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P-CAB-based dual therapy ranks highest in efficiency and safety for first-line H. pylori therapy, outperforming triple and quadruple regimens.
A recent comprehensive analysis has highlighted dual therapy using potassium-competitive acid blockers (P-CABs) as the most effective and safest option for first-line treatment of Helicobacter pylori (H. pylori) infection.
Over recent years, numerous clinical trials across different countries have determined the role of P-CABs in managing H. pylori. Despite this growing body of research, there had been no single comprehensive study comparing the performance of various P-CAB-based regimens—including dual, triple, and quadruple therapies—until now. To address this gap, researchers conducted a systematic review and network meta-analysis, bringing together data from 25 randomized controlled trials (RCTs) involving a total of 7,605 patients.
The analysis compared 6 treatment strategies: [1] P-CAB dual therapy, [2] P-CAB triple therapy, [3] P-CAB quadruple therapy, [4] proton pump inhibitor (PPI) dual therapy, [5] PPI triple therapy, and [6] PPI quadruple therapy. Using a Bayesian statistical approach, the team evaluated each regimen based on both efficacy and safety, ranking them through surface under the cumulative ranking curve (SUCRA) values—an established method for determining the likelihood that a given treatment is the best among several options.
Among all regimens assessed, P-CAB dual therapy stood out with a SUCRA value of 92.7% for efficacy, remarkably outperforming other approaches. It was followed by PPI dual therapy (75.1%) and P-CAB triple therapy (62.5%), while P-CAB quadruple (33.9%), PPI triple (19.4%), and PPI quadruple therapy (16.3%) ranked lower. Importantly, P-CAB dual therapy also illustrated the lowest incidence of side effects, making it the top performer overall when both effectiveness and tolerability were considered together.
These findings carry substantial clinical relevance, particularly in light of the ongoing global challenge of antibiotic resistance. Dual therapy regimens not only streamline treatment by decreasing the number of drugs involved, but also help circumvent the growing problem of clarithromycin resistance—one of the main reasons behind treatment failure in many regions. By offering a simpler, more tolerable, and highly effective approach, P-CAB dual therapy may represent a new standard for H. pylori care.
The American Journal of Gastroenterology
Meta-analysis supports P-CAB dual therapy as first-line treatment for H. pylori
Theodore Rokkas et al.
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