Treatment of Helicobacter pylori with potassium competitive acid blockers: A systematic review and meta-analysis

Table 1 Summary of the main findings from studies

Ref.	Country	Methods	Results
Chey et al[8], 2022	United States and Europe	Intervention: VPZ 20 mg + AMX 1 g + CLR 500 mg BD 14 d. Control: LPZ 30 mg + AMX 1 g + CLR 500 mg BD 14 d	H. pylori eradication in VPZ triple therapy in 84.7% of patients’ vs 78.8% for LPZ triple therapy (difference 5.9%; 95%CI: 0.8-12.6; noninferiority P < 0.001). VPZ triple therapy is non-inferior to LPZ triple therapy
Murakami et al[18], 2016	Japan	Intervention: VPZ 20 mg + AMX 750 mg + CLR 200 mg/400 mg BD 7 d. Control: LPZ 30 mg + AMX 750 mg + CLR 200 mg/400 mg BD 7 d	H. pylori eradication rate with VPZ was 92.6% (95%CI: 89.2%-95.2%) compare to 75.9% (95%CI: 70.9%-80.5%) with LPZ with the difference being 16.7% (95%CI: 11.2%-22.1%) indicating the non-inferiority of VPZ (P < 0.0001). VPZ tripple therapy is non-inferior to LPZ. VPZ is also well tolerated and safe
Maruyama et al[19], 2017	Japan	Intervention: VPZ 20 mg + AMX 750 mg, and CLR 200 mg/400 mg BD 7 d. Control: LPZ 30 mg + AMX 750 mg, and CLR 200 mg/400 mg BD 7 d	H. pylori eradication rate was significantly higher 95.8% in VPZ group compare to 69.6% in PPI group 95%CI: 88.3%-99.1%, P = 0.00003. VPZ-based therapy is superior to PPI as first line Pylori eradication and is safe
Bunchorntavakul et al[20], 2021	Thailand	Intervention: VPZ 20 mg + AMX 1 g + CLR 500 mg BD 7 d. Control: OPZ 20 mg + AMX 1 g + CLR 500 mg BD 14 d	The H. pylori eradication rates was 96.7% in VPZ group compare to 88.5% in OPZ group (P = 0.083). VPZ triple therapy is non-inferior to OPZ triple therapy and it is well tolerated and safe
Kim et al[21], 2023	South Korea	Intervention: TBMT group-TPZ 50 mg bid + TET 500 g qid, MTZ 500 mg tid + BBS 300 mg qid for 14 d. Control: LBMT group-LPZ 30 mg bid + TET 500 g qid, MTZ 500 mg tid + BBS 300 mg qid for 14 d	H. pylori eradication rates of TBMT group was 80.0% compare to LBMT group 77.4% with 95%CI: -8.4 to 13.7, P = 0.0124. Tegoprazan TBMT was non-inferior compare to lansoprazole LBMT and TBMT is also safe
Choi et al[22], 2022	South Korea	Intervention: TPZ 50 mg + AMX 1 g + CLR 500 mg bid 7 d. Control: LPZ 30 mg + AMX 1 g + CLR 500 mg bid 7 d	The H. Pylori eradication rates in the TPZ group was 62.86% and LPZ groups was 60.57% with 95%CI: -8.53 with non-inferiority test, P = 0.009. TPZ based triple therapy is non-inferior to LPZ triple regimen and TPZ is safe
Tanabe et al[23], 2018	Japan	Intervention: VPZ 20 mg + AMX 750 mg + CLR 200 mg/400 mg bid for 7 d. Control: PPI (LPZ 30 mg or RPZ 10 mg or EPZ 20 mg) + AMX 750 mg + CLR 200 mg/400 mg bid for 7 d	H. pylori eradication rates in VPZ based therapy group was 97.4% compare to the empirical PPI based therapy group 86.3% with 95%CI: 83.8-88.8 compare to with 95%CI: 95.7-99.1. The VPZ-based therapy was significantly more effective (P < 0.001) than PPI based empirical therapy
Shinozaki et al[24], 2016	Japan	Intervention: VAC group VPZ 20 mg + AMX 750 mg + CLR 200 mg for 7 d. Control: PPI group [(LAC) LPZ 30 mg + AMX 750 mg + CLR 200 mg for bid 7 d or (RAC) RPZ 10 mg + AMX 750 mg + CLR 200 mg bid for 7 d or (EAC) EPZ 40 mg + AMX 750 mg + CLR 200 mg bid for 7 d]	H. pylori eradication therapy was 83% in VAC with 95%CI: 75-89 compare to LAC 66% with 95%CI: 59-72; RAC 67% with 95%CI: 58-74; EAC 85% with 95%CI: 75-89. The VAC group showed a significantly higher eradication rate compared with the LAC and RAC groups VAC 83%, LAC 66% and RAC 67%, P < 0.01. Similar eradication rate were observed in VAC group 83% compare to EAC group 83%
Ozaki et al[25], 2018	Japan	Intervention: VPZ 40 mg + CLR 400 mg/800 mg + AMX 1500 mg daily for 7 d. Control: EPZ 40 mg + CLR 400 mg/800 mg + AMX 1500 daily for 7 d or RPZ 20 mg + CLR 400 mg/800 mg + AMX 1500 mg daily 7 d	H. pylori eradication rate in EPZ group 77.5% and the RPZ group 68.4%, no significant difference. There was a significantly superior eradication rate in VPZ group 90.8% compare to EPZ 77.5% and RPZ 68.4%. VPZ-based triple therapy eradication rates was remarkably higher compared with PPIs-based triple therapy in real world
Chiu et al[26], 2023	Japan	Intervention: VAC group-VPZ 20 mg + AMX 1 g + CLR 500 mg bid for 7 d. Control: PPI (LPZ 30 mg or RPZ 20 mg or PPZ 40 mg) + AMX 1 g bid daily for 7 d, followed by the same PPI + CLR 500 mg + MTZ 500 mg bid for 7 d	H. pylori eradication rate was 83.0% in the VAC compare to 88.8% in the PPI group. There was no significant difference in eradication rate between VAC 7 d therapy and LAC 14 d sequential therapy P = 0.12
Mori et al[27], 2018	Japan	Intervention: VPZ 20 mg + AMX 750 mg + CLR 200 mg/400 mg bid for 7 d. Control: LPZ 30 mg + AMX 750 mg + CLR 200 mg/400 mg bid for 7 d	H. pylori eradication rate with VPZ was significantly higher than the LPZ group 91.0% compare to 84.7% P = 0.030. VPZ was significantly more effective than LPZ for first-line treatment
Jung et al[10], 2023	South Korea	Intervention: TPZ 50 mg + AMX 1 g + CLR 500 mg bid for 14 d. Control: RPZ 20 mg + AMX 1 g + CLR 500 mg bid for 14 d	Eradication rate 76.7% in TPZ group with 95%CI: 72.1%-81.0% compare to 75.4% in RPZ group with 95%CI: 70.5%-79.8%, P > 0.999. The eradication rate of TPZ-based triple therapy was similar to that of RPZ-based triple therapy
Kim et al[28], 2021	South Korea	Intervention: TACB-TPZ 50 mg + AMX 1 g, CLR 500 mg, and BBS 300 mg bid for 7 d. Control: LACB LPZ 30 mg + AMX 1 g + CLR 500 mg, and BBS 300 mg bid for 7 d	Eradication rates were 78.8% in the tegoprazan TACB and 74.5% in the lansoprazole LACB group (P = 0.323). Both the tegoprazan and lansoprazole group showed simlar eradication rates
Hojo et al[29], 2020	Japan	Intervention: VPZ 20 mg + AMX 750 mg + MTZ 250 mg bid for 7 d - as 2nd line. Control: RPZ 10 mg + AMX 750 mg + MTZ 250 mg bid for 7 d - as 2nd line	Eradication rates in the was 73.9% in VPZ with 95%CI: 51.6%-89.8% compare to 82.6% in RPZ with 95%CI: 61.2%-95.0%, P = 0.72. VPZ based 2nd line therapy is non-inferior to RPZ 2nd line therapy and is safe
Nabeta et al[30], 2020	Japan	Intervention: VPZ 20 mg + MTZ 250 mg + AMX 750 mg bid for 7 d. Control: LPZ 30 mg or RPZ 10 mg + MTZ 250 mg + AMX 750 mg bid for 7 d	H. pylori eradication rate in VPZ 2nd line therapy 90% (298/330) compare to 85% in lansoprazole 2nd line therapy (250/294), P = 0.045. P-CAB-based (VPZ) second-line H. pylori eradication is significantly better than PPI-based (lansoprazole) therapy

VPZ: Vonoprazan; AMX: Amoxicillin; CLR: Clarithromycin; BD: Twice a day; LPZ: Lansoprazole; H. pylori: Helicobacter pylori; CI: Confidence interval; PPI: Proton pump inhibitor; RPZ: Rabeprazole; MTZ: Metronidazole; P-CAB: Potassium competitive acid blocker; LACB: Lanzoprazole + amoxicillin+ clarithromycin+ bismuth subsalicylate; TACB: Tegoprazan + amoxicillin + clarithromycin+ bismuth subsalicylate; TPZ: Tegoprazan; VAC: Vonoprazan + amoxicillin + clarithromycin + bismuth subsalicylate; LAC: Lansoprazole + amoxicillin+ clarithromycin; EPZ: Esomeprazole; EAC: Esomeprazole + amoxicillin + clarithromycin; RAC: Rabeprazole + amoxicillin + clarithromycin; LBMT: Lansoprazole + bismuth subsalicylate + metronidazole + tetracycline; TBMT: Tegoprazan + bismuth subsalicylate + metronidazole + tetracycline; BBS: Bismuth subsalicylate; TET: Tetracycline; OPZ: Omeprazole; tid: Three times in a day.