Potassium-Competitive Acid Blockers for First-Line

Background and Aims: Potassium-competitive acid blockers (P-CABs) have emerged as an alternative to proton pump inhibitors (PPIs) for Methods: A systematic search of PubMed, ScienceDirect, Cochrane, and Scopus databases was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials comparing P-CAB-based regimens with B-PPI-based quadruple therapies were included. Pooled risk ratios (RRs) were calculated. The primary outcome was the eradication rate; secondary outcomes were treatment compliance and subgroup analysis according to the specific P-CAB used. Results: Twenty-five trials including 8789 patients were analyzed. In the intention-to-treat analysis, pooled eradication rates were 86.8% for P-CAB-based regimens and 83.3% for PPI-based quadruple therapy (RR: 1.04; 95% confidence interval [CI]: 1.01-1.07; Conclusion: Compared with B-PPI-based quadruple therapy, P-CAB-based regimens showed a small statistical advantage in intention-to-treat analysis, which was not consistently supported by per-protocol or subgroup analyses. No difference in treatment adherence was observed. These findings suggest that P-CAB-based regimens should be considered alternative first-line options rather than clear replacements for standard PPI-based quadruple therapy.