Helicobacter pylori infection contributes to peptic ulcer disease and gastric cancer, making eradication crucial. However, standard therapy with a proton pump inhibitor (PPI) plus antibiotics has shown declining success rates. Tegoprazan is a novel potassium-competitive acid blocker (P-CAB) that producing rapid, meal-independent and CYP2C19-genotype–independent acid suppression.

We performed a meta-analysis to compare the efficacy and safety of tegoprazan-based regimens versus PPI-based regimens for H. pylori eradication

We systematically searched PubMed, Scopus, Cochrane Library and Web of Science. Eligible randomized and comparative studies evaluated tegoprazan-based versus PPI-based regimens. The primary endpoint was intention-to-treat (ITT) eradication; secondary endpoint was overall adverse events (AEs). Random-effects meta-analysis pooled risk ratios (RR) with 95% confidence intervals (CI); heterogeneity was assessed with I². Prespecified subgroup analyses were by treatment regimen (triple, dual, other).

Eleven studies met inclusion criteria. Eradication efficacy was equivalent between groups (RR 1.01, 95% CI 0.96–1.05, p = 0.77; I² = 0%). Subgroups showed no effect modification: triple RR 1.00 (0.92–1.08; I² = 0%), dual RR 1.02 (0.93–1.12; I² = 0%), other RR 1.01 (0.93–1.09; I² = 0%). AEs were similar overall (RR 0.92, 0.82–1.03; p = 0.15; I² = 29.7%, τ² = 0.01). By regimen, dual therapy favored tegoprazan with fewer AEs (RR 0.68, 0.53–0.89; I² = 0%; p = 0.005), whereas triple (RR 0.93, 0.78–1.12; I² = 23.4%) and other regimens (RR 1.02, 0.87–1.19) showed no difference.

Tegoprazan-based regimens are non-inferior to PPI-based regimens for ITT eradication, with highly consistent results across regimen types. Overall tolerability is at least comparable, and dual-therapy regimens demonstrate significantly fewer AEs with tegoprazan. Tegoprazan is an effective, well-tolerated first-line alternative to PPIs.