Eradication Efficacy of Modified Dual Therapy Compared with Bismuth-Containing Quadruple Therapy as a First-Line Treatment of Helicobacter pylori

Abstract

OBJECTIVES: This study assessed the effectiveness, adverse events, patient adherence, and costs of modified dual therapy compared with bismuth-containing quadruple therapy for treating Helicobacter pylori infection in Chinese patients. We also sought to determine whether modified dual therapy could be used as an alternative first-line treatment for H. pylori infection. METHODS: A total of 232 H. pylori-infected, treatment-naive patients were enrolled in this open-label, randomized controlled clinical trial. Patients were randomly allocated into 2 groups: the 14-day modified dual therapy group and the bismuth-containing quadruple therapy group. Eradication rates, drug-related adverse events, patient compliance, and drug costs were compared between the 2 groups. RESULTS: The modified dual therapy group achieved eradication rates of 87.9%, 91.1%, and 91.1% as determined by the intention-to-treat, per-protocol, and modified intention-to-treat analyses, respectively. The eradication rates were similar compared with the bismuth-containing quadruple therapy group: 89.7%, 91.2%, and 90.4%. In addition, modified dual therapy ameliorated variations in the CYP2C19, IL-1B-511, and H. pylori VacA genotypes. There were no significant differences in the compliance rates between the 2 groups. The modified dual therapy group exhibited significantly less overall side effects compared with the bismuth-containing quadruple therapy group (P < 0.001). Furthermore, the cost of medications in the modified dual therapy was lower compared with that in the bismuth-containing quadruple therapy. CONCLUSIONS: Modified dual therapy at high dose and administration frequency is equally effective and safer and less costly compared with bismuth-containing quadruple therapy.

Seven-day vonoprazan and low-dose amoxicillin dual therapy as first-lineHelicobacter pyloritreatment: a multicentre randomised trial in Japan

“…The efficacy of a low-dose and/or less frequent dual therapy consisting of AMO (2.0 g/day or less) and PPI (twice/day or less) resulted in unacceptable eradication rates 32–34. Recently, high-dose and high-frequency dual therapy, defined as the administration of both AMO (≥2.0 g/day) and PPI (at least twice daily) for 14 days, has been reported to have greater H. pylori eradication efficacy as first-line therapy 35–38. However, side effects and poor patient compliance due to high dose, high administration frequency and long duration of treatment are the most common setbacks.…”

A comparative study of 14‐day dual therapy (esomeprazole and amoxicillin four times daily) and triple plus bismuth therapy for first‐line Helicobacter pylori infection eradication: A randomized trial

“…Yang et al 10 in a single‐center randomized controlled study conducted in mainland China in 2019 have reported the application of 14‐day dual therapy with esomeprazole (20 mg qid) and amoxicillin (750 mg qid) for treatment‐naïve patients (n = 116) and achieved relatively good eradication rates (87.9% in ITT and 91.1% in PP analyses). The eradication rates and compliance were similar to TPB therapy, but dual therapy had a lower incidence of adverse events.…”

“…Taiwan is a region of low antibiotic resistance, and the study results might not be generalizable to populations with high rates of antibiotic resistance. The other study is a single‐center randomized controlled study from mainland China, 10 and dual therapy (esomeprazole 20 mg and amoxicillin 750 mg) also achieved relatively good eradication rates of 87.9% in ITT and 91.1% in PP analyses. The eradication rates and compliance were comparable to triple plus bismuth (TBP) therapy (PPI, amoxicillin, clarithromycin, and bismuth), and dual therapy is associated with lower incidence of adverse events.…”

Searching for an optimal therapy for H pylori eradication: High‐dose proton‐pump inhibitor dual therapy with amoxicillin vs. standard triple therapy for 14 days

“…This was significantly higher compared with the 10 days sequential therapy or 1‐week STT. A more recent paper from China compared the HDDT with the bismuth‐containing quadruple therapy for 2 weeks and showed an equivalent eradication rate of close to 90% for the HDDT regimen 20 . In another study from Taiwan, the HDDT achieved an eradication rate on ITT of 91.7% and was comparable to a non‐bismuth containing quadruple therapy 21 .…”