The Efficacy and Safety of Vonoprazan and Amoxicillin Dual Therapy for Helicobacter pylori Infection: A Systematic Review and Network Meta-Analysis
Abstract
:1. Introduction
2. Method
2.1. Search Strategy and Selection Criteria
2.2. Outcome Measures
2.3. Data Extraction and Quality Assessment
2.4. Data Synthesis and Statistical Analysis
2.5. Subgroup Analysis
3. Results
3.1. Study Characteristics and Quality Assessment
3.2. Primary Outcome: Efficacy
3.3. Subgroup Analysis
3.3.1. Study Type Effect
3.3.2. Treatment Duration Effect
3.3.3. Amoxicillin Dose Effect
3.3.4. Regional Effect
3.3.5. Efficacy of Clarithromycin-Resistant Strains
3.4. Secondary Outcomes
3.4.1. Treatment Discontinuation
3.4.2. Total Incidence of Adverse Events
3.4.3. Diarrhea
3.4.4. Abdominal Pain
3.4.5. Bloating
3.4.6. Constipation
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Matsumoto, H.; Shiotani, A.; Graham, D.Y. Current and future treatment of Helicobacter pylori infections. Adv. Exp. Med. Biol. 2019, 1149, 211–225. [Google Scholar] [PubMed]
- Crowe, S.E. Helicobacter pylori infection. N. Engl. J. Med. 2019, 380, 1158–1165. [Google Scholar] [CrossRef] [PubMed]
- Peery, A.F.; Crockett, S.D.; Murphy, C.C.; Jensen, E.T.; Kim, H.P.; Egberg, M.D.; Lund, J.L.; Moon, A.M.; Pate, V.; Barnes, E.L.; et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2021. Gastroenterology 2022, 162, 621–644. [Google Scholar] [CrossRef]
- International Agency for Research on Cancer. Schistosomes, Liver Flukes and Helicobacter pylori; IARC: Lyon, France, 1994; Volume 61, pp. 1–241. [Google Scholar]
- Eight Substances Added to 15th Report on Carcinogens. Available online: https://www.nih.gov/news-events/news-releases/eight-substances-added-15th-report-carcinogens#:~:text=Eight%20substances%20added%20to%2015th%20Report%20on%20Carcinogens,acids%20%28HAAs%29%20found%20as%20water%20disinfection%20byproducts%20 (accessed on 26 October 2022).
- Chiang, T.H.; Chang, W.J.; Chen, S.L.; Yen, A.M.; Fann, J.C.; Chiu, S.Y.; Chen, Y.R.; Chuang, S.L.; Shieh, C.F.; Liu, C.Y.; et al. Mass eradication of Helicobacter pylori to reduce gastric cancer incidence and mortality: A long-term cohort study on Matsu Islands. Gut 2021, 70, 243–250. [Google Scholar]
- Hooi, J.K.Y.; Lai, W.Y.; Ng, W.K.; Suen, M.M.Y.; Underwood, F.E.; Tanyingoh, D.; Malfertheiner, P.; Graham, D.Y.; Wong, V.W.S.; Wu, J.C.Y.; et al. Global prevalence of Helicobacter pylori infection: Systematic Review and Meta-Analysis. Gastroenterology 2017, 153, 420–429. [Google Scholar] [CrossRef]
- Sugano, K.; Tack, J.; Kuipers, E.J.; Graham, D.Y.; El-Omar, E.M.; Miura, S.; Haruma, K.; Asaka, M.; Uemura, N.; Malfertheiner, P.; et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut 2015, 64, 1353–1367. [Google Scholar] [CrossRef] [PubMed]
