The nonadherence and risk factors of eradication failure by sequential therapy as first‐line anti‐Helicobacter pylori treatment in real‐world clinical practice

Abstract

BackgroundThe eradication rates of sequential therapy are high in clinical trials; however, the adherence for follow‐up or the patient population in a real‐world setting might be different from those in trails. This study investigates the effectiveness of sequential therapy in a real‐world setting and the factors that lead to treatment failure.Materials and MethodsIn this retrospective study, patients receiving sequential therapy as a first‐line anti‐Helicobacter pylori (H. pylori) treatment in a real‐world setting were reviewed. The age adjusted Charlson Comorbidity Index (age‐CCI) and baseline variety of medications were reviewed to determine factors correlated with nonadherence for post‐treatment testing and H. pylori eradication failure.ResultsA total of 1053 patients were reviewed. A total of 579 patients receiving sequential therapy were included in the analyses. Among them, 462 received post‐treatment testing and were placed into the follow‐up group. Thus, the post‐treatment testing rate was 79.8%. Stroke was an independent factor of nonadherence for post‐treatment testing. In the follow‐up group, the eradication failure rate was 8.2%. Female sex (odds ratio [OR] 2.41 [95% CI 1.16–5.03], p = 0.02) and age‐CCI ≥2 (OR 3.16 [1.05–9.48], p = 0.04) were independent factors of H. pylori eradication failure. The eradication failure rates were 14.4%, 7.8%, 7.1%, and 3.1% for the females with age‐CCI ≥2, females with age‐CCI <2, males with age‐CCI ≥2, and males with age‐CCI <2 subgroups, respectively (p = 0.027).ConclusionsIn a real‐world setting, the adherence rate of post‐treatment testing for sequential therapy as a first‐line anti‐H. pylori treatment was found to be suboptimal. Female sex and age‐CCI ≥2 were independent factors of eradication failure.

10-Day versus 14-day bismuth quadruple therapy for first-line eradication of Helicobacter pylori infection: a randomised, open-label, non-inferiority trial

“…Female sex is a factor of eradication failure with concomitant therapy or sequential therapy, 25 but not of 10-day bismuth quadruple therapy. 7 , 8 , 9 In this study, sex-based analyses confirmed that the efficacy of 10-day bismuth quadruple therapy was non-inferior to that of 14-day therapy in male sex.…”

“…In the future, it requires a large-scale prospective multicentre study in different countries and regions or where the prevalence rate of metronidazole-resistance H. pