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This meta-analysis compared the efficacy, safety, and tolerability of potassium-competitive acid blockers (P-CABs) versus proton pump inhibitors (PPIs) for Helicobacter pylori (H. pylori) infection.
P-CAB-based triple therapy is more efficient than PPI-based therapy as a first-line treatment for H. pylori, particularly in Japanese patients. When used as salvage therapy, both treatments show similar efficacy.
This meta-analysis compared the efficacy, safety, and tolerability of potassium-competitive acid blockers (P-CABs) versus proton pump inhibitors (PPIs) for Helicobacter pylori (H. pylori) infection.
A systematic search of Cochrane Library, Embase, and PubMed was conducted for English-language RCTs comparing P-CAB- and PPI-based therapies for H. pylori eradication. Considering the predefined inclusion and exclusion criteria, two authors screened the eligible studies. Utilizing Cochrane Risk of Bias tool, the study quality was assessed.
Data on study characteristics, eradication outcomes, and adverse events were independently procured. A meta-analysis using Review Manager 5.3 calculated pooled risk ratios (RR) with 95% confidence intervals (CIs). Heterogeneity was assessed using Chi-square and I² statistics, determining the use of fixed- or random-effects models.
In total, 7 RCTs involving 1,168 volunteers met the inclusion criteria. P-CAB-based regimens exhibited a substantially higher eradication rate than PPI-based therapies in both intention-to-treat (ITT: 90.2% vs. 75.5%; RR = 1.17) and per-protocol (PP: 92.4% vs. 77.8%; RR = 1.14) analyses. When used as first-line treatment, P-CABs consistently outperformed PPIs (ITT: 91.8% vs. 76.4%; RR = 1.18; PP: 93.0% vs. 78.6%; RR = 1.13).
However, in salvage settings, P-CABs did not illustrate a significant advantage over PPIs. Regional differences were observed in Japanese patients. P-CABs exhibited clear superiority (ITT: 89.6% vs. 73.9%; RR = 1.21; PP: 92.0% vs. 75.7%; RR = 1.18), whereas no statistically significant benefit was noted in non-Japanese populations. Adverse event rates were comparable between the two therapies (33.6% vs. 40.0%; RR = 0.84), and there were no notable differences in serious adverse events or discontinuation due to side effects.
As a first-line treatment, P-CAB-based triple therapy showed superior efficacy over PPI-based regimens, particularly in Japanese cohorts. In salvage therapy, both options were equally effective. Overall, the safety profiles of P-CABs and PPIs were similar, supporting the broader use of P-CABs as a potent alternative in initial H. pylori eradication strategies.
Clinics
Efficacy and safety of potassium-competitive acid blockers versus proton pump inhibitors as Helicobacter pylori eradication therapy: a meta-analysis of randomized clinical trials
Mengran Zhang et al.
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