- Chey, W.D.; Leontiadis, G.I.; Howden, C.W.; Moss, S.F. ACG Clinical Guideline: Treatment of Helicobacter pylori infection. Am. J. Gastroenterol. 2017, 112, 212–239. [Google Scholar] [CrossRef] [PubMed]
- Savoldi, A.; Carrara, E.; Graham, D.Y.; Conti, M.; Tacconelli, E. Prevalence of antibiotic resistance in Helicobacter pylori: A systematic review and meta-analysis in World Health Organization Regions. Gastroenterology 2018, 155, 1372–1382.e17. [Google Scholar] [CrossRef]
- Ho, J.J.C.; Navarro, M.; Sawyer, K.; Elfanagely, Y.; Moss, S.F. Helicobacter pylori antibiotic resistance in the United States between 2011 and 2021: A systematic review and meta-analysis. Am. J. Gastroenterol. 2022, 117, 1221–1230. [Google Scholar] [CrossRef]
- Rokkas, T.; Gisbert, J.P.; Malfertheiner, P.; Niv, Y.; Gasbarrini, A.; Leja, M.; Megraud, F.; O’Morain, C.; Graham, D.Y. Comparative effectiveness of multiple different first-line treatment regimens for Helicobacter pylori infection: A network meta-analysis. Gastroenterology 2021, 161, 495–507.e4. [Google Scholar] [CrossRef]
- Strand, D.S.; Kim, D.; Peura, D.A. 25 Years of proton pump inhibitors: A comprehensive review. Gut Liver 2017, 11, 27–37. [Google Scholar] [CrossRef] [PubMed]
- Zhu, X.Y.; Liu, F. Probiotics as an adjuvant treatment in Helicobacter pylori eradication therapy. J. Dig. Dis. 2017, 18, 195–202. [Google Scholar] [CrossRef] [PubMed]
- Abdel-Aziz, Y.; Metz, D.C.; Howden, C.W. Review article: Potassium-competitive acid blockers for the treatment of acid-related disorders. Aliment. Pharmacol. Ther. 2021, 53, 794–809. [Google Scholar]
- Garnock-Jones, K.P. Vonoprazan: First global approval. Drugs 2015, 75, 439–443. [Google Scholar] [CrossRef] [PubMed]
- Kato, M.; Ota, H.; Okuda, M.; Kikuchi, S.; Satoh, K.; Shimoyama, T.; Suzuki, H.; Handa, O.; Furuta, T.; Mabe, K.; et al. Guidelines for the management of Helicobacter pylori infection in Japan: 2016 Revised Edition. Helicobacter 2019, 24, e12597. [Google Scholar] [CrossRef]
- Malfertheiner, P.; Megraud, F.; Rokkas, T.; Gisbert, J.; Liou, J.-M.; Schulz, C.; Gasbarrini, A.; Hunt, R.H.; Leja, M.; O’Morain, C.; et al. Management of Helicobacter pylori infection: The Maastricht VI/Florence consensus report. Gut 2022, 71, 1724–1762. [Google Scholar] [CrossRef]
- Simadibrata, D.M.; Syam, A.F.; Lee, Y.Y. A comparison of efficacy and safety of potassium-competitive acid blocker and proton pump inhibitor in gastric acid-related diseases: A systematic review and meta-analysis. J. Gastroenterol. Hepatol. 2022, 37, 2217–2228. [Google Scholar] [CrossRef]
- Shinozaki, S.; Kobayashi, Y.; Osawa, H.; Sakamoto, H.; Hayashi, Y.; Lefor, A.K.; Yamamoto, H. Effectiveness and safety of vonoprazan versus proton pump inhibitors for second-line Helicobacter pylori eradication therapy: Systematic review and meta-analysis. Digestion 2021, 102, 319–325. [Google Scholar] [CrossRef]
