Standard triple therapy for Helicobacter pylori infection in China: A meta-analysis

AIM:To assess the efficacy and safety of standard triple therapy compared with other pre-existing and new therapies in China.METHODS:Literature searches were conducted in the following databases:PubMed,EMBASE,the Cochrane Central Register of Controlled Trials,the VIP database,the China National Knowledge Infrastructure database,and the Chinese Biomedical Database.A meta-analysis of all randomized controlled trials(RCTs)comparing standard triple therapy for the eradication of Helicobacter pylori with pre-existing and new therapies in China was performed using Comprehensive Meta-Analysis 2.0.There were 49 studies that met our criteria and the qualities of these studies were assessed using the Jadad scale.The Mantel-Haenszel method was used for pooling dichotomous data.We also conducted subgroupanalyses according to age,duration of treatment and drug type.Sensitivity analyses and a cumulative metaanalysis were also performed with CMA 2.0.Publication bias was evaluated using Egger’s test,Begg’s test or a funnel plot.RESULTS:A total of 49 RCTs including 8332 patients were assessed.This meta-analysis showed that standard triple therapy with proton pump inhibitors(PPIs),amoxicillin(AMO)and clarithromycin(CLA)was inferior to sequential therapy[relative risk(RR)=0.863;95%confidence interval(CI):0.824-0.904],but was not superior to quadruple therapy(RR=1.073;95%CI:0.849-1.357)or other triple therapies(RR=1.01;95%CI:0.936-1.089).The meta-analysis also suggested that standard triple therapy is slightly more effective than dual therapy(RR=1.14;95%CI:0.99-1.31).However,the differences were not statistically significant.We removed the only trial with a regimen lasting14 d by sensitivity analysis and found that 7-d standard triple therapy was superior to 7-d dual therapy(RR=1.222;95%CI:1.021-1.461).Moreover,a sub-analysis based on the duration of quadruple therapy indicated that the 7-d and 10-d standard triple therapies were inferior to sequential therapy(RR=0.790;95%CI:0.718-0.868;RR=0.917;95%CI:0.839-1.002,respectively).Additionally,there were no significant differences in cure rate or adverse events among standard triple therapy,quadruple therapy,and other triple therapies(RR=0.940;95%CI:0.825-1.072;RR=1.081;95%CI:0.848-1.378,respectively).Standard triple therapy had a higher occurrence of side effects than sequential therapy(RR=1.283;95%CI:1.066-1.544).CONCLUSION:The eradication rates with a standard triple therapy consisting of PPI,AMO,and CLA are suboptimal in China,and new treatment agents need to be developed.

Meta-analysis:Is combination of tetracycline and amoxicillin suitable for Helicobacter pylori infection?

AIM:To access the efficacy of combination with amoxicillin and tetracycline for eradication of Helicobacter pylori(H.pylori),thus providing clinical practice guidelines.METHODS:Pub Med,EMBASE,Cochrane Central Register of Controlled Trials,Science Citation Index,China National Knowledge Infrastructure,Wanfang,and Chinese Biomedical Literature databases and abstract books of major European,American,and Asian gastroenterological meetings were searched.All clinical trials that examined the efficacy of H.pylori eradication therapies and included both tetracycline and amoxicillin in one study arm were selected for this systematic review and meta-analysis.Statistical analysis was performed with Comprehensive Meta-Analysis Software(Version 2).Subgroup,meta-regression,and sensitivity analyses were also carried out.RESULTS:Thirty-three studies met the inclusion criteria.The pooled odds ratio(OR)was 0.90(95%CI:0.42-1.78)for quadruple therapy with amoxicillin and tetracycline vs other quadruple regimens,and total eradication rates were 78.1%by intention-to-treat(ITT)and 84.5%by per-protocol(PP)analyses in the experimental groups.The pooled eradication rates of 14-d quadruple regimens with a combination of amoxicillin and tetracycline were 82.3%by ITT and89.0%by PP,and those of 10-d regimens were 84.6%by ITT and 93.7%by PP.The OR by ITT were 1.21(95%CI:0.64-2.28)for triple regimens with amoxicillin and tetracycline vs other regimens and 1.81(95%CI:1.37-2.41)for sequential treatment with amoxicillin and tetracycline vs other regimens,respectively.CONCLUSION:The effectiveness of regimens employing amoxicillin and tetracycline for H.pylori eradication may be not inferior to other regimens,but further study should be necessary.