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. 2025 Apr 22;38(5):716-721.
doi: 10.1080/08998280.2025.2491964. eCollection 2025.

Vonoprazan and amoxicillin dual therapy versus bismuth-based therapy for Helicobacter pylori eradication: a systematic review and meta-analysis of randomized controlled trials

Hazem Abosheaishaa  1 , Hesham Elsayed  2 , Omar Abdelhalim  1 , Islam Mohsen El Haddad  3 , Mohamed K Harfoush  4 , Abdallfatah Abdallfatah  5 , Arshia Sethi  1 , Mohammed Abusuliman  6 , Rahul Karna  7 , Mohammad Bilal  7
Affiliations

Vonoprazan and amoxicillin dual therapy versus bismuth-based therapy for Helicobacter pylori eradication: a systematic review and meta-analysis of randomized controlled trials

Hazem Abosheaishaa et al. Proc (Bayl Univ Med Cent). .

Abstract

Introduction: Helicobacter pylori infection can cause peptic ulcer disease, chronic gastritis, primary gastric lymphoma, and gastric cancer. Treatment with bismuth-based quadruple therapy is typically the first line of treatment but can be challenging due to increased pill burden and adverse effects, leading to nonadherence to therapy. Recent studies have shown that vonoprazan can be used in combination with amoxicillin as a potential treatment option. We conducted a systematic review and meta-analysis to assess the efficacy and tolerability of vonoprazan-based dual therapy as compared to bismuth-based therapy (BBT).

Methodology: We conducted a comprehensive search of multiple electronic databases including PubMed, Embase, and Cochrane Library to identify randomized controlled studies assessing vonoprazan and amoxicillin (VA) in comparison to BBT for H. pylori treatment in adults >18 years of age. Studies with pediatric populations, written in languages other than English, or without control groups were excluded.

Results: Out of the 1968 citations, 9 studies including 2039 patients were included in the final analysis. There were 463 and 481 men in the VA and the BBT groups, respectively. The mean age ranged from 38.1 to 48.7 years in the VA group and from 38.6 to 46.1 in the BBT group. The VA group had an eradication rate similar to that of the BBT group (odds ratio [OR]: 0.32, 95% confidence interval [CI]: 0.26-0.40; P = 0.08). The VA group had a lower incidence of total adverse events than the BBT group (OR: 0.32, 95% CI: 0.26-0.40; P = 0.0001), including a reduced occurrence of nausea and vomiting (OR: 0.42, 95% CI: 0.28-0.65; P = 0.0001). There was no difference in compliance between the VA and BBT groups (OR: 1.16, 95% CI: 0.76-1.76; P = 0.50).

Conclusion: Our study showed a similar eradication rate of H. pylori but a significantly lower incidence of adverse events in the VA group compared with the BBT group. Our analysis suggests that a VA-based regimen is an acceptable treatment option for H. pylori patients who cannot tolerate BBT.

Keywords: Bismuth; Helicobacter pylori; vonoprazan.

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Conflict of interest statement

The authors report no funding or conflicts of interest.

Figures

Figure 1.
Figure 1.
PRISMA flow chart showing different stages of screening and number of studies included.
Figure 2.
Figure 2.
H. pylori eradication rate in the vonoprazan and amoxicillin group compared to the bismuth-based therapy group.
Figure 3.
Figure 3.
Leave-one-out sensitivity analysis comparing eradication of H. pylori in the vonoprazan and amoxicillin group compared to the bismuth-based therapy group.
Figure 4.
Figure 4.
Incidence of overall adverse events in the vonoprazan and amoxicillin group compared to the bismuth-based therapy group.
Figure 5.
Figure 5.
Incidence of nausea and vomiting in the vonoprazan and amoxicillin group compared to the bismuth-based therapy group.
Figure 6.
Figure 6.
Compliance in the vonoprazan and amoxicillin group compared to the bismuth-based therapy group.
See this image and copyright information in PMC

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