Article Text

Download PDFPDF

Efficacy of second-line regimens for Helicobacter pylori eradication treatment: a systemic review and network meta-analysis
  1. Yen-Lin Chang1,2,
  2. Yu-Chun Tung2,3,
  3. Yu-Kang Tu4,5,6,
  4. Hong-Zen Yeh7,
  5. Jyh-Chin Yang8,
  6. Ping-I Hsu9,
  7. Sung-Eun Kim10,
  8. Ming-Fen Wu1,
  9. Wen-Shyong Liou1,11,
  10. Sz-Iuan Shiu2,7,12
  1. 1Department of Pharmacy, Taichung Veterans General Hospital, Taichung, Taiwan
  2. 2Evidence-based Practice and Policymaking Committee, Taichung Veterans General Hospital, Taichung, Taiwan
  3. 3Department of Pharmacy, Puli Branch, Taichung Veterans General Hospital, Taichung, Taiwan
  4. 4Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
  5. 5Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
  6. 6Department of Dentistry, National Taiwan University Hospital and School of Dentistry, National Taiwan University, Taipei, Taiwan
  7. 7Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
  8. 8Division of Gastroenterology, Department of Internal Medicine, Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
  9. 9Division of Gastroenterology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
  10. 10Division of Gastroenterology, Department of Internal Medicine, Kosin University College of Medicine, Busan, South Korea
  11. 11School of Pharmacy, China Medical University, Taichung, Taiwan
  12. 12Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
  1. Correspondence to Dr Sz-Iuan Shiu; b9002007{at}hotmail.com

Abstract

Background Current guidelines recommend bismuth-containing quadruple therapy (BQT) and quinolone-containing therapy after failure of first-line Helicobacter pylori eradication therapy. However, the optimum regimen of second-line eradication therapy remains elusive. We conducted a network meta-analysis to compare the relative efficacy of 16 second-line H. pylori eradication regimens.

Methods Three major bibliographic databases were reviewed to enrol relevant randomised controlled trials between January 2000 and September 2018. Network meta-analysis was conducted by STATA software and we performed subgroup analysis in countries with high clarithromycin resistance and high levofloxacin resistance, and in patients with documented failure of first-line triple therapy.

Results Fifty-four studies totalling 8752 participants who received 16 regimens were eligible for analysis. Compared with a 7-day BQT, use of probiotic add-on therapy during, before, and after second-line antibiotic regimens, quinolone-based sequential therapy for 10–14 days, quinolone-based bismuth quadruple therapy for 10–14 days, bismuth quadruple therapy for 10–14 days, and quinolone-based triple therapy for 10–14 days were significantly superior to the other regimens. Subgroup analysis of countries with high clarithromycin resistance and high levofloxacin resistance revealed that the ranking of second-line eradication regimens was distributed similarly in each group, as well as in patients with failure of first-line triple therapy.

Conclusion We conducted a detailed comparison of second-line H. pylori regimens according to different antibiotic resistance rates and the results suggest alternative treatment choices with potential benefits beyond those that could be achieved using salvage therapies recommended by guidelines.

  • Helicobacter pylori infection
  • Helicobacter pylori - treatment
  • meta-analysis
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Statistics from Altmetric.com

Footnotes

  • Contributors S-IS, Y-LC, Y-CT, and H-ZY designed the meta-analysis, with input from all listed authors. Y-LC, Y-CT, and S-IS contributed to data acquisition and drafted the article. Y-KT, S-IS, and Y-LC contributed to data analysis and interpretation. All authors performed critical revision of the manuscript and approved the final draft of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The data supporting this meta-analysis are from previously reported studies and datasets, which have been cited and belong to deidentified participant data.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.