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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
Author(s) -
Li Min,
Oshima Tadayuki,
Horikawa Tomoki,
Tozawa Katsuyuki,
Tomita Toshihiko,
Fukui Hirokazu,
Watari Jiro,
Miwa Hiroto
Publication year - 2018
Publication title -
helicobacter
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 79
eISSN - 1523-5378
pISSN - 1083-4389
DOI - 10.1111/hel.12495
Subject(s) - clarithromycin , medicine , helicobacter pylori , meta analysis , cochrane library , gastroenterology , odds ratio , randomized controlled trial , confidence interval
Background Vonoprazan is a novel gastric acid suppressant that is applied in Japan to treat gastric diseases including Helicobacter pylori ( H. pylori ) infection. This meta‐analysis aimed to summarize the ability of vonoprazan to eradicate clarithromycin‐susceptible and clarithromycin‐resistant H. pylori strains. Materials and Methods A systematic search was performed using PubMed, EMBASE , Web of Science, and Cochrane Library. Studies were included if they evaluated eradication rates of vonoprazan‐based and conventional PPI ‐based triple therapies and checked for clarithromycin susceptibility of H. pylori . Results We identified 5 studies including a total of 1599 patients containing data regarding H. pylori with clarithromycin susceptibility. Among those infected with clarithromycin‐susceptible H. pylori , eradication rates for vonoprazan‐based and conventional PPI ‐based therapies did not significantly differ in either the randomized ( RCT ; pooled eradication rates, 95.4% vs 92.8%; pooled odds ratio [ OR ], 1.63; 95% confidence intervals [ CI ], 0.74‐3.61; P = .225) and nonrandomized ( NRCT ; pooled eradication rates, 92.9% vs 86.2%; OR , 4.58; 95% CI , 0.67‐31.45; P = .122) controlled trials. However, vonoprazan‐based triple therapy was significantly superiority to PPI ‐based therapy for patients with clarithromycin‐resistant strains in both RCT (pooled eradication rates, 82.0% vs 40.0%; OR , 6.83; 95% CI , 3.63‐12.86; P < .0001) and NRCT (pooled eradication rates, 80.8% vs 41.8%; OR , 4.98; 95% CI , 2.47‐10.03; P < .0001). Conclusions Vonoprazan‐based and conventional PPI ‐based therapies are similarly effective for the eradication of clarithromycin‐susceptible H. pylori strains. Vonoprazan is superior to conventional PPI ‐based therapy for the eradication of clarithromycin‐resistant H. pylori strains. However, clarithromycin was misused because the combination of vonoprazan and amoxicillin cures approximately 80% of infections without clarithromycin.