52 - Efficacy of High-Dose Dual Therapy Versus Bismuth Quadruple Therapy for Rescue Treatment of Helicobacter Pylori — An Interim Report of Multi-Center, Randomized Control Study

Hu, Chi-Tan; Tung, Chien‐Chih; Lin, Chan‐Yu; Kuo, I-Nan; Lin, Bor-Ru; Wang, Honglong; Chen, Jin-De; Cheng, Mu-Liang; Shun, Chia‐Tung; Li, Hui-Mi; Hung, Jui‐Sheng; Lei, Wei‐Yi; Shieh, Ming Jium; Wong, Jau‐Min; Kao, John Y.; Yang, Jyh‐Chin

doi:10.1016/s0016-5085(18)30541-9

Cited by 5 publications

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“…Four studies on H . pylori rescue therapy encompassed 639 patients 5,10,26,27 . In both ITT and PP analyses, no significant difference was detected between DT and other regimens in the eradication rate of H .…”

Section: Resultsmentioning

confidence: 95%

“…In this study, we included a total of nine articles, 5‐7,10,23‐27 comprising 2638 patients, of which 1999 patients received first‐line therapy, and 639 patients received salvage treatment. In the ITT analysis, the H .…”

Section: Resultsmentioning

confidence: 99%

“…Six studies involving H. pylori first-line therapy encompassed 1999 patients. [5][6][7][23][24][25] In the ITT analysis, the eradication rate of the S6), (90.8% vs 88.2%, OR: 1.24, 95% CI: 0.77-2.00, p = 0.37, PP analysis) (Figure S7).…”

Section: Ppi-amoxicillin Dt Administered Four-times Daily In the First-line Treatmentmentioning

confidence: 99%

“…DT was significantly higher than that of other regimens (89.8% vs 84.2%, OR: 1.63, 95% CI: 1.02-2.61, p = 0.04). In the PP analysis, the eradication rate of dual therapy tended to be higher than other regimens (92.9% vs 88.3%, OR: 1.68, 95% CI: 0.98-2.89, p = 0.06), albeit not significant.3.2.3 | PPI-amoxicillin DT administered four-times daily in the salvage treatmentFour studies on H. pylori rescue therapy encompassed 639 patients 5,10,26,27. In both ITT and PP analyses, no significant difference was detected between DT and other regimens in the eradication rate of H. pylori (89.3 vs. 85.9%, OR: 1.34, 95% CI: 0.78-2.29, p = 0.28, ITT…”

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confidence: 98%

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PPI‐amoxicillin dual therapy four times daily is superior to guidelines recommended regimens in the Helicobacter pylori eradication therapy within Asia: A systematic review and meta‐analysis

Shi

Suo

et al. 2021

Helicobacter

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Background: Systematic reviews suggested that the eradication efficacy of PPIamoxicillin dual therapy is similar to that of other commonly used regimens. However, it might be affected by the medication frequency. Basic and clinical studies have shown that dual therapy administered four-times daily has a reliable pathophysiological basis and could achieve satisfactory efficacy. Therefore, a systematic review of RCTs of dual therapy and other regimens was conducted to clarify whether dual therapy is superior to guidelines recommended regimens. Materials and Methods:The RCTs comparing dual therapy with other regimens were subjected to meta-analysis to evaluate the eradication rate, adverse reactions, and compliance using a random-effects model. Results:Dual therapy administered four-times daily had a higher eradication rate than other regimens (intention-to-treat analysis: 89.7% vs 84.6%, OR: 1.52, 95%CI 1.08-2.14, p = 0.02; per-protocol analysis: 92.6% vs 88.2%, OR: 1.54, 95%CI 1.01-2.34, p = 0.04). In first-line therapy, according to intention-to-treat analysis, the eradication rate of dual therapy was higher than other regimens (89.8% vs 84.2%, OR: 1.63, 95%CI 1.02-2.61, p = 0.04). In per-protocol analysis, dual therapy showed better efficacy than others (92.9% vs 88.3%, OR: 1.68, 95% CI 0.98-2.89, p = 0.06), but not significantly. In salvage treatment, no significant difference was detected. The safety of dual therapy was significantly better than other regimens (19.6% vs 36.7%, p < 0.01), but no difference was observed in compliance (p = 0.58). Conclusion:PPI-amoxicillin dual therapy administered four-times daily has better efficacy and safety in H. pylori eradication than current guidelines recommended regimens, especially in first-line therapy, and mainly in Asia.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Ppi-amoxicillin Dt Administered Four-times Daily In the First-line Treatmentmentioning

confidence: 99%

mentioning

confidence: 98%

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PPI‐amoxicillin dual therapy four times daily is superior to guidelines recommended regimens in the Helicobacter pylori eradication therapy within Asia: A systematic review and meta‐analysis

