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Vonoprazan-based versus proton pump inhibitor-based therapy in Helicobacter pylori eradication: an updated systematic review and meta-analysis of randomised trials
  1. Po-Yueh Chen1,
  2. Feng-Pai Tsai2,
  3. Mei-Jyh Chen3,4,
  4. Hsin-Yi Yang5,
  5. Ming-Shiang Wu3,4,
  6. Jyh-Ming Liou3,4,6
  1. 1 Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
  2. 2 Departments of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
  3. 3 Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
  4. 4 Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
  5. 5 Clinial Data Center, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
  6. 6 Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
  1. Correspondence to Dr Jyh-Ming Liou, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, 100, Taiwan; jyhmingliou{at}

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We read the Maastricht VI/Florence consensus report published in GUT with great interest.1 The report suggested that vonoprazan-based therapy is superior, or not inferior, to conventional proton pump inhibitor (PPI)-based triple therapies for Helicobacter pylori eradication.1 However, the number of randomised controlled trials (RCTs) was small and the majority of previous trials were conducted in Japan.2–5 Recently, several new RCTs from other populations have been reported.6–8 Therefore, we conducted an updated systematic review and meta-analysis of RCTs to compare the efficacy and tolerability of vonoprazan and PPI-based therapies for H. pylori eradication.

Detailed methods of the inclusion and exclusion criteria, systematic review, and statistical methods were shown in online supplemental file 1, and the registration number is CRD42023394825. Of the 489 articles identified, 476 articles were excluded (online supplemental figure 1). A total of 13 RCTs were included which consisted of 11 first-line therapy trials and the other 2 were second-line and third-line therapy trial, respectively (online supplemental table 1). The regimens, dose and frequency of antibiotics, durations of treatment and eradication rate by intention-to-treat (ITT) and per-protocol (PP) analysis …

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  • Contributors P-YC and J-ML designed the study and wrote the protocol. P-YC and F-PT conducted the systematic review. H-YY prepared the statistical analyses. P-YC, F-PT and J-ML drafted the article which was critically revised and approved by all authors. All authors had full access to the data and participated in the decision to submit for publication.

  • Funding Supported by the Ministry of Science and Technology, Taiwan (grant number: 109-2314-B-002-096; MOST 109-2314-B-002-096;MOST 111-2314-B-002-012; MOST 109-2314-B-002-090-MY3), the Ministry of Health and Welfare, Taiwan (MOHW110-TDU-B-211-124002; MOHW111-TDU-B-221-014008), the National Taiwan University Excellence Research Program Core Consortiums (grant number: 110-L1009.110-L1010.110-L1011) and the Liver Disease Prevention & Treatment Research Foundation, Taiwan.

  • Disclaimer The funding source had no role in study design, data collection, analysis, report writing or the decision to submit this paper for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.