optimal treatment regimen especially in the western countries.
METHODS: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for eligible randomized controlled trials (RCTs) up to December 15, 2023. The efficacy outcome was eradication rate, and safety outcomes included the rates of adverse events and treatment discontinuation.
RESULTS: Twenty-seven RCTs were included. The pooled eradication rates were 82.8% for VA, 89.1% for VAC, and 91.8% for VBQT, which increased with the higher amoxicillin frequency of administration and extended duration of therapy within each regimen. There were no significant differences in eradication rate when comparing 7-VA versus 7-VAC and 14-VA versus 14-VAC. VA was at least comparable to PAC. The eradication rate did not differ significantly between 10-H-VA or 14-H-VA versus 14-PBQT. 7-L-VAC demonstrated higher eradication rate versus 7-PAC and comparable rate to 14-PAC. 14-VBQT showed higher eradication rates versus 14-PBQT. The adverse events rate was 19.3% for VA, 30.6% for VAC, and 38.4% for VBQT. VA had similar risk of adverse events versus VAC and significantly fewer adverse events compared to PBQT. The treatment discontinuation rate did not differ significantly between treatments.
CONCLUSIONS: The eradication rate of VBQT was the highest at above 90% followed by VAC and VA. VA was as effective as VAC and superior to PPI-based therapies with favorable safety, highlighting the potential of VA therapy as a promising alternative to traditional PPI-based therapies. VPZ-based triple or quadruple therapies was more effective than PPI-based therapies. Further studies are needed to establish the optimal treatment regimen especially in the western countries.
摘要：
背景：这项研究旨在评估vonoprazan-阿莫西林（VA）的疗效和安全性，vonoprazan-阿莫西林-克拉霉素（VAC），基于vonoprazan的含铋四联疗法（VBQT），和基于PPI的三联疗法（PAC）或四联疗法（PBQT）用于幽门螺杆菌感染，同时考虑治疗持续时间和阿莫西林剂量（H：高；L：低）。
方法：PubMed，Embase,我们在Cochrane中央对照试验注册中心中搜索了截至2023年12月15日的符合条件的随机对照试验(RCT).疗效结果为根除率，安全性结局包括不良事件发生率和治疗中止率.
结果：纳入了27个随机对照试验。VA的合并根除率为82.8%，VAC为89.1%，VBQT为91.8%，随着阿莫西林给药频率的增加和每种方案治疗持续时间的延长而增加。比较7-VA与7-VAC和14-VA与14-VAC时，根除率没有显着差异。VA至少与PAC相当。10-H-VA或14-H-VA与14-PBQT的根除率没有显着差异。与7-PAC相比，7-L-VAC的根除率更高，与14-PAC的根除率相当。与14-PBQT相比，14-VBQT显示更高的根除率。VA的不良事件发生率为19.3%，VAC为30.6%，VBQT为38.4%。与VAC相比，VA具有相似的不良事件风险，与PBQT相比，不良事件明显减少。治疗中止率在治疗之间没有显着差异。
结论：VBQT的根除率最高，达90％以上，其次是VAC和VA。VA与VAC一样有效，优于基于PPI的治疗，具有良好的安全性，强调VA治疗作为传统PPI治疗的有希望的替代方案的潜力。基于VPZ的三联或四联疗法比基于PPI的疗法更有效。需要进一步的研究来建立最佳的治疗方案，尤其是在西方国家。
方法：PubMed，Embase,我们在Cochrane中央对照试验注册中心中搜索了截至2023年12月15日的符合条件的随机对照试验(RCT).疗效结果为根除率，安全性结局包括不良事件发生率和治疗中止率.
结果：纳入了27个随机对照试验。VA的合并根除率为82.8%，VAC为89.1%，VBQT为91.8%，随着阿莫西林给药频率的增加和每种方案治疗持续时间的延长而增加。比较7-VA与7-VAC和14-VA与14-VAC时，根除率没有显着差异。VA至少与PAC相当。10-H-VA或14-H-VA与14-PBQT的根除率没有显着差异。与7-PAC相比，7-L-VAC的根除率更高，与14-PAC的根除率相当。与14-PBQT相比，14-VBQT显示更高的根除率。VA的不良事件发生率为19.3%，VAC为30.6%，VBQT为38.4%。与VAC相比，VA具有相似的不良事件风险，与PBQT相比，不良事件明显减少。治疗中止率在治疗之间没有显着差异。
结论：VBQT的根除率最高，达90％以上，其次是VAC和VA。VA与VAC一样有效，优于基于PPI的治疗，具有良好的安全性，强调VA治疗作为传统PPI治疗的有希望的替代方案的潜力。基于VPZ的三联或四联疗法比基于PPI的疗法更有效。需要进一步的研究来建立最佳的治疗方案，尤其是在西方国家。
