In a systematic review and meta-analysis, it was observed that Vonoprazan and Amoxicillin (VA) dual therapy showed effectiveness in alleviating Helicobacter pylori (H. pylori) infection. The study aimed to assess the potency of VA dual therapy in comparison to the at present recommended therapy for H. pylori. A thorough search of the Cochrane, PubMed, and Embase databases was conducted. Fifteen studies, comprising 4,568 patients, were included.

The primary endpoint of the investigation was to assess the elimination rate through intention-to-treat (ITT) and per-protocol (PP) assessment. On the other hand, the secondary endpoints encompassed compliance and adverse events. The H. pylori elimination rate was assessed through both PP and ITT analyses. The pooled elimination rate of VA dual therapy was 85.0% and 90.0% by ITT and PP assessment, respectively. Notably, the compliance and noxious events rate of VA dual therapy were 96% and 17.5%, respectively.

VA dual therapy demonstrated greater efficacy than proton pump inhibitors (PPI)-based triple therapy (82.0% vs. 71.4%, p < 0.01) but was less effective than Vonoprazan containing quadruple therapy (83.1% vs. 93.3%, p = 0.02). Lower eradication rates were noted for seven-day VA dual therapy compared to ten-day (χ2 = 24.09, p < 0.01) and fourteen-day VA dual therapy (χ2 = 11.87, p < 0.01).

The undesirable events rate of VA dual therapy was less as opposed to bismuth-containing quadruple therapy ((20.5% vs. 47.9%, p < 0.01) and Vonoprazan triple therapy (24.6% vs. 30.9%, p = 0.01). There was no notable variance in compliance between VA dual therapy and any of the subgroups. Hence, VA dual therapy presents a highly promising approach for the initial eradication of H. pylori, and it should be optimized before being implemented in various regions.