- Lyu, Q.J.; Pu, Q.H.; Zhong, X.F.; Zhang, J. Efficacy and safety of vonoprazan-based versus proton pump inhibitor-based triple therapy for Helicobacter pylori eradication: A meta-analysis of randomized clinical trials. Biomed Res. Int. 2019, 2019, 9781212. [Google Scholar] [CrossRef]
- Liu, L.; Nahata, M.C. Vonoprazan with amoxicillin or amoxicillin and clarithromycin for the treatment of Helicobacter pylori infection. Ann. Pharmacother. 2023, 10600280221149708, epub ahead of print. [Google Scholar] [CrossRef]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021, 372, n71. [Google Scholar] [CrossRef] [PubMed]
- Sterne, J.A.C.; Savović, J.; Page, M.J.; Elbers, R.G.; Blencowe, N.S.; Boutron, I.; Cates, C.J.; Cheng, H.Y.; Corbett, M.S.; Eldridge, S.M.; et al. RoB 2: A revised tool for assessing risk of bias in randomized trials. BMJ 2019, 366, l4898. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Furuta, T.; Yamade, M.; Kagami, T.; Uotani, T.; Suzuki, T.; Higuchi, T.; Tani, S.; Hamaya, Y.; Iwaizumi, M.; Miyajima, H.; et al. Dual therapy with vonoprazan and amoxicillin is as effective as triple therapy with vonoprazan, amoxicillin and clarithromycin for eradication of Helicobacter pylori. Digestion 2020, 101, 743–751. [Google Scholar] [CrossRef] [PubMed]
- Chey, W.D.; Mégraud, F.; Laine, L.; López, L.J.; Hunt, B.J.; Howden, C.W. Vonoprazan triple and dual therapy for Helicobacter pylori infection in the United States and Europe: Randomized clinical trial. Gastroenterology 2022, 163, 608–619. [Google Scholar] [CrossRef]
- Horii, T.; Suzuki, S.; Takano, C.; Shibuya, H.; Ichijima, R.; Kusano, C.; Ikehara, H.; Gotoda, T. Lower impact of vonoprazan–amoxicillin dual therapy on gut microbiota for Helicobacter pylori eradication. J. Gastroenterol. Hepatol. 2021, 36, 3314–3321. [Google Scholar] [CrossRef]
- Suzuki, S.; Gotoda, T.; Kusano, C.; Ikehara, H.; Ichijima, R.; Ohyauchi, M.; Ito, H.; Kawamura, M.; Ogata, Y.; Ohtaka, M.; et al. Seven-day vonoprazan and low-dose amoxicillin dual therapy as first-line Helicobacter pylori treatment: A multicenter randomized trial in Japan. Gut 2020, 69, 1019–1026. [Google Scholar] [CrossRef]
- Zuberi, B.F.; Ali, F.S.; Rasheed, T.; Bader, N.; Hussain, S.M.; Saleem, A. Comparison of vonoprazan and amoxicillin dual therapy with standard triple therapy with proton pump inhibitor for Helicobacter pylori eradication: A randomized control trial. Pak. J. Med. Sci. 2022, 38, 965–969. [Google Scholar] [CrossRef]
- Lin, Y.; Xu, H.; Yun, J.; Yu, X.; Shi, Y.; Zhang, D. The efficacy of vonoprazan combined with different dose amoxicillin on eradication of Helicobacter pylori: An open, multicenter, randomized clinical study. Ann. Transl. Med. 2022, 10, 987. [Google Scholar] [CrossRef]
