Constance A Kovarbasic, Camille El Khiati, Hannah C Knölker, Salvador Benlloch, Antonio Barrasa
Compared with B-PPI-based quadruple therapy, P-CAB-based regimens showed a small statistical advantage in intention-to-treat analysis, which was not consistently supported by per-protocol or subgroup analyses. No difference in treatment adherence was observed. These findings suggest that P-CAB-based regimens should be considered alternative first-line options rather than clear replacements for standard PPI-based quadruple therapy.
BACKGROUND AND AIMS: Potassium-competitive acid blockers (P-CABs) have emerged as an alternative to proton pump inhibitors (PPIs) for Helicobacter pylori eradication. However, much of the available evidence is based on comparisons with suboptimal PPI-based regimens. We conducted a systematic review and meta-analysis to compare P-CAB-based regimens with bismuth-containing PPI (B-PPI)-based quadruple therapies as first-line treatment for H pylori eradication.
METHODS: A systematic search of PubMed, ScienceDirect, Cochrane, and Scopus databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials comparing P-CAB-based regimens with B-PPI-based quadruple therapies were included. Pooled risk ratios (RRs) were calculated. The primary outcome was the eradication rate; secondary outcomes were treatment compliance and subgroup analysis according to the specific P-CAB used.
RESULTS: Twenty-five trials including 8789 patients were analyzed. In the intention-to-treat analysis, pooled eradication rates were 86.8% for P-CAB-based regimens and 83.3% for PPI-based quadruple therapy (RR: 1.04; 95% confidence interval [CI]: 1.01-1.07; P = .005). In the per-protocol analysis, no statistical significance was observed (89.4% vs 88.5%; RR: 1.02; 95% CI: 0.99-1.05; P = .17). Treatment compliance was similar between groups (92.6% vs 91.3%; RR: 1.01; 95% CI: 0.99-1.02; P = .40). In subgroup analyses, no significant differences were confirmed for individual P-CABs.
CONCLUSION: Compared with B-PPI-based quadruple therapy, P-CAB-based regimens showed a small statistical advantage in intention-to-treat analysis, which was not consistently supported by per-protocol or subgroup analyses. No difference in treatment adherence was observed. These findings suggest that P-CAB-based regimens should be considered alternative first-line options rather than clear replacements for standard PPI-based quadruple therapy.