Meta-analysis: Sequential Therapy Is Superior to Conventional Therapy for<i>Helicobacter pylori</i>Infection in Korea

Chung, Jae‐Yong; Ha, Minsu; Yun, Sung Cheol; Kim, Jung Ho; Lee, Jong Jun; Kim, Yoon Jae; Kim, Kyoung Oh; Kwon, Kwang An; Park, Dong Kyun; Lee, Dong Hoon

doi:10.4166/kjg.2013.62.5.267

Cited by 23 publications

(8 citation statements)

References 30 publications

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“…Primary treatment failure of H. pylori -related disease is a large problem in Korea. Several previous Korean meta-analyses have reported SET to be superior to STT for eradication of H. pylori ( 3 4 5 6 ). However, no study has performed subgroup analysis of duration of STT.…”

Section: Introductionmentioning

confidence: 98%

Treatment of Helicobacter pylori Infection in Korea: A Systematic Review and Meta-analysis

Lee

Kim

2015

J Korean Med Sci

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The efficacy of seven-day clarithromycin-based standard triple therapy (STT) for Helicobacter pylori has decreased in Korea over the past decade. The aim of this meta-analysis was to clarify the efficacy of first-line and second-line therapies in Korea. This systematic review will provide an overview of H. pylori eradication and present new therapeutic strategies used in Korea. An extensive search of the literature concerning STT, sequential therapy (SET), concomitant therapy (CT), bismuth-containing quadruple therapy (BCQT) and various other therapies used in Korea was performed. All selected studies were randomized controlled trials (RCTs). Eighteen RCTs were eligible for systematic review. The alternative regimens comparing seven-day STT as a first-line therapy include SET, CT, levofloxacin-based therapy (LBT), BCQT, and STT with prolonged duration. The results of the meta-analysis suggest that SET is superior to seven-day STT. The overall eradication rate by intention to treat (ITT) analysis was 69.8% for STT and 79.7% for SET. The overall eradication rate by per-protocol (PP) analysis was 77.0% for STT and 85.0% for SET. The odds ratios for the ITT and PP eradication rate were 0.57 (95% confidence interval [CI], 0.43 to 0.74) and 0.52 (95% CI, 0.35 to 0.76), respectively. In the subgroup analysis, however, there were no significant differences between SET and STT with prolonged durations. Alternative regimens to seven-day BCQT as second-line therapy include LBT, moxifloxacin-based therapy and 14-day BCQT. The eradication rates of these alternative regimens were not superior to that of the conventional treatment. SET is superior to seven-day STT but not to STT with prolonged duration.Graphical Abstract

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Section: Introductionmentioning

confidence: 98%

Treatment of Helicobacter pylori Infection in Korea: A Systematic Review and Meta-analysis

Lee

Kim

2015

J Korean Med Sci

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“…Reasonable treatment regimens need to attain H. pylori eradication rate of higher than 80.0% by intention to treat (ITT) analysis, and higher than 90.0% by per protocol (PP) analysis [15, 16]. Several previous meta-analyses reported the superiority of SET than TT [17, 18], whereas other studies revealed conflicting results [19, 20]. …”

Section: Introductionmentioning

confidence: 99%

Triple therapy versus sequential therapy for the first-line Helicobacter pylori eradication

et al. 2017

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BackgroundThe eradication rate of Helicobacter pylori (H. pylori) with triple therapy which was considered as standard first-line treatment has decreased to 70–85%. The aim of this study is to compare 7-day triple therapy versus 10-day sequential therapy as the first line treatment.MethodsData of 1240 H. pylori positive patients treated with triple therapy or sequential therapy from January 2013 to December 2015 were analyzed retrospectively. The patients who had undertaken previous H. pylori eradication therapy or gastric surgery were excluded.ResultsThere were 872 (74.3%) patients in the triple therapy group, and 302 (25.7%) patients in the sequential therapy group. There was no significant difference between the two groups regarding age, residence, comorbidities or drug compliance, but several differences were noted in endoscopic characteristics and indication for the treatment. The eradication rate of H. pylori by intention to treat analysis was 64.3% in the triple therapy group, and 81.9% in the sequential therapy group (P = 0.001). In per protocol analysis, H. pylori eradication rate in the triple therapy and sequential therapy group was 81.9 and 90.3%, respectively (P = 0.002). There was no significant difference in overall adverse events between the two groups (P = 0.706). For the rescue therapy, bismuth-containing quadruple therapy showed comparable treatment efficacy after sequential therapy, as following triple therapy.ConclusionsThe eradication rate of triple therapy was below the recommended threshold. Sequential therapy could be effective and tolerable candidate for the first-line H. pylori eradication therapy.

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“…This regimen includes a PPI and amoxicillin for 5 d, followed by a PPI, clarithromycin, and tinidazole triple therapy for another 5 d. Several studies have indicated that the eradication rate of sequential therapy was significantly higher than that of STT [85][86][87] . The reason that sequential therapy has a higher eradication rate than STT is that amoxicillin and PPI administered during the first 5 d decreases H. pylori density in the stomach, which increases clarithromycin and metronidazole efficacy [32,[88][89][90] .…”

Section: Are There Suitable Sequential and Concomitant Therapy Alternmentioning

confidence: 99%

Antibiotic treatment forHelicobacter pylori: Is the end coming?

Kim

Choi

Chung

2015

WJGPT

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Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori ) has been associated with gastroduodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori ) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.

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Meta-analysis: Sequential Therapy Is Superior to Conventional Therapy forHelicobacter pyloriInfection in Korea

Abstract: Ten-day ST was superior to CT in terms of eradicating H. pylori infection. Therefore, ST should be considered as a first-line therapy in Korea. However, ST did not achieve a sufficient eradication rate. More effective therapy should be developed.

Cited by 23 publications

References 30 publications

Treatment of Helicobacter pylori Infection in Korea: A Systematic Review and Meta-analysis

Treatment of Helicobacter pylori Infection in Korea: A Systematic Review and Meta-analysis

Triple therapy versus sequential therapy for the first-line Helicobacter pylori eradication

Antibiotic treatment forHelicobacter pylori: Is the end coming?

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