Efficacy and Safety of Potassium-Competitive Acid Blockers in Helicobacter pylori Rescue Therapy: A Meta-Analysis

Background: Helicobacter pylori (H. pylori) infection is associated with the development of various gastrointestinal pathologies, including gastritis, peptic ulcers, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and gastric adenocarcinoma. Eradication of this pathogen is therefore essential for both the treatment and prevention of these conditions. Potassium-competitive acid blockers (P-CABs), a novel class of acid-suppressive agents, have been extensively incorporated into first-line H. pylori eradication regimens and have demonstrated superior efficacy compared to conventional proton pump inhibitors (PPIs). Nevertheless, their effectiveness in rescue therapy remains a subject of debate. Objective: To evaluate the efficacy and safety of P-CAB-containing regimens in the rescue therapy for H. pylori eradication. Methods: Based on the PRISMA 2020 guideline（Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA 2020 Statement）, A systematic search was conducted across three electronic databases: PubMed, Web of Science, and EMBASE. The primary outcome was the eradication rate assessed by per-protocol (PP) analysis. The secondary outcome was safety. We synthesized the effect sizes using risk difference (RD) and 95% confidence interval (95% CI). Results: A total of 1373 references were retrieved through the search, and 14 studies (2 RCTs and 12 non-RCTs) were included, comparing P-CAB-containing rescue regimens with traditional PPI-containing rescue regimens. The PP analysis included 10,494 patients (P-CABs intervention group: 4498; PPI control group: 5996). A comparison of P-CAB- and PPI-based regimens revealed a statistically significant difference in eradication rates within the context of H. pylori rescue therapy.[RD=0.04, 95% CI=0.03 to 0.04]. Conclusion: P-CAB-based anti- H. pylori regimens are more effective than PPI-based regimens in rescue therapy, with no significant difference in safety.