The efficacy and safety of vonoprazan-based high-dose dual therapy for eradication of Helicobacter pylori: A systematic review and meta-analysis

In order to evaluate the effectiveness and safety of high-dose dual therapy with vonoprazan for eradicating Helicobacter pylori, we searched seven electronic databases from the establishment of the database to March 2025, collecting randomized controlled clinical trials (RCTs) comparing high-dose dual therapy with vonoprazan to high-dose dual therapy with PPI and quadruple therapy with bismuth, including 13 RCTs with 4023 patients. The primary outcome is the eradication rate determined based on intention to treat analysis and protocol analysis, while secondary outcomes include incidence of adverse events and compliance. According to ITT analysis and PP treatment analysis, the eradication rates of VA therapy were 88.81 % and 93.56 %, respectively. The incidence of adverse reactions was significantly lower (14.56 % vs 26.00 %, RR=0.57, 95 % CI: 0.48-0.67, p < 0.0001), and compliance was better (96.29 % vs 93.56 %, RR=1.03, 95 % CI: 1.01-1.05, p = 0.003), making it a reliable alternative therapy. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).