Efficacy and Safety of Potassium Competitive Acid Blocker Based Therapies vs Proton-Pump Inhibitor Based Therapies in H. pylori Eradication: A Meta-Analysis

Margarette Y. Baldeo, MD; Melizza J. Soriano, MD; Enrik John T. Aguila, MD; Marianne Linley Sy-Janairo, MD
St. Luke’s Medical Center – Global City

Significance: Helicobacter pylori infection has affected approximately 50% of the world’s population with rates being higher in developing countries than in developed ones. Conventional proton-pump inhibitors (PPIs) are widely used as first-line treatments but have notable limitations which include slow onset of action, short plasma half-life of 60–90 minutes, dependence on acidic conditions for activation and suboptimal nighttime acid suppression. In contrast, potassium- competitive acid blockers (P-CABs) were recently developed which may offer beneficial effects, offering a promising alternative to PPIs.

Methodology: Randomized Controlled Trials (RCTs) involving adult patients with H. pylori infection treated with PCAB-based or PPI-based therapies were included. Exclusion criteria included RCT not using PPIs or PCABs, studies lacking sufficient data, and duplicates. Systematic searches were conducted on PubMed, Cochrane CENTRAL, Google Scholar, and HERDIN for studies published between 2013 and 2023, using keywords such as “H. pylori,” “Potassium Competitive Acid Blocker,” and “Proton Pump Inhibitor.” No language restrictions were applied. Quality assessment used the Modified Cochrane risk-of-bias tool, and statistical analysis was performed using ReviewManager 5.4.1 Effect sizes were expressed as risk ratios (RR) with 95% confidence intervals (CI) using a fixed-effects model. Heterogeneity was evaluated using Cochran’s Q test and I² statistics.

Results: Fifteen RCTs with 4129 participants who received H pylori eradication therapy comparing potassium competitive acid blockers (Tegoprazan, Vonoprazan, and YH808) with proton pump inhibitors were analyzed. H. pylori eradication rate of potassium competitive acid blocker-based therapy was higher than that of PPI-based triple therapy RR 1.04, CI 1.10-1.18, P < 0.05. Subgroup analysis showed that PCAB- based regimens had significantly higher eradication rates than PPI in treatment-naive patients (RR 1.14, 95% CI 1.1-1.18, pP < 0.05 ) and that Vonoprazan-based regimen in particular, had superior eradication rates compared to PPI-based regimen (RR 1.16 95% CI 1.12-1.20 P < 0.05). No significant differences were seen between the Tegoprazan and YH4808 groups compared to the PPI group. Adverse events were also lower in the PCAB group compared to the PPI group.

Conclusion: Our study shows that Potassium channel acid blockers are effective and have significantly higher eradication rates compared to PPIs, with lower incidence of adverse events. Clinical practice may benefit from integrating PCABs as first-line options for H. pylori management.

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