Tegoprazan-Amoxicillin Dual Therapy Versus Bismuth Quadruple Therapy Versus Tegoprazan-Based Quadruple Therapy for Helicobacter pylori Eradication: A Network Meta-Analysis

Helicobacter pylori eradication remains a global clinical challenge, compounded by rising antibiotic resistance. Bismuth quadruple therapy (BQT) is the guideline-preferred first-line regimen, yet its high pill burden and adverse event profile limit real-world adherence. Tegoprazan, a novel potassium-competitive acid blocker (P-CAB), has demonstrated potent acid suppression and is being evaluated both as a dual therapy (tegoprazan-amoxicillin dual therapy (TADT)) and as a component of quadruple regimens (tegoprazan-based quadruple therapy (TBQT)). The aim of this study was to compare the efficacy, compliance, and adverse event profile of TADT, BQT, and TBQT for first-line H. pylori eradication using network meta-analysis (NMA) methodology. A systematic search of PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Scopus was conducted from inception to March 5, 2026. Randomised controlled trials (RCTs) and observational studies comparing at least two of the three specified regimens in treatment-naive adults were eligible. Eight studies (seven RCTs and one observational) encompassing 3,513 patients were included. All three regimens achieved statistically comparable H. pylori eradication rates. The risk ratio (RR) for BQT versus TADT was 0.82 (95% confidence interval (CI): 0.53-1.28), and for TBQT versus TADT, the RR was 1.01 (95% CI: 0.63-1.61). Treatment compliance was equally high across regimens (all comparisons p > 0.05). TADT was associated with a significantly lower risk of adverse events compared to BQT and TBQT. Global inconsistency testing confirmed model validity for all three outcomes (all p > 0.05). All three strategies yield equivalent H. pylori eradication efficacy and compliance as first-line treatment. TADT provides a significantly superior adverse event profile over BQT, making it a well-tolerated, simplified alternative suitable for most treatment-naive patients. TBQT offers comparable eradication with an intermediate safety profile and may be preferred in high antibiotic resistance settings. However, future large-scale RCTs are required to confirm these findings.