Meta-Analysis of Sequential, Concomitant and Hybrid Therapy for <i>Helicobacter pylori</i> Eradication

Abstract

Objective To compare the efficacy of sequential therapy, concomitant therapy and hybrid therapy for the treatment of Helicobacter pylori (H. pylori) infection. Methods PubMed, Web of Science, Medline, Embase, the Cochrane Central Register of Controlled Trials and CNKI were searched up to the end of May 10, 2014 in order to identify all randomized controlled trials (RCTs) reporting the effects of sequential therapy, concomitant therapy and hybrid therapy on H. pylori eradication. The relative risk (RR) of eradicating H. pylori infection after sequential therapy compared with concomitant therapy or hybrid therapy was pooled. The eradication rates were considered both on an intention-to-treat (ITT) and per-protocol (PP) basis. Results A total of 10 RCTs involving 3,501 patients were included. The pooled data suggested that the differences between the three groups were not statistically significant (ITT analysis: sequential therapy vs. concomitant therapy: RR=1.01, 95%confidence interval (CI): 0.97-1.04, sequential therapy vs. hybrid therapy: RR=1.02, 95%CI: 0.85-1.22, concomitant therapy vs. hybrid therapy: RR=1.03, 95%CI: 0.97-1.08; PP analysis: sequential therapy vs. concomitant therapy: RR=1.00, 95%CI: 0.96-1.03, sequential therapy vs. hybrid therapy: RR=0.97, 95%CI: 0.86-1.09, concomitant therapy vs. hybrid therapy: RR=1.01, 95%CI: 0.93-1.10). In the ITT and PP analyses, the overall eradication rates were 84.3% (95%CI: 79.1-89.4) and 86.4% (95%CI: 81.7-91.0) for the sequential therapy group, 86.7% (95%CI: 81.0-92.3) and 89.8% (95%CI: 85.1-94.5) for the concomitant therapy group and 86.6% (95%CI: 82.3-91.0) and 92.7% (95%CI: 90.5-94.9) for the hybrid therapy group, respectively. There were no significant differences among these therapies in terms of the rate of side effects. Conclusion The pooled evidence suggests that sequential therapy, concomitant therapy and hybrid therapy are similar with respect to the treatment of H. pylori infection.

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

“…When data from the hybrid therapy treatment arms were pooled, the ITT eradication rate was 88.6%. Th is ITT eradication rate was confi rmed by two other recent meta-analyses (Li 89% (95% CI, 81-94%); He 86.6% (95% CI, 82-91%) ( 103,137 ). Hybrid therapy appears to be more eff ective than the 7-day clarithromycin triple therapy (89 vs. 73%, Network meta-analysis RR 1.22; 95% CI 1.11-1.29) ( 103 ).…”

“…Tolerability of hybrid therapy is similar to clarithromycin triple therapy ( 103 ). Further, there appear to be no signifi cant differences in the effi cacy, tolerability, or compliance observed with hybrid, sequential, or concomitant therapies ( 136,137 ).…”

“…Several recent meta-analyses have summarized results from RCTs conducted in other parts of the world ( 103,136,137 ). A meta-analysis by Wang et al ( 136 ) identifi ed six RCTs which assessed hybrid therapy vs. sequential and/or concomitant therapy.…”

Diagnosis and Treatment of Helicobacter Pylori Infection: Main Statements of the Maastricht v/Florence Consensus Report (2015)

“…Несколько метаанализов продемонстрировали одинаковую эффективность квадротерапии без препаратов висмута, последова-тельной и гибридной схемы ЭТ [17,18,46]. Тем не менее, последовательная схема ЭТ требует смены препаратов через 5 дней, что может снизить ком-плайенс пациентов.…”

Ensuring the highest eradication rates in H. pylori: the case of non-bismuth quadruple concomitant therapy

“…Recent randomized clinical trials have compared these regimenssequential and concomitant-head to head, and these publications have been meta-analyzed by several authors, but they are either outdated [15,18,19] due to the recently published trials, have a smaller scope, focus on pediatric population [20], or have serious limitations such as combining studies without sub-analyzing data from different length of treatment between arms [17,21,22]. However, the most recent reviews seem to indicate that concomitant regimen achieves an 85-90% eradication rate by intention-to-treat and offers slightly (5-10%) better eradication rates than the sequential prescription of drugs [23].…”