- Suzuki, S.; Esaki, M.; Kusano, C.; Ikehara, H.; Gotoda, T. Development of Helicobacter pylori treatment: How do we manage antimicrobial resistance? World J. Gastroenterol. 2019, 25, 1907–1912. [Google Scholar] [CrossRef]
- Park, J.Y.; Dunbar, K.B.; Mitui, M.; Arnold, C.A.; Lam-Himlin, D.M.; Valasek, M.A.; Thung, I.; Okwara, C.; Coss, E.; Cryer, B.; et al. Helicobacter pylori clarithromycin resistance and treatment failure are common in the USA. Dig. Dis. Sci. 2016, 61, 2373–2380. [Google Scholar] [CrossRef]
- Shehryar, M.; Ahmad, R.U.; Kareem, H.K.; Khan, L.; Ashraf, M.F.; Hassan, A.; Saeed, S.; Tareen, H.K.; Nazir, D.A.; Ashraf, M.A. Efficacy, safety and cost-effectiveness of vonoprazan vs proton pump inhibitors in reflux disorders and H. pylori eradication: A literature review. Ann. Med. Surg. 2022, 82, 104760. [Google Scholar] [CrossRef] [PubMed]
- Kiyotoki, S.; Nishikawa, J.; Sakaida, I. Efficacy of vonoprazan for Helicobacter pylori eradication. Intern. Med. 2020, 59, 153–161. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Miftahussurur, M.; Pratama Putra, B.; Yamaoka, Y. The Potential benefits of vonoprazan as Helicobacter pylori infection therapy. Pharmaceuticals 2020, 13, 276. [Google Scholar] [CrossRef] [PubMed]
- Vincent, C.; Manges, A.R. Antimicrobial Use, Human Gut Microbiota and Clostridium difficile Colonization and Infection. Antibiotics 2015, 4, 230–253. [Google Scholar] [CrossRef] [PubMed]
- Baù, M.; Moretti, A.; Bertoni, E.; Vazzoler, V.; Luini, C.; Agosti, M.; Salvatore, S. Risk and protective factors for gastrointestinal symptoms associated with antibiotic treatment in children: A population study. Pediatr. Gastroenterol. Hepatol. Nutr. 2020, 23, 35–48. [Google Scholar] [CrossRef]
- Yun, J.; Wu, Z.; Qi, G.; Han, T.; Zhang, D. The high-dose amoxicillin-proton pump inhibitor dual therapy in eradication of Helicobacter pylori infection. Expert Rev. Gastroenterol. Hepatol. 2021, 15, 149–157. [Google Scholar] [CrossRef]
- Graham, D.Y.; Shiotani, A. New concepts of resistance in the treatment of Helicobacter pylori infections. Nat. Clin. Pract. Gastroenterol. Hepatol. 2008, 5, 321–331. [Google Scholar] [CrossRef]
- Yuan, Y.; Ford, A.C.; Khan, K.J.; Gisbert, J.P.; Forman, D.; Leontiadis, G.I.; Tse, F.; Calvet, X.; Fallone, C.; Fischbach, L.; et al. Optimum duration of regimens for Helicobacter pylori eradication. Cochrane Database Syst. Rev. 2013, 12, CD008337. [Google Scholar]
- Hu, Y.; Xu, X.; Ouyang, Y.B.; He, C.; Li, N.S.; Xie, C.; Peng, C.; Zhu, Z.H.; Xie, Y.; Shu, X.; et al. Optimization of vonoprazan-amoxicillin dual therapy for eradicating Helicobacter pylori infection in China: A prospective, randomized clinical pilot study. Helicobacter 2022, 27, e12896. [Google Scholar] [CrossRef]
