Efficacy Of Potassium-Competitive Acid Blocker vs Proton Pump Inhibitor as First-Line and Second-Line Treatment for Helicobacter Pylori Eradication

Abstract

Introduction: Eradication of H. pylori reduced the risk of gastric cancer by 75%, thus, its therapy with high eradication rates is needed. Nowadays, the success rate of H.pylori eradication regimen (PPI-based) has dropped to less than 75% due to clarithromycin resistance and inadequate gastric acid suppression. Vonoprazan, a Potassium-competitive acid blocker (PCAB) was released for use in first-line and second-line treatment for H.pylori eradication. It shows better acid suppression effect in acid-related disease. Aim: The aim of this study was to compare the efficacy of PCAB and PPI as first-line and second-line treatment for H. pylori eradication. Method: We search the Medline, Google Scholar and Directory of Open Access Journals (DOAJ) databases in October 2019. The study selection process was plotted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Results: In studies assessing first-line therapy, 776 patient were using PPI and 965 patient were using PCAB. In first-line therapy, PCAB has higher ITT and PP compared to PPI. According to Sue et al, in PPI group, more patient complain of diarrhea (49 vs 25; p < 0.001). In studies assessing second-line therapy, 1,069 patient were using PPI and 605 patient were using PCAB. Two studies showed no significant differences between PCAB and PPI in second-line therapy, but one study showed PCAB superiority (ITT PPI vs PCAB 85% vs 90% p=0.045; PP PPI vs PCAB 91% vs 96% p=0.008). There is no difference in adverse event between PCAB and PPI. Conclusion: In conclusion, PCAB has higher eradication rate (ITT and PP) compared to PPI as first-line therapy for H.pylori eradication. Further study is still needed in comparing efficacy of PCAB and PPI as second-line therapy. Both therapies were safe and well tolerated.