Table 1.
Comparative Studies of H. Pylori First-line Eradication Therapy with Vonoprazan and Proton Pump Inhibitors.
| References | Study design | Triple therapy regimen | Eradication rate (95% CI) | Adverse events (discontinuation) | |||||
|---|---|---|---|---|---|---|---|---|---|
| Vonoprazan | PPI | Vonoprazan | PPI | ||||||
| ITT/FAS | PP | ITT/FAS | PP | Vonoprazan | PPI | ||||
| (24) | Prospective, non-randomized, open-label, multicenter | VPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=1,688 | RPZ 10 mg, or EPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=76 (RPZ), 71 (EPZ) | NA | 90.8% | NA | RPZ 68.4%, EPZ 77.5% | NA (0%) | NA (0%) |
| (27) | Retrospective, single-center | VPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=111 | RPZ 10 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=98 | 94.6% (88.6-98.0) | 95.5% (89.7-98.5) | 86.7% (78.4-92.7) | 86.7% (78.4-92.7) | 2.7% (NA) | 3.1% (NA) |
| (23) | Randomized, single-blind, single-center, parallel-group comparison | VPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=72 | RPZ 20 mg or LPZ 30 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=69 | 95.8% (88.3-99.1) | 95.7% (88.0-99.1) | 69.6% (57.3-80.1) | 71.4% (58.7-82.1) | 26.3% (NA) | 37.7% (NA) |
| (28) | Retrospective, single-center | VPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=125 | LPZ 30 mg, RPZ 10 mg, or EPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=295 | 89.6% (84-95) | 89.6% (84-95) | 71.9% (67-77) | 73.1% (68-78) | 11.9% (0%) | 10.7% (5 dropouts) |
| (21) | Randomized, double-blind, multicenter, parallel-group comparison | VPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=329 | LPZ 30 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=321 | 92.6% (89.2-95.2) | NA | 75.9% (70.9-80.5) | NA | 34.0% (0.9%) | 41.4% (0.6%) |
| (38) | Retrospective, single-center | VPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=308 | LPZ 30 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=272 | NA | 91.0% | NA | 84.7% | NA (2 dropouts) | NA (2 dropouts) |
| (29) | Retrospective, single-center | VPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=353 | LPZ 30 mg or RPZ 10 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=2,173 | 62.3% | 89.4% | 47.1% | 66.8% | 8.4% (NA) | 5.7% (NA) |
| (30) | Prospective and retrospective, single-center | VPZ 20 mg + AMX 750 mg + CAM 400 mg, twice-daily, 7 days, n=146 | LPZ 30 mg, RPZ 10 mg, OPZ 20 mg, or EPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=1,305 | NA | 89.7% (87.9-91.3) | NA | 73.9% (66.0-80.8) | NA | NA |
| (31) | Retrospective, single-center | VPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=546 | LPZ 30 mg, RPZ 10 mg, or EPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=211 (LPZ), 89 (RPZ), 507 (EPZ) | 87.9% (84.9-90.5) | NA | LPZ 57.3% (50.4-64.1), RPZ 62.9% (52.0-72.9), EPZ 71.6% (67.5-75.5) | NA | 11.2% (0%) | LPZ 5.7%, RPZ 10.1%, EPZ 7.7% (0%) |
| (32) | Retrospective, multicenter | VPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=422 | LPZ 30 mg, RPZ 10 mg, OPZ 20 mg, or EPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=2,293 | 87.2% | NA | 72.4% | NA | 6.2% (NA) | 6.2% (NA) |
| (33) | Retrospective, two-institution | VPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=117 | LPZ 30 mg, RPZ 10 mg, or EPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=198 (LPZ), 138 (RPZ), 120 (EPZ) | 83% (75-89) | 85% (77-91) | LPZ 66% (59-72), RPZ 67% (58-74), EPZ 83% (75-89) | LPZ 69% (62-76), RPZ 70% (61-77), EPZ 87% (79-93) | 5% (NA) | LPZ 11%, RPZ 6%, EPZ 3% (NA) |
| (22) | Non-randomized, open-label, multicenter, parallel-group comparison | VPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=623 | LPZ 30 mg, RPZ 10 mg, OPZ 20 mg, or EPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=608 | 84.9% (81.9-87.6) | 86.4% (83.5-89.1) | 78.8% (75.3-82.0) | 79.4% (76.0-82.6) | NA | NA |
| (25) | Randomized, open-label, multicenter | VPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=55 [CAM-susceptible H. pylori] | LPZ 30 mg, RPZ 10 mg, or EPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=42 (LPZ), 4 (RPZ), 5 (EPZ) [CAM-susceptible H. pylori] | 87.3% (75.5-94.7) | 88.9% (77.4-95.8) | 76.5% (62.5-87.2) | 86.7% (73.2-94.9) | NA (0%) | NA (1 dropout) |
| VPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=41 [CAM-resistant H. pylori] | 82.9% (67.9-92.8) | 82.9% (67.9-92.8) | |||||||
| (34) | Retrospective, single-center, propensity score matching analysis | VPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=181 | LPZ 30 mg or RPZ 10 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=480 | 89.0% (84.4-93.5) [89.1% (84.5-93.8) in propensity score matching] | 91.5% (87.3-95.6) [91.2% (87.0-95.5)] | 74.2% (70.3-78.1) [70.9% (64.1-77.6)] | 77.9% (74.1-81.7) [71.7% (64.9-78.4)] | 12.7% (0%) | 14.4% (0%) |
| (37) | Retrospective, single-center | VPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=363 | LPZ 30 mg, RPZ 10 mg, or EPZ 20 mg + AMX 750 mg + CAM 200 or 400 mg, twice-daily, 7 days, n=207 (LPZ), 450 (RPZ), 123 (EPZ) | 91.5% (88.6-94.3) | 97.4% (95.7-99.1) | LPZ 77.3% (71.6-83.0), RPZ 79.8% (76.1-83.5), EPZ 81.3% (74.4-88.2) | LPZ 85.6% (80.5-90.6), RPZ 86.1% (82.8-89.4), EPZ 88.5% (82.6-94.4) | NA | NA |
| (35) | Retrospective, single-center | VPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=443 | EPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=431 | 84.6% | 86.3% | 79.1% | 79.9% | 0.68% (1 dropout) | 1.17% (3 dropouts) |
| (36) | Retrospective, single-center | VPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=335 | LPZ 30 mg, RPZ 10 mg, or EPZ 20 mg + AMX 750 mg + CAM 200 mg, twice-daily, 7 days, n=1,720 | 85.7% | 90.3% | 73.2% | 76.4% | NA (0%) | NA (0.4%) |
PPI: proton pump inhibitor, CI: confidence interval, ITT: intention to treat analysis, FAS: full analysis set, PP: per protocol analysis, VPZ: vonoprazan, AMX: amoxicillin, CAM: clarithromycin, LPZ: lansoprazole, RPZ: rabeprazole, OPZ: omeprazole, EPZ: esomeprazole, NA: not available