- Gotoda, T.; Kusano, C.; Suzuki, S.; Horii, T.; Ichijima, R.; Ikehara, H. Clinical impact of vonoprazan-based dual therapy with amoxicillin for H. pylori infection in a treatment-naïve cohort of junior high school students in Japan. J. Gastroenterol. 2020, 55, 969–976. [Google Scholar] [CrossRef]
- Ouyang, Y.; Wang, M.; Xu, Y.L.; Zhu, Y.; Lu, N.H.; Hu, Y. Amoxicillin-vonoprazan dual therapy for Helicobacter pylori eradication: A systematic review and meta-analysis. J. Gastroenterol. Hepatol. 2022, 37, 1666–1672. [Google Scholar] [CrossRef] [PubMed]
- Gao, W.; Teng, G.; Wang, C.; Xu, Y.; Li, Y.; Cheng, H. Eradication rate and safety of a “simplified rescue therapy”: 14-day vonoprazan and amoxicillin dual regimen as rescue therapy on treatment of Helicobacter pylori infection previously failed in eradication: A real-world, retrospective clinical study in China. Helicobacter 2022, 27, e12918. [Google Scholar] [PubMed]
- Zha, J.; Li, Y.Y.; Qu, J.Y.; Yang, X.X.; Han, Z.X.; Zuo, X. Effects of enhanced education for patients with the Helicobacter pylori infection: A systematic review and meta-analysis. Helicobacter 2022, 27, e12880. [Google Scholar] [CrossRef] [PubMed]
- Penumetcha, S.S.; Ahluwalia, S.; Irfan, R.; Khan, S.A.; Rohit Reddy, S.; Vasquez Lopez, M.E.; Zahid, M.; Busmail, A.; Mohammed, L. The Efficacy of probiotics in the management of Helicobacter pylori: A systematic review. Cureus 2021, 13, e20483. [Google Scholar] [CrossRef] [PubMed]
- Li, H.; Shen, Y.; Song, X.; Tang, X.; Hu, R.; Marshall, B.J.; Tang, H.; Benghezal, M. Need for standardization and harmonization of Helicobacter pylori antimicrobial susceptibility testing. Helicobacter 2022, 27, e12873. [Google Scholar] [CrossRef]
- El-Serag, H.B.; Kao, J.Y.; Kanwal, F.; Gilger, M.; LoVecchio, F.; Moss, S.F.; Crowe, S.E.; Elfant, A.; Haas, T.; Hapke, R.J.; et al. Houston consensus conference on testing for Helicobacter pylori infection in the United States. Clin. Gastroenterol. Hepatol. 2018, 16, 992–1002.e6. [Google Scholar] [CrossRef]
- Howden, C.W.; Graham, D.Y. Recent developments pertaining to H. pylori Infection. Am. J. Gastroenterol. 2021, 116, 1–3. [Google Scholar] [CrossRef]
- Ma, Q.; Li, H.; Liao, J.; Cai, Z.; Zhang, B. Tailored therapy for Helicobacter pylori eradication: A systematic review and meta-analysis. Front. Pharmacol. 2022, 13, 908202. [Google Scholar] [CrossRef]
- Eto, H.; Suzuki, S.; Kusano, C.; Ikehara, H.; Ichijima, R.; Ito, H.; Kawabe, K.; Kawamura, M.; Yoda, Y.; Nakahara, M.; et al. Impact of body size on first-line Helicobacter pylori eradication success using vonoprazan and amoxicillin dual therapy. Helicobacter 2021, 26, e12788. [Google Scholar] [CrossRef]
- Graham, D.Y.; Lu, H.; Shiotani, A. Vonoprazan-containing Helicobacter pylori triple therapies contribution to global antimicrobial resistance. J. Gastroenterol. Hepatol. 2021, 36, 1159–1163. [Google Scholar] [CrossRef]
