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The Efficacy and Safety of Regimens for Helicobacter pylori Eradication Treatment in China: A Systemic Review and Network Meta-Analysis

BACKGROUND

With Helicobacter pylori's increasing antibiotic resistance, evidence of more effective treatments is lacking in China, where H. pylori prevalence is nearly 50%. Thus, we performed a network meta-analysis to compare therapeutic regimens.

METHODS

Data extracted from eligible randomized controlled trials from January 2000 to September 2021 were entered into a Bayesian hierarchical random-effects model to evaluate the efficacy and safety of H. pylori eradication regimens.

RESULTS

This study included 101 trials involving 21,745 patients. Vonoprazan-bismuth-containing quadruple therapy (VBQT) ranked the highest [surfaces under cumulative ranking curve (SUCRA), 83.64%], followed by high-dose amoxicillin dual therapy (HDDT) [SUCRA, 79.70%, odds ratio (OR)=1.31, 95% credible interval (CrI) (0.36, 4.72)] and proton pump inhibitor-based bismuth-containing quadruple therapy (BQT) [SUCRA, 63.59%, OR=1.59, 95% CrI (0.48, 5.24)]. HDDT [OR=2.47, 95% CrI (1.51, 4.06)], BQT [OR=2.04, 95% CrI (1.69, 2.47)], concomitant quadruple nonbismuth therapy (CT) [OR=1.93, 95% CrI (1.19, 3.15)], and sequential therapy (ST) [OR=1.86, 95% CrI (1.50, 2.32)] had higher eradication rates than standard triple therapy (TT). ST (SUCRA, 82.52%) and VBQT (SUCRA, 83.89%) had the highest eradication rate before and after 2010 in the effectiveness ranking, respectively. Furthermore, the H. pylori eradication rate of patients receiving 14-day BQT treatment was higher than that of 10-day BQT regimen [OR=2.55, 95% CI (1.84, 3.53)] and 7-day BQT regimen [OR=3.64, 95% CI (2.64, 5.01)].

CONCLUSIONS

The TT regimen was not an optimal choice in China for H. pylori eradication; VBQT, HDDT, and BQT showed better efficacy. After 2010, there is a trend toward significance that VBQT provided a higher H. pylori eradication rate in China, but with only 1 randomized controlled trial. Thus, more supportive real-world data are needed to confirm its effectiveness.

Efficacy of 8-day versus 10-day sequential therapy for Helicobacter pylori eradication

AIM: To compare the efficacy of 8-day versus 10-day sequential therapy in the eradication of Helicobacter pylori (H.pylori) infection.

METHODS: Two hundred and seventeen patients with H.pylori infection who had peptic ulcer or chronic gastritis were randomly divided into two groups: 8-d group (n = 103, received rabeprazole 10 mg plus amoxicillin 1.0 g for 4 days, and rabeprazole 10 mg plus clarithromycin 500 mg and ornidazole 500 mg for another 4 days) and 10-d group (n = 114, received rabeprazole 10 mg plus amoxicillin 1.0 g for 5 days, and rabeprazole 10 mg plus clarithromycin 500 mg and ornidazole 500 mg for another 5 days). All drugs were given twice daily. H.pylori infection status was compared between the two groups after completion of treatment.

RESULTS: Intention-to-treat eradication rate was 89.3% and 91.2% (P>0.05), and per-protocol eradication rate was 92.0% and 93.7% (P>0.05) in the 8-d and 10-d group, respectively. However, the treatment cost was lower for the 8-day group. There were no significant differences in the incidence of side effects and the rate of symptomatic relief between the two groups (both P>0.05).

CONCLUSION: The 8-day sequential therapy can achieve a high H.pylori eradication and relieve the symptoms effectively, and may be used as first-line treatment for H.pylori eradication.

Sequential therapy versus quadruple therapy in the management of Helicobacter pylori infection after initial treatment failure

AIM: To evaluate the efficacy and safety of levofloxacin-containing sequential therapy versus bismuth-containing quadruple therapy in the management of Helicobacter pylori (H. pylori) infection after initial treatment failure.

METHODS: Ninty-eight patients who had failed eradication of H. pylori infection using traditional standard triple therapy were enrolled and randomly divided into treatment group and control group. The treatment group underwent a 10-day sequential therapy, which consisted of rabeprazole and levofloxacin for the first 5 days, and rabeprazole, clarithromycin and furazolidone for another 5 days. The control group received a 7-day quadruple therapy, which consisted of proton pump, clarithromycin inhibitors, criterion, and bismuth. The curative effects were estimated using the urea breath test four weeks after the treatment, and the safety was also evaluated.

RESULTS: The eradication rate of H. pylori infection was 83.0% in the treatment group and 68.2% in the control group. There was a significant difference in the eradication rate of H. pylori infection between the two groups (P < 0.05). The incidence of adverse reactions was comparable between the two groups, and no serious adverse reactions occurred.

CONCLUSION: Although both sequential therapy and quadruple therapy are effective and safe in the management of H. pylori infection after initial treatment failure, sequential therapy is associated with better efficacy.