First-line therapies for H. pylori infection in Italy: a pooled-data analysis

Abstract

Background: Curing H. pylori infection remains challenging, and the use of most effective first-line therapy represents a therapeutic cornerstone. To monitor the efficacy of first-line therapies in Italy, we designed a systematic review with pooled- data analysis of data published in the last 15 years. Methods: The search was focused on standard regimens and adult patients. Studies that included modified therapy regimens, pediatric patients, case series with less than 5 patients, and those in language other than English were excluded. Results: A total of 40 studies, with 74 therapeutic arms and 13,539 patients were evaluated. Among the 14-day triple therapies, the combination with proton pump inhibitor (PPI), clarithromycin and amoxicillin achieved the highest (77.9%) success rate, whilst the lowest success rate (62.7%) was observed following the 14-day PPI, clarithromycin and tinidazole regimen. The overall efficacy of triple therapies significantly decreased from 75.7% to 72.1% in the last decade. Sequential (88.3% on 3431 patients), concomitant (88.8% on 376 patients), and the bismuth-based quadruple therapy with three-in-one capsule, containing bismuth subcitrate potassium (140 mg), metronidazole (125 mg), tetracycline (125 mg) (90.4% on 999 patients) achieved similarly high eradication rates, but data on concomitant are still limited. The bismuth-based was associated with the higher (38.7%) incidence of side-effects. Conclusions: Data found that all triple therapies, irrespective of drug combination and therapy duration, should be abandoned in Italy due to their unacceptable low success rates. Monitoring the efficacy of standard first-line therapies in other countries could be clinically useful for both patients and clinicians.

Effectiveness of first and second‐line empirical treatment in Italy: Results of the European registry on Helicobacter pylori management

“…Indeed, the updated Italian and European guidelines, recently published in 2022, recommended that the duration of CT has to be 14 days 12,27 . The eradication rates found in our study were also comparable to those reported in a review evaluating the effectiveness of empirical first lines in Italy, suggesting the reproducibility of our results 28 . Similarly, a Hp‐EuReg study performed over 21,000 treatment‐naïve patients encompassing 27 European countries and assessing the prescriptions and effectiveness trends of first‐line empirical therapy reported that only quadruple therapies lasting at least 10 days were able to achieve over 90% eradication rates, in line with current study results 17 .…”

“…12,27 The eradication rates found in our study were also comparable to those reported in a review evaluating the effectiveness of empirical first lines in Italy, suggesting the reproducibility of our results. 28 Similarly, a Hp-EuReg study performed over 21,000 treatment-naïve patients encompassing 27 European countries and assessing the prescriptions and effectiveness trends of first-line empirical therapy reported that only quadruple therapies lasting at least 10 days were able to achieve over 90% eradication rates, in line with current study results. 17 Furthermore, a similar Hp-EuReg sub-study focussing on the Spanish cohort, found that the highest first-line effectiveness outcomes were obtained with the 10-day BQT-TSC (95% cure rate by intention-to-treat), with the 14day bismuth-clarithromycin quadruple therapy (PPI-bismuth-clarithromycin-amoxicillin: 91%) and the 14-day non-bismuth CT therapy (PPI-clarithromycin-amoxicillin-metronidazole: 92%), findings that were also in line with present study conclusions.…”