- Malhotra-Kumar, S.; Lammens, C.; Coenen, S.; Van Herck, K.; Goossens, H. Effect of azithromycin and clarithromycin therapy on pharyngeal carriage of macrolide-resistant streptococci in healthy volunteers: A randomized, double-blind, placebo-controlled study. Lancet 2007, 369, 482–490. [Google Scholar] [CrossRef] [PubMed]
- Li, M.; Oshima, T.; Horikawa, T.; Tozawa, K.; Tomita, T.; Fukui, H.; Watari, J.; Miwa, H. Systematic review with meta-analysis: Vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori. Helicobacter 2018, 23, e12495. [Google Scholar] [CrossRef] [PubMed]
- Suzuki, S.; Kusano, C.; Horii, T.; Ichijima, R.; Ikehara, H. The ideal Helicobacter pylori treatment for the present and the future. Digestion 2022, 103, 62–68. [Google Scholar] [CrossRef] [PubMed]
- Wang, Z.; Wang, F. Efficacy and safety comparison of Helicobacter pylori eradication between vonoprazan dual therapy versus triple therapy: A systematic review and meta-analysis. Ther. Adv. Gastroenterol. 2022, 15, 17562848221125308. [Google Scholar] [CrossRef] [PubMed]
Authors (Year, Country) | Study Design | Number | Test for Confirming Helicobacter Pylori | Duration | Eradication Regimen | Eradication Rate | Common Adverse Events | |||
---|---|---|---|---|---|---|---|---|---|---|
Infection | Eradication | VA | VAC/PPI | ITT | PP | |||||
Furuta et al. (2020, Japan) [25] | Retrospective cohort study | 112 | RUT | UBT | 7 days | VA: VPZ 20 mg bid, AMO 500 mg tid | VAC: VPZ 20 mg, AMO 750 mg, CLA 200 mg, bid | VA: 92.9% (52/56), VAC: 91.9% (51/56), p = 0.728 | VA: 94.4% (51/54), VAC: 92.7% (51/55), p = 0.715 | Diarrhea: VA (8.9%); VAC (17.8%) |
Nausea/vomiting: VA (0%); VAC (1.8%) | ||||||||||
Skin rash: VA (3.6%); VAC (0%) | ||||||||||
Abdominal pain: VA (1.8%); VAC (3.6%) | ||||||||||
Dysgeusia: VA (0%); VAC (1.8%) | ||||||||||
Suzuki et al. (2020, Japan) [28] | RCT | 335 | C | UBT | 7 days | VA: VPZ 20 mg, AMO 750 mg, bid | VAC: VPZ 20 mg, AMO 750 mg, CLA 200 mg, bid | VA: 84.5% (142/168); VAC: 89.2% (149/167), p = 0.203 | VA: 87.1% (142/163); VAC: 90.2% (148/164), p = 0.372; CLA-R VA: 92.3%, VAC: 76.2%, p = 0.048 | Total: VA (27.4%); VAC (30.5%), p = 0.524 |
Diarrhea: VA (9.5%); VAC (15.0%) | ||||||||||
Nausea/vomiting: VA (3.0%); VAC (2.4%) | ||||||||||
Skin rash: VA (5.4%); VAC (3.0%) | ||||||||||
Abdominal pain: VA (3.6%); VAC (1.2%) | ||||||||||
Dysgeusia: VA (1.8%); VAC (1.8%) | ||||||||||
Bloating: VA (11.9%); VAC (8.4%) | ||||||||||
Horii et al. (2021, Japan) [27] | RCT | 43 | C | C | 7 days | VA: VPZ 20 mg, AMO 750 mg, bid | VAC: VPZ 20 mg, AMO 750 mg, CLA 200 mg, bid | N/A | VA: 84.2% (16/19); VAC: 95.8% (23/24), p = 0.31 | Diarrhea: VA (5.3%); VAC (12.5%) |
Abdominal pain: VA (5.3%); VAC (0) | ||||||||||