Shi

Suo

et al. 2021

Helicobacter

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“…To overcome clarithromycin resistance, other first-line regimens have been studied to replace triple therapy including bismuth-containing quadruple therapy (BCQT) [ 4 ], non-bismuth quadruple (concomitant therapy [CT]) [ 5 ], sequential therapy [ 6 ], hybrid therapy [ 7 ], and high-dose dual therapy (HDDT) [ 8 9 10 ], all of which feature in the current guidelines [ 2 11 12 13 ]. The Maastricht V/Florence guideline recommended that, in areas exhibiting high-level (>15%) clarithromycin resistance but low-level dual clarithromycin and metronidazole resistance (<15%), BCQT or CT should be recommended.…”

Section: Introductionmentioning

confidence: 99%

High-dose dual therapy versus bismuth-containing quadruple therapy for the treatment of Helicobacter pylori infection – A review of the strengths, weaknesses, and proposed solutions

Hu¹

2022

Tzu Chi Medical Journal

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A BSTRACT Helicobacter pylori is the principal cause of peptic ulcers, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. The first treatment to H. pylori infection is dual therapy (a bismuth compound plus metronidazole). On the launch of omeprazole in 1988, dual therapy became omeprazole and amoxicillin (low dose). The poor H. pylori eradication rates by either bismuth-based or low-dose dual therapy drove more combinations of antibiotics were needed. Antibiotic resistance, especially clarithromycin and metronidazole, has made bismuth-containing quadruple therapy (BCQT) a savior for first-line and second-line treatments. However, its complicated dosing regimen commonly causes more adverse events and poor drug compliance. Thus, high-dose dual therapy (HDDT) has been re-arising. This article reviews the strengths and weaknesses of HDDT versus BCQT with proposed solutions.

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High‐dose dual therapy versus bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori: A systematic review and meta‐analysis

Wang,

Kong,

et al. 2024

J of Digest Diseases

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ObjectiveTo update evidence‐based data comparing the efficacy and safety of high‐dose dual therapy (HDDT) and bismuth‐containing quadruple therapy (BQT) in eradicating Helicobacter pylori infection through meta‐analysis.MethodsMultiple databases were systematically searched for randomized controlled trials (RCTs) published up to May 18, 2023. Dichotomous data were evaluated using risk ratio (RR) and 95% confidence interval (CI). Subgroup analysis, sensitivity analysis, risk of bias assessment, and quality of evidence evaluation were performed.ResultsTwenty RCTs containing 7891 subjects were included in the analysis. There was no statistically significant difference in H. pylori eradication rate between HDDT and BQT in the intention‐to‐treat (ITT) analysis (86.31% vs 84.88%; RR 1.02, 95% CI 1.00–1.04, P = 0.12). In the per‐protocol (PP) analysis, the eradication rates for HDDT and BQT were 90.27% and 89.94%, respectively (RR 1.01, 95% CI 0.99–1.03, P = 0.44). Adverse events were significantly lower with HDDT than with BQT (RR 0.44, 95% CI 0.38–0.51, P < 0.00001). Patient adherence was significantly different between the two groups (RR 1.01, 95% CI 1.00–1.03, P = 0.02). Subgroup analysis based on antibiotic combinations within the BQT group showed a significantly higher eradication rate for HDDT than for BQT only when BQT used amoxicillin combined with clarithromycin (P = 0.0009).ConclusionsHDDT showed comparable efficacy with BQT for H. pylori eradication, with fewer adverse effects and higher compliance. Due to regional differences, antibiotic resistance rates, and combined BQT antibiotics, more studies are needed for further validation and optimization of HDDT.

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52 - Efficacy of High-Dose Dual Therapy Versus Bismuth Quadruple Therapy for Rescue Treatment of Helicobacter Pylori — An Interim Report of Multi-Center, Randomized Control Study

Cited by 5 publications

References 0 publications

PPI‐amoxicillin dual therapy four times daily is superior to guidelines recommended regimens in the Helicobacter pylori eradication therapy within Asia: A systematic review and meta‐analysis

PPI‐amoxicillin dual therapy four times daily is superior to guidelines recommended regimens in the Helicobacter pylori eradication therapy within Asia: A systematic review and meta‐analysis

High-dose dual therapy versus bismuth-containing quadruple therapy for the treatment of Helicobacter pylori infection – A review of the strengths, weaknesses, and proposed solutions

High‐dose dual therapy versus bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori: A systematic review and meta‐analysis

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