Comparison of tegoprazan-based and proton pump inhibitor-based regimens for Helicobacter pylori eradication: a meta-analysis and systematic review

Abstract

Background and aim: Tegoprazan (TEG) is a novel potassium-competitive acid blocker (P-CAB) that provides long-lasting acid-suppressing effects. The role of TEG-based Helicobacter pylori (H. pylori) eradication regimens in comparison to proton pump inhibitor (PPI)-based regimens requires further investigation.

Methods: We conducted a comprehensive search across multiple databases. Studies comparing H. pylori eradication rates, adverse events (AEs), and compliance between TEG-based and PPI-based regimens were included. Statistical analyses were performed using RevMan 5.4.

Results: A total of eight studies involving 4,640 patients were included. Based on intention-to-treat (ITT) analyses, the overall eradication rate (78.6% vs. 76.6%; odds ratio [OR] = 1.08, 95% CI: 0.93-1.24; p = 0.31, I ² = 0%) and compliance (97.8% vs. 97.8%; OR = 1.16, 95% CI: 0.54-2.50; p = 0.33, I ² = 13%) were comparable between the TEG and PPI groups. The AE rate of TEG-based regimens was significantly lower than that of PPI-based regimens (30.8% vs. 34.9%; OR = 0.88; 95% CI: 0.78-1.00; p = 0.04, I ² = 67%), although this difference was not significant in the randomized controlled trials (RCTs). The subgroup analyses showed higher eradication rates in studies conducted in China, those with treatment durations of 10 or 14 days, and those using dual or bismuth quadruple regimens. However, the treatment regimens did not significantly influence eradication rates within any subgroup.

Conclusion: TEG-based H. pylori eradication treatment demonstrated similar eradication rates, compliance, and safety to PPI-based regimens.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024629665.

Keywords: Helicobacter pylori; adverse events; compliance; eradication; proton pump inhibitor; tegoprazan.

Figure 1

Search flow diagram in accordance with the preferred reporting items for systematic reviews and meta-analyses principles.

Figure 2

Forest plots comparing the overall eradication rate of H. pylori between TEG-based therapy vs. PPI-based therapy.

Figure 3

Forest plots comparing the H. pylori eradication rate between TEG-based therapy and PPI-based therapy by region (Korea vs. China) (A), length of treatment (7-,10- and 14- days) (B), and treatment regimens (bismuth-containing quadruple therapy, bismuth-containing triple therapy, and non-bismuth-containing dual therapy) (C).

Figure 4

Forest plots comparing TEG-based therapy and PPI-based therapy on compliance.

Figure 5

Forest plots comparing TEG-based therapy and PPI-based therapy on overall adverse events and severe adverse events.