Dysgeusia: VA (0); VAC (4.2%) | ||||||||||
Skin rash: VA (5.3%); VAC (0) | ||||||||||
Nausea: VA (10.5%); VAC (0) | ||||||||||
Zuberi et al. (2022, Pakistan) [29] | RCT | 179 | SAT or Giemsa Stain | HP Stool Ag | 14 days | VA: VPZ 20 mg, AMO 1g, bid | OAC: OME 20 mg, AMO 1 g, CLA 500 mg, bid | N/A | VA: 93.5% (86/92); OAC: 83.9% (73/87), p = 0.042 | Diarrhea: OAC (10.3%); VA (3.3%) |
Nausea/vomiting: OAC (14.9%); VA (5.4%) | ||||||||||
Bloating: OAC (12.6%), VA (4.3%) | ||||||||||
Chey et al. (2022, The United States and Europe) [26] | RCT | 992 | UBT or biopsy | UBT | 14 days | VA: VPZ 20 mg bid, AMO 1 g tid | LAC: LAN 30 mg, AMO 1 g, and CLA 500 mg, bid; VAC: VPZ 20 mg, AMO 1 g, CLA 500 mg, bid | N-R VA: 78.5% (208/265), LAC: 78.8% (201/255), VAC: 84.7% (222/262); CLR-R VA: 69.6% (39/ 56), LAC 31.9% (23/ 72), VAC: 65.8% (48/73); All VA: 77.2% (250/324); LAC: 68.5% (226/330), VAC: 80.8% (273/338) | N-R VA: 81.2% (177/218), LAC: 82.1% (174/212), VAC: 90.4% (198/219); CLR-R VA: 79.5% (35 /44), LAC: 29.0% (18/62), VAC: 67.2% (39/58); All VA: 81.1% (215/265), LAC: 70.0% (194/277), VAC: 85.7% (240/280) | Total: VA: (29.9%); LAC (34.5%); VAC (34.1%) |
Diarrhea: VA (5.2%); LAC (9.6%); VAC (4.0%) | ||||||||||
Headache/dizziness: VA (1.4%); LAC (1.4%); VAC (2.6%) | ||||||||||
Dysgeusia: VA (0.6%); LAC (6.1%); VAC (4.3%) | ||||||||||
Nausea/vomiting: VA (2.3%); LAC (4.6%); VAC (2.0%) | ||||||||||
Abdominal pain: VA (1.4%); LAC (2.0%); VAC (1.2%) | ||||||||||
Lin et al. (2022, China) [30] | RCT | 230 | UBT | UBT | 7 days | H-VA: VPZ 20 mg bid, AMO 750 mg qid L-VA: VPZ 20 mg bid, AMO 500 mg qid | VAC: VPZ 20 mg, AMO 750 mg, CLA 500 mg, bid | H-VA: 63.5% (54/85); L-VA: 58.3% (49/84); VAC: 60.7% (37/61) | H-VA: 65.1% (54/83); L-VA: 66.2% (49/74); VAC: 64.9% (37/57) | Total: H-VA (16.90%); L-VA (13.20%); VAC (24.10%) |
Diarrhea: H-VA (1.2%); L-VA (0); VAC (1.6%) | ||||||||||
Abdominal pain: H-VA (2.4%), L-VA (1.2%); VAC (6.6%) | ||||||||||
Dizziness: H-VA (2.4%); L-VA (1.2%); VAC (0). | ||||||||||
Nausea/vomiting: H-VA (4.7%); L-VA (6.0%); VAC (3.3%) | ||||||||||
Skin rash: H-VA (1.2%); L-VA (0); VAC (0) |
Authors | Year | Randomization Process | Deviations from Intended Interventions | Missing Outcome Data | Measurement of the Outcome | Selection of the Reported Result | Overall Bias |
---|---|---|---|---|---|---|---|
Chey et al. [26] | 2022 | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Horii et al. [27] | 2021 | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Suzuki et al. [28] | 2020 | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Zuberi et al. [29] | 2022 | Low risk | Low risk | Low risk | Low risk | Some bias | Low risk |
Lin et al. [30] | 2022 | Low risk | Low risk | Low risk | Low risk | Low risk | Low risk |
Overall | ||
---|---|---|
