Sains Malaysiana 49(6)(2020): 1371-1380

http://dx.doi.org/10.17576/jsm-2020-4906-15

Vonoprazan and Proton Pump Inhibitors in Helicobacter pylori Eradication Therapy: A Systematic Review

(Vonoprazan dan Perencat Pam Proton dalam Terapi Eradikasi Helicobacter pylori: Suatu Ulasan Sistematik)

MOHD FAHAMI NUR AZLINA¹* & CHE ROOS NUR AISHAH²

¹Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Federal Territory, Malaysia

²Universiti Pertahanan Nasional Malaysia, Kem Sungai Besi, 57000 Kuala Lumpur, Federal Territory, Malaysia

Received: 12 July 2019/Accepted: 18 February 2020

ABSTRACT

This systematic review sought to summarise data on the efficacy of vonoprazan, a novel potassium-competitive acid blocker, as compared with a proton pump inhibitor (PPI)-based regimen for first-line treatment of Helicobacter pylori eradication.  A systematic literature search of MEDLINE, EMBASE, and the Cochrane Library using the primary keywords ‘vonoprazan’, ‘takecab’, ‘TAK-438’, ‘potassium’, ‘competitive’, ‘potassium-competitive’, ‘Helicobacter’, and ‘pylori’ was performed. Studies were included if they evaluated the eradication rate between vonoprazan-based and PPI-triple therapies. Overall, 15 studies were included in this review (three randomised controlled trials (RCTs), 12 non-RCTs). Both the included RCTs and non-RCTs showed a statistically significant superiority of vonoprazan-based therapy to PPI-based therapy as esomeprazole. Only 11 of the included studies were deemed as having good quality. In two RCTs, vonoprazan-based therapy showed a statistically significant superiority over PPI-based therapy with H. pylori eradication rates in excess of 90% (p-value < 0.001). Meanwhile, observational studies demonstrated first-line therapy eradication rates ranging between 85.0 and 95.5% in the vonoprazan-based group versus between 66.8 and 86.7% in the PPI-based group with statistical significance. In conclusion, vonoprazan-based triple therapy provided superior efficacy in H. pylori eradication versus PPI-based triple therapy. Vonoprazan shows a promising ability as a potent and long-acting, acid-reducing agent, with some potential advantages over traditional PPIs, particularly in the treatment of H. pylori infection. As a relatively new agent, whether vonoprazan is appropriate and safe for long-term or life-long use remains to be determined in the near future.

Keywords: Eradication; Helicobacter pylori; potassium-competitive acid blocker; proton-pump inhibitor; triple therapy; vonoprazan

ABSTRAK

Kajian ulasan sistematik ini meringkaskan data berkenaan keberkesanan Vonoprazan iaitu penghalang asid potassium-kompetatif novel berbanding regimen penghalang pam proton (PPI) sebagai rawatan barisan pertama eradikasi Helicobacter pylori. Kajian perpustakaan di MEDLINE, EMBASE dan Cochrane Library mengunakan kata kunci ‘vonoprazan’, ‘takecab’, ‘TAK-438’, ‘potassium’, ‘competitive’, ‘potassium-competitive’, ‘Helicobacter’, dan ‘pylori’ telah dilakukan. Kajian dipilih seandainya terdapat bandingan kadar eradikasi antara vonoprazan-based dan PPI-tiga serangkai. Secara keseluruhan, sebanyak 15 kajian telah diterima-pakai dalam kajian ini (tiga kajian kawalan rawak (RCT), 12 bukan-RCT). Kedua-dua RCT dan bukan-RCT menunjukkan keberkesanan rawatan secara signifikan dengan vonoprazan berbanding PPI seperti esomeprazole. Hanya 11 kajian diterima-pakai kerana mempunyai kualiti kajian yang bagus. Dalam dua kajian RCT, terapi berasaskan vonoprazan menunjukkan kesan signifikan secara statistik berbanding PPI untuk kadar eradikasi H. pylori sebanyak 90% (p < 0.001). Manakala, kajian pengamatan menunjukkan kadar eradikasi antara 85.0 dan 95.5% pada kumpulah vonoprazan berbanding 66.8 dan 86.7% pada kumpulan PPI dengan signifikan. Sebagai kesimpulan, terapi berasakan vonoprazan memberikan keberkesanan unggul dalam pembasmian H. pylori berbanding terapi berasaskan PPI. Vonoprazan menunjukkan keupayaan yang memberangsangkan sebagai agen pengurangan asid yang poten dan berjangkamasa tindak panjang, dengan beberapa kelebihan yang berpotensi berbanding PPI, terutamanya dalam rawatan jangkitan H. pylori. Sebagai agen yang agak baru, sama ada vonoprazan sesuai dan selamat untuk jangka panjang atau penggunaan sepanjang hayat masih perlu ditentukan dalam masa akan datang.

Kata kunci: Helicobacter pylori; pembasmian; penyekat asid kompetitif kalium; perencat pam proton; terapi tiga kali ganda; vonoprazan

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*Corresponding author; email: nurazlinamf@ukm.edu.my