S3137 Efficacy and Safety of 14-Day Vonoprazan-Based Quadruple Therapy vs PPI-Based Regimens for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis

Introduction: Eradication of Helicobacter pylori is essential for treating gastric ulcers and reducing the risk of gastric cancer. Proton pump inhibitors (PPIs) have traditionally been a key component of triple therapy for H. pylori eradication; however, their efficacy has diminished globally due to the rising prevalence of antibiotic resistance. In contrast, novel potassium-competitive acid blockers, such as vonoprazan-based quadruple therapy (VPZ-Q-14), significantly enhance the success of first-line H. pylori eradication by providing potent suppression of gastric acid secretion. This systematic review and meta-analysis aimed to assess the safety and efficacy of VPZ-Q-14 compared to conventional PPI-based regimens for H. pylori eradication. Methods: A comprehensive search was conducted in PubMed, Cochrane, and Embase through October 2024 to identify randomized clinical trials involving adult patients with H. pylori who were treated with vonoprazan-based therapies. Trials assessing the safety and efficacy of VPZ-Q-14 and PPI-based regimens for H. pylori eradication were included. The primary outcomes were H. pylori eradication (intention-to-treat) and adverse events. A random-effects model was applied for statistical analysis using Comprehensive Meta-Analysis software, and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Five clinical trials involving 1,816 patients were included in the analysis. VPZ-Q-14 demonstrated superior H. pylori eradication compared to PPI-based therapies (OR = 1.66; 95% CI 1.20-2.29; P = 0.002). In contrast, the incidence of adverse events with 14-day VPZ-based therapy was comparable to that of 14-day PPI-based therapies (OR = 0.89; 95% CI 0.60-1.32; P = 0.56). Conclusion: VPZ-Q-14 demonstrated a significantly higher H. pylori eradication rate compared to PPI-based therapies. The incidence of adverse events was similar between the 2 treatment groups. These results suggest that 14-day vonoprazan-based therapy is as effective and safe as 14-day PPI-based therapy for H. pylori eradication, with a superior eradication rate and comparable adverse events.