Efficacy of Vonoprazan with Amoxicillin as the First Line Therapy for Helicobacter pylori Eradication in Asian Population: A Systematic Review, Meta-Analysis, and Meta-Regression of Clinical Studies

Abstract

Background and Aims: Helicobacter pylori (H. pylori) infection remains a major public health problem in Asia, with high prevalence and increasing therapeutic resistance. Vonoprazan (VPZ), a potassium-competitive acid blocker, combined with amoxicillin is thought to improve eradication rates in first-line therapy. This study evaluated the efficacy of VPZ with amoxicillin as first-line therapy for H. pylori eradication in an Asian population.

Methods: A systematic review and meta-analysis of clinical studies was conducted according to PRISMA guidelines. A literature search was conducted in PubMed and ScienceDirect through September 2025. Data related to the eradication rate (ER) of VPZ-amoxicillin and the comparison of VPZ-amoxicillin eradication with proton pump inhibitors (PPIs) were extracted and analyzed. Data were analyzed using a random-effects model with the main effect sizes being ER and risk difference (RD), as well as meta-regression against age and body mass index (BMI). Data analysis was performed using RevMan 5.4 and R software.

Results: This study included 22 clinical studies with 32 comparisons involving 7,498 participants. The VPZ-amoxicillin combination in dual, triple, and quadruple therapy regimens had ERs of 0.92 (95%CI: 0.90-0.95); 0.93 (95%CI: 0.91-0.95); and 0.96 (95%CI: 0.93-0.99), respectively, for a total eradication rate of 0.94 (95%CI: 0.91-0.96). Comparison with PPIs showed a risk difference of 0.06 (95%CI: 0.02-0.09) overall and 0.03 (95%CI: -0.02-0.08); 0.07 (95%CI: 0.02-0.12) and 0.04 (95%CI: 0-0.07) in dual, triple, and quadruple therapy, respectively. Meta-regression showed that age (p=0.006) influenced therapy effectiveness, but BMI (p=0.411) did not.

Conclusion: Vonoprazan with amoxicillin is effective as first-line therapy for H. pylori eradication in the Asian population.