P5045 - The Efficacy and Safety of Vonoprazan-Based Regimens for Helicobacter pylori Eradication Treatment: A Systemic Review and Network Meta-Analysis

Award: Presidential Poster Award

Cangui Zhang, MD¹, Bingyun Lu, MD², Li Xie, ³, Xi Ran, ³, Ye Chen, MD^2
1Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China; ²Shenzhen Hospital of Southern Medical University, Shenzhen, Guangdong, China; ³Takeda Pharmaceutical Company Ltd., Shanghai, Shanghai, China

Introduction: Helicobacter pylori (Hp) infection is a public health concern due to its high disease burden and complications, emphasising the crucial need for effective eradication therapy. While Vonoprazan (VPZ)-based treatments show promising outcomes, there remains a significant dearth of comprehensive data evaluating their effectiveness and safety worldwide, as well as their performance against proton pump inhibitor (PPI) -based treatments. This review aims to provide guidance for Hp eradication in clinical practice.

Methods: A systematic search was conducted in PubMed, EMBASE, the Cochrane Library, web of science, CNKI, Wanfang, VIP and CBM from inception to 9th January, 2024. Randomized controlled trials (RCTs) involving adult patients investigating VPZ and PPI-based dual, triple, and quadruple treatments were included. Each RCT comprised at least one arm receiving VPZ-based regimens. The eradication rate of VPZ-based regimens was analysed using proportional meta-analysis. Network meta-analysis employing a Bayesian hierarchical random-effects model was performed to compare eradication rates and adverse events between groups.

Results: Forty-three studies with 11043 patients were analysed, revealing eradication rates of 85.89% for VPZ-dual, 86.38% for VPZ-triple, and 91.00% for VPZ-quadruple regimens, 84.00% for PPI-dual, 78.68% for PPI-triple, and 82.33% for PPI-quadruple regimens. In terms of surfaces under cumulative ranking curve (SUCRA) for eradication rate, VPZ-quadruple regimen ranked the highest (SUCRA=90.88%), followed by VPZ-triple (SUCRA=79.2%) and VPZ-dual (SUCRA=62.66%) regimen. All VPZ-based regimens showed significantly higher eradication rates than PPI-quadruple or triple regimen (Table 1). No significant difference was showed in eradication rates between VPZ-based regimens. Regarding safety, PPI-dual ranked the highest (SUCRA=90.18%), followed by VPZ-dual (SUCRA=86.51%) and VPZ-triple (SUCRA=53.13%) regimen. VPZ-dual showed a significantly lower likelihood of experiencing any adverse events compared to VPZ-triple, (OR 0.57, 95% CI 0.34–0.95), VPZ-quadruple, (OR 0.44, 95% CI 0.26–0.75), PPI-triple (OR 0.38, 95% CI 0.18–0.83) and PPI-quadruple (OR 0.41, 95% CI 0.29–0.56).

Discussion: VPZ-based regimens demonstrated benefits on eradication compared to PPI-quadruple and triple regimens, with VPZ-quadruple being the most effective. VPZ-dual regimen showed better safety profile compared to VPZ and PPI-based triple and quadruple regimens.


Disclosures:


Cangui Zhang, MD¹, Bingyun Lu, MD², Li Xie, ³, Xi Ran, ³, Ye Chen, MD². P5045 - The Efficacy and Safety of Vonoprazan-Based Regimens for <i>Helicobacter pylori</i> Eradication Treatment: A Systemic Review and Network Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.