Home›Infectious Disease› Tegoprazan-based first-line regimens raise H. pylori eradication success versus PPIs
Tegoprazan-based first-line regimens raise H. pylori eradication success versus PPIsTegoprazan shows higher success rates in treating H. pylori infection
HelicobacterPublished November 6, 2026Study authors: Gao Yang, Xing Jia-Hui, Fu Meng-Meng, Zhao Jun, Li Wei-Ya, Yang Feng-KunPubMed ↗DOI ↗Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease
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Key Takeaway
Consider tegoprazan-based first-line regimens for a small eradication gain, but safety certainty is low.
This meta-analysis pooled data from 3872 treatment-naive adults receiving first-line Helicobacter pylori eradication therapy to compare tegoprazan-containing regimens with proton pump inhibitor (PPI)-containing regimens. The primary outcome was eradication success by intention-to-treat analysis.
Tegoprazan-containing regimens were associated with higher eradication success than PPI-containing regimens (85.7% vs 81.1%; RR=1.06, 95% CI: 1.03-1.09, p<0.0001). Subgroup findings favored tegoprazan for 14-day treatment (RR=1.07, 95% CI: 1.04-1.11) and for quadruple therapy (RR=1.10, 95% CI: 1.05-1.15).
Adverse events were reported less frequently in tegoprazan groups (27.1% vs 30.5%; RR=0.90, 95% CI: 0.82-0.99, p=0.03). Treatment adherence was high in both groups, with a small between-group difference; no effect estimate was reported for adherence.
The authors note clinical heterogeneity, geographic limitations, and limited evidence in refractory or special populations. Certainty of evidence was moderate for eradication success and low for adverse events and adherence. A clinically meaningful advantage in safety or adherence was not established.
In practice, tegoprazan-containing first-line therapy may offer a small improvement in eradication compared with PPI-containing therapy, particularly in 14-day quadruple regimens, but the modest absolute difference and low certainty for safety outcomes warrant cautious interpretation.
How this fits prior evidence
This meta-analysis extends prior coverage of tegoprazan in H. pylori eradication. A previous report found no difference in eradication between tegoprazan-amoxicillin dual therapy and bismuth quadruple therapy, whereas this analysis reports higher success with tegoprazan-containing regimens versus PPIs (85.7% vs 81.1%; RR=1.06, 95% CI: 1.03-1.09). The favorable findings for 14-day and quadruple regimens align with the broader interest in optimizing regimen duration and composition. Separately, Lactobacillus-supplemented therapy was associated with a 10% increase in eradication success, and minocycline-based regimens were noninferior for refractory disease, underscoring that multiple strategies are being evaluated.
Living with a stomach infection caused by the bacteria H. pylori can be a frustrating hurdle to digestive health. Doctors often use proton pump inhibitors (PPIs) as a standard first step to clear the infection. However, new data suggests that a different medication, tegoprazan, might perform better than these traditional options.
Researchers looked at data from 3,872 adults who had never been treated for the infection before. They found that patients taking tegoprazan had a higher success rate in clearing the bacteria compared to those on PPI-based treatments. This success was particularly notable in 14-day treatment plans and quadruple therapy regimens. Additionally, the tegoprazan group reported fewer side effects than the group using standard medications.
While the results are promising, it is important to note that the evidence for safety is currently considered low-certainty. The study also noted that more research is needed for people with difficult-to-treat cases or specific medical needs. For now, tegoprazan shows a small but measurable improvement in clearing the infection and staying comfortable during treatment.
What this means for you:
Tegoprazan may be more effective at clearing H. pylori infections while causing fewer side effects than standard drugs.
Common questions
Is tegoprazan more effective than standard treatments?
Yes, the data shows that tegoprazan-containing regimens had a higher success rate for clearing H. pylori compared to proton pump inhibitor-containing regimens. Specifically, the success rate was 85.7% for tegoprazan versus 81.1% for the standard treatment.
Are there fewer side effects with tegoprazan?
The study reported fewer adverse events in the tegoprazan groups (27.1%) compared to the proton pump inhibitor groups (30.5%). However, the evidence for this specific safety finding is currently considered low-certainty by researchers.
How does it work for different treatment lengths?
Tegoprazan showed favorable results in both 14-day treatment plans and quadruple therapy regimens. These types of plans were more successful at clearing the infection than the standard treatments used in the study.
BACKGROUND: Effective acid-suppressing treatment is of vital importance for the successful eradication of Helicobacter pylori (H. pylori). Tegoprazan, which is a potassium-competitive acid blocker (P-CAB), has been evaluated as a substitute for proton pump inhibitors (PPIs) in first-line eradication therapy, but updated evidence from randomized controlled trials (RCTs) remains limited.
AIMS: To evaluate and compare the first-line treatment regimens containing tegoprazan with those containing PPIs in terms of efficacy and safety for the eradication of H. pylori infection.
METHODS: We searched the literature in PubMed, Embase, Web of Science, CENTRAL, CNKI, Wanfang, and CBM databases for all available years until November 2025. Randomized trials enrolling treatment-naïve adults receiving first-line eradication therapy were eligible. The primary outcome was the rate of eradication success based on an intention-to-treat (ITT) population analysis, while adverse events and treatment adherence were assessed as secondary outcomes. A pooled analysis was conducted using the risk ratio (RR) and its 95% confidence interval (CI), and the reliability of the evidence was rated on the basis of the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
RESULTS: Data were available from 11 randomized trials, including 3872 participants and 14 treatment comparisons. In ITT analyses, tegoprazan-containing regimens were associated with higher eradication success than PPI-containing regimens, but the magnitude of benefit was small (85.7% vs. 81.1%; RR = 1.06, 95% CI: 1.03-1.09, p < 0.0001, I = 31%; moderate-certainty evidence). The subgroup finding was most favorable for 14-day treatment and quadruple therapy (RR = 1.07, 95% CI: 1.04-1.11; RR = 1.10, 95% CI: 1.05-1.15). Fewer adverse events were reported in tegoprazan groups than in comparator groups (27.1% vs. 30.5%; RR = 0.90, 95% CI: 0.82-0.99, p = 0.03; low-certainty evidence). Treatment adherence was high in both groups, with a small between-group difference and substantial heterogeneity (low-certainty evidence).
CONCLUSIONS: Tegoprazan-containing first-line therapy may provide a small improvement in H. pylori eradication compared with PPI-containing therapy, particularly in 14-day quadruple regimens. Current evidence does not establish a clinically meaningful advantage in safety or adherence, and the findings should be interpreted in light of clinical heterogeneity, geographic limitations, and limited evidence in refractory or special populations. Further well-designed randomized trials are needed.
TRIAL REGISTRATION: PROSPERO registration ID: CRD420261290197.
