Sequential Therapy for Helicobacter pylori Infection in Korea: Systematic Review and Meta-Analysis

Abstract

Background/AimsSequential therapy (ST) for Helicobacter pylori infection in countries other than Korea has shown higher eradication rates than triple therapy (TT). The aim of this study was to evaluate the efficacy of ST in Korea by performing a meta-analysis.MethodsWe performed a comprehensive literature search on the efficacy of ST as a first-line therapy. The odds ratios (ORs) of eradicating H. pylori infection after ST compared with TT were pooled. Pooled estimates of the eradication rates of ST and TT were also calculated.ResultsA total of six studies provided data on 1,759 adult patients. The ORs for the intention to treat (ITT) and the per-protocol (PP) eradication rate were 1.761 (95% confidence interval [CI], 1.403 to 2.209) and 1.966 (95% CI, 1.489 to 2.595). Pooled estimates of the ITT and PP eradication rate were 79.4% (95% CI, 76.3% to 82.2%) and 86.4% (95% CI, 83.5% to 88.8%), respectively, for the ST group, and 68.2% (95% CI, 62.1% to 73.8%) and 78.9% (95% CI, 68.9% to 81.7%), respectively, for the TT group.ConclusionsAlthough ST presented a higher eradication rate than TT in Korea, the pooled eradication rates were lower than expected. Further studies are needed to validate ST as a first-line treatment for H. pylori in Korea.

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

“…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]. …”

Comparison of efficacy and safety of levofloxacin-containing versus standard sequential therapy in eradication of Helicobacter pylori infection in Korea

“…This is the cause of geographical variation in eradication rates from the sequential regimen [33]. In Korean meta-analysis, pooled estimates of the ITT and PP eradication rate were 79.4% (95% CI, 76.3% to 82.2%) and 86.4% (95% CI, 83.5% to 88.8%), respectively, for patients receiving the 10-day sequential treatment [29]. However, fair efficacy of the sequential regimen cannot be further guaranteed because of the increase in primary and secondary antibiotic resistance to clarithromycin in H. pylori in Korea is ongoing.…”

“…Based on previous studies about SST in Korea and LST, we assumed that SST and LST would achieve eradication rates of 79.3% and 96.0%, respectively [25,29]. Thus, to determine the 17% difference, 99 patients in each group were required with a power of 90% at a 5% significance level, with the expectation of a drop-out rate of 10%.…”

A Comparison of Five Different Treatment Regimens as the First‐Line Treatment of Helicobacter pylori in Turkey

“…It is an acceptable treatment option in countries other than Turkey and Latin American countries [25,26]. It is an acceptable treatment option in countries other than Turkey and Latin American countries [25,26].…”