The CYP2C19 polymorphisms effects on H. pylori cure rate in proton pump inhibitor-based therapeutic regimens: An updated meta-analysis

Introduction: CYP2C19 genotypes induce H. pylori eradication rate in the patients receiving PPI-based treatment regimens. The present study aimed to evaluate the effect of CYP2C19 variants on the H. pylori eradication rate in naive patients treated with PPI-based anti -H. pylori therapies. Methods: A computer-assisted comprehensive literature search was done in the Scopus, Pubmed, Embase, and the Cochran Register of Controlled Trials (CENTRAL) databases, for the relevant studies to be collected with no limitation in the language and publication date. All statistic analyses were performed using Comprehensive meta analysis software. Eradication rate of H. pylori in different CYP2C19 genotypes was measured via event rate; In addition, we pooled the data by the odds ratio with 95% CI to evaluate the effect of CYP2C19 polymorphisms on the changes in the rates of H. pylori eradication as well as sup-grouping analysis for individual PPIs. Publication bias also was assessed via Begg's p-value, Egger's p-value, and funnel the plot. Results: The number of studies included in the present one was 38 studies with 7079 data from the patients. H. pylori eradication rates in HomEMs, HetEMs and PMs were 77%, 82.7% and 85.4%, respectively. We observed a significant difference in H. pylori eradication rates between the HomEMs vs. HetEMs (OR: 0.69; 95% CI: 0.57-0.85), HomEMs vs. PMs (OR: 0.57; 95% CI: 0.46-0.72), as well as HetEMs vs. PMs (OR: 0.70; 95% CI: 0.56-0.87). However, the subgroup analysis was performed due to significant heterogeneity. A significantly lower eradication rate in HomEMs vs. HetEMs (OR: 0.34; 95% CI: 0.22-0.52) and HomEMs vs. PMs (OR: 0.22; 95% CI: 0.10-0.47) for Omeprazole as well as HomEMs vs. HetEMs (OR: 0.56; 95% CI: 0.39-0.82) for Lansoprazole or HomEMs vs. PMs (0.57; 95% CI: 0.33-1.00) were observed for Esomeprazole. Conclusion: The H. pylori eradication rate in HomEM, HetEM, and PM was 77%, 82.7%, and 85.4% respectively. Moreover, the clinical efficacy of Omeprazole, Lansoprazole, and Esomeprazole-based first-line therapies is significantly dependent on the CYP2C19 genotype status, while polymorphisms of this gene have no significant effect on the efficacy of Pantoprazole and Rabeprazole-based diets.