Vonoprazan–amoxicillin dual therapy improves 14-day eradication and reduces adverse events in patients with Helicobacter pylori infection: an updated landmark systematic review and meta-analysis of 11 randomized trials with subgroup analysis

Background Vonoprazan, a potassium-competitive acid blocker (P-CAB), may enhance Helicobacter pylori (H.pylori) eradication in combination with amoxicillin.With increasing drug resistance, dual therapy is a potential alternative to standard triple and quadruple regimens.This systematic review and meta-analysis evaluated the efficacy and safety of vonoprazan dual therapy (VDT) as first-line treatment for H. pylori infection.Methods A comprehensive systematic search on PubMed, Embase, Scopus and Cochrane Library identified 11 randomized controlled trials (RCTs) involving 2877 patients (1439 VDT; 1438 control), comparing VDT with standard triple therapy, quadruple therapy or individualized treatment regimens for H. pylori eradication, up to March 2025.Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using the Mantel-Haenszel method for dichotomous outcomes.Random or fixed-effects models were applied based on heterogeneity, assessed using the Higgins I 2 statistic.A P-value