Open AccessEffectiveness and Safety of Vonoprazan versus Proton Pump Inhibitors for Second-Line Helicobacter pylori Eradication Therapy: Systematic Review and Meta-Analysis
Author(s) -
Satoshi Shinozaki,
Yasutoshi Kobayashi,
Hiroyuki Osawa,
Hirotsugu Sakamoto,
Yoshikazu Hayashi,
Alan Kawarai Lefor,
Hironori Yamamoto
Publication year - 2020
Publication title -
digestion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.882
H-Index - 75
eISSN - 1421-9867
pISSN - 0012-2823
DOI - 10.1159/000504939
Subject(s) - helicobacter pylori , regimen , meta analysis , medicine , cochrane library , proton pump inhibitor , adverse effect , gastroenterology , medline , political science , law
Background: A novel potassium-competitive acid blocker, vonoprazan (VPZ), improves first-line Helicobacter pylori eradication success. The aim of this systematic review is to clarify the effectiveness and safety of second-line H. pylori eradication therapy comparing VPZ and proton pump inhibitor (PPI)-based regimens. Methods: Medline (PubMed), EMBASE, Web of Science, Cochrane Library, and the Japan Medical Abstract Society Database were searched. Results: We selected 16 studies for quantitative review. Forest plot analysis showed significant superiority of VPZ over PPI-based regimens in overall second-line H. pylori eradication success (OR 1.51, 95% CI 1.27–1.81, p < 0.001). Forest plots from 2 studies with propensity score matched analysis showed significant superiority of VPZ over PPI-based regimens (OR 3.09, 95% CI 1.71–5.58, p < 0.001). The remaining 14 studies with per-protocol analysis and the full analysis set also showed significant superiority (OR 1.40, 95% CI 1.16–1.69, p < 0.001). Regarding adverse events, Forest plot analysis did not show a significant difference between the 2 regimens (OR 0.88, 95% CI 0.58–1.32, p = 0.53). Conclusions: A VPZ-based regimen has significant superiority over a PPI-based regimen for second-line H. pylori eradication therapy. A VPZ-based second-line H. pylori eradication regimen can be the first choice.