VA | 1.25 (0.77, 2.06) | 0.49 (0.25, 0.87) |
0.80 (0.49,1.29) | VAC | 0.39 (0.18, 0.72) |
2.04 (1.15, 4.07) | 2.55 (1.39, 5.46) | PPI |
RCTs | ||
VA | 1.30 (0.77, 2.33) | 0.49 (0.23, 0.96) |
0.77 (0.49,1.29) | VAC | 0.38 (0.16, 0.76) |
2.04 (1.04, 4.42) | 2.66 (1.32, 6.07) | PPI |
14-day treatment | ||
VA | 1.34 (0.45, 3.96) | 0.49 (0.18, 1.16) |
0.75 (0.25,2.24) | VAC | 0.36 (0.13, 1.03) |
2.07 (0.86, 5.66) | 2.77 (0.97, 7.93) | PPI |
Asia | ||
VA | 1.20 (0.60, 2.64) | 0.34 (0.08, 1.58) |
0.83 (0.38, 1.68) | VAC | 0.29 (0.05, 1.60) |
2.86 (0.63, 13.29) | 3.47 (0.62, 19.93) | PPI |
High-dose amoxicillin | ||
VA | 1.18 (0.56, 2.29) | 0.47 (0.21, 0.97) |
0.85 (0.44,1.78) | VAC | 0.40 (0.17, 092) |
2.13 (1.03, 4.86) | 2.52 (1.09, 5.91) | PPI |
Treatment Discontinuation | ||
---|---|---|
VA | 0.83 (0.15, 3.17) | 0.67 (0.05, 5.91) |
1.21 (0.32, 6.78) | VAC | 0.81 (0.08, 9.01) |
1.49 (0.17, 19.09) | 1.24 (0.11, 12.07) | PPI |
Incidence of adverse events | ||
VA | 1.45 (0.81, 2.77) | 1.92 (0.92, 4.90) |
0.69 (0.36, 1.24) | VAC | 1.31 (0.56, 3.61) |
0.52 (0.20, 1.08) | 0.76 (0.28, 1.78) | PPI |
Diarrhea | ||
VA | 1.43 (0.75, 3.02) | 2.79 (1.18, 7.34) |
0.70 (0.33, 1.34) | VAC | 1.97 (0.75, 5.22) |
0.36 (0.14, 0.85) | 0.51 (0.19, 1.34) | PPI |
Abdominal pain | ||
VA | 0.92 (0.28, 2.95) | 1.52 (0.25, 9.64) |
1.09 (0.34, 3.52) | VAC | 1.68 (0.27, 11.21) |
0.66 (0.10, 4.07) | 0.60 (0.09, 3.65) | PPI |
Bloating | ||
VA | 0.68 (0.15, 2.94) | 3.37 (0.59, 23.29) |
1.48 (0.34, 6.67) | VAC | 5.09 (0.52, 56.40) |
0.30 (0.04, 1.70) | 0.20 (0.02, 1.94) | PPI |
Constipation | ||
VA | 0.56 (0.13, 1.95) | N/A |
1.76 (0.51, 7.46) | VAC | N/A |
N/A | N/A | PPI |
VA | VAC | PPI | |
---|---|---|---|
Treatment discontinuation | 0.369 | 0.513 | 0.618 |
Incidence of adverse events | 0.938 | 0.433 | 0.128 |
Diarrhea | 0.931 | 0.531 | 0.374 |
Abdominal pain | 0.57 | 0.642 | 0.288 |
Bloating | 0.592 | 0.834 | 0.075 |
Constipation | 0.178 | 0.822 | N/A |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Liu, L.; Li, F.; Shi, H.; Nahata, M.C. The Efficacy and Safety of Vonoprazan and Amoxicillin Dual Therapy for Helicobacter pylori Infection: A Systematic Review and Network Meta-Analysis. Antibiotics 2023, 12, 346. https://doi.org/10.3390/antibiotics12020346
Liu L, Li F, Shi H, Nahata MC. The Efficacy and Safety of Vonoprazan and Amoxicillin Dual Therapy for Helicobacter pylori Infection: A Systematic Review and Network Meta-Analysis. Antibiotics. 2023; 12(2):346. https://doi.org/10.3390/antibiotics12020346
Chicago/Turabian StyleLiu, Ligang, Fang Li, Hekai Shi, and Milap C. Nahata. 2023. "The Efficacy and Safety of Vonoprazan and Amoxicillin Dual Therapy for Helicobacter pylori Infection: A Systematic Review and Network Meta-Analysis" Antibiotics 12, no. 2: 346. https://doi.org/10.3390/antibiotics12020346