Vonoprazan (VPZ), a new potassium-competitive acid blocker, has been approved and used for Helicobacter pylori eradication in Japan. To date, many studies, as well as several systematic reviews and meta-analyses (MAs), have compared VPZ-based 7-day triple therapy with proton pump inhibitor (PPI)-based therapy. An MA of randomized controlled trials (RCTs) comparing first-line VPZ- with PPI-based triple therapy, the latter featuring amoxicillin (AMPC) and clarithromycin (CAM), found that approximately 30% of patients hosted CAM-resistant H. pylori; however, the reliability was poor because of high heterogeneity and a risk of selection bias. VPZ-based triple therapy is superior to PPI-based triple therapy for patients with CAM-resistant H. pylori, but not for those with CAM-susceptible H. pylori. An MA of non-RCTs found that second-line VPZbased triple therapies were slightly (~2.6%) better than PPI-based triple therapies (with AMPC and metronidazole). However, the reliability of that MA was also low because of selection bias, confounding variables and a risk of publication bias; in addition, it is difficult to generalize the results because of a lack of data on antibiotic resistance. VPZ-based triple therapy (involving AMPC and sitafloxacin) was more effective than PPI-based triple therapy in a third-line setting, but a confirmatory RCT is needed. Non-RCT studies indicated that VPZ-based triple therapy involving CAM and metronidazole may be promising. Any further RCTs must explore the antibiotic- resistance status when evaluating the possible superiority of a potassium-competitive acid blocker.

中文翻译：

---

就根除幽门螺杆菌而言，钾竞争性酸阻滞剂真的优于质子泵抑制剂吗？

Vonoprazan (VPZ) 是一种新型钾竞争性酸阻滞剂，已在日本获批用于根除幽门螺杆菌。迄今为止，许多研究以及多项系统评价和荟萃分析 (MA) 将基于 VPZ 的 7 天三联疗法与基于质子泵抑制剂 (PPI) 的疗法进行了比较。一项比较一线 VPZ 与基于 PPI 的三联疗法（后者以阿莫西林 (AMPC) 和克拉霉素 (CAM) 为特色）的随机对照试验 (RCT) 的 MA 发现，大约 30% 的患者患有 CAM 耐药性幽门螺杆菌；然而，由于高异质性和选择偏倚的风险，可靠性很差。对于CAM耐药的幽门螺杆菌患者，基于VPZ的三联疗法优于基于PPI的三联疗法, 但不适用于那些对 CAM 敏感的幽门螺杆菌. 一项非 RCT 的 MA 发现，基于 VPZ 的二线三联疗法比基于 PPI 的三联疗法（使用 AMPC 和甲硝唑）略好（约 2.6%）。然而，由于选择偏倚、混杂变量和发表偏倚风险，该 MA 的可靠性也很低。此外，由于缺乏抗生素耐药性数据，很难对结果进行概括。在三线环境中，基于 VPZ 的三联疗法（包括 AMPC 和西他沙星）比基于 PPI 的三联疗法更有效，但需要验证性 RCT。非 RCT 研究表明，包括 CAM 和甲硝唑在内的基于 VPZ 的三联疗法可能是有希望的。在评估钾竞争性酸阻滞剂的可能优势时，任何进一步的 RCT 都必须探索抗生素耐药性状态。