Amoxicillin‐vonoprazan dual therapy for Helicobacter pylori eradication: A systematic review and meta‐analysis

Abstract Background and Aim The efficacy and safety of amoxicillin‐vonoprazan (VA) dual therapy remained unclear. Methods This systematic review was conducted in accordance with the PRISMA 2009 guidelines. A systematic search of the Pubmed, Embase, and Cochrane database was conducted using the combination of “ Helicobacter pylori or H. pylori or Hp ,” “amoxicillin or penicillin,” and “Vonoprazan or TAK‐438 or Takecab or (potassium AND competitive) or potassium‐competitive.” The initial and secondary outcome of this meta‐analysis was to evaluate the efficacy and safety of VA dual therapy. Results Three studies and 668 H. pylori infected patients were included in this meta‐analysis. The crude eradication rate of VA dual therapy was 87.5% and 89.6% by ITT and PP analysis, respectively. No significant differences were observed regarding the VA dual therapy and vonoprazan‐amoxicillin‐clarithromycin (VAC) triple therapy according to ITT (RR = 0.99, 95% CI, 0.93–1.05, P = 0.65) and PP (RR = 0.99, 95% CI, 0.94–1.05, P = 0.82) analysis. The side effect of VA dual therapy was 19.1% (95% CI, 5.9–32.4), which was lower than that of VAC triple therapy but there was no statistical significance (RR = 0.75, 95% CI, 0.59–1.06, P = 0.12). Conclusion VA dual therapy shows acceptable efficacy, good safety and avoid unnecessary antibiotic use in the first‐line treatment for H. pylori infection. However, its application in other regions need to be further explored.