OBJECTIVES:

The objective of this systematic review was to determine the clinical benefit of vonoprazan triple therapy (vonoprazan, amoxicillin, clarithromycin) (VAC) in helicobacter pylori infection eradication compared to other active therapies available in this indication.

METHODS:

Medline^® and Embase^® databases via Ovid, clinicaltrials.gov, bibliographic searches were performed to identify the relevant English studies. Observational and randomized controlled trials (RCTs) including adults with helicobacter pylori infection, treated with vonoprazan triple therapy (vonoprazan, amoxicillin, clarithromycin) were included. The Cochrane risk of bias V 2.0 was used to assess study quality RCTs. A meta-analysis using fixed effects model was conducted to calculate pooled effect estimates with 95% confidence intervals (CI) for eradication rate.

RESULTS:

The SLR identified four RCTs from 86 publications which were included in the evidence synthesis. Pooled analysis of four RCTs including n=1019 participants reported that VAC based triple therapy was associated with higher eradication rates compared to proton pump inhibitors (PPI)-based regimen (risk ratio [RR] 1.20, 95%CI 1.14 to 1.27). No significant difference was observed between the two groups in terms of, nausea (RR1.48, 95%CI 0.67 to 3.29, 4RCTs), dysgeusia (RR 1.26, 95%CI 0.94 to 1.70, 4RCTs), and skin rash (RR 0.47, 95%CI 0.12 to 1.81, 3RCTs). However, VAC was associated with significantly lower diarrhea (RR 0.69, 95%CI 0.51 to 0.94, 4RCTs) and higher bloating (RR 2.16, 95%CI 1.04 to 4.49, 3RCTs) than PPI.

CONCLUSIONS:

Overall, despite few limitations, this systematic review provides up-to-date evidence and confirms that vonoprazan, amoxicillin, clarithromycin based triple therapy found to be superior in the helicobacter pylori infection eradication than proton pump inhibitors-based regimen. However, no difference observed with respective to nausea, dysgeusia, and skin rash between treatment groups. Future studies with more research are needed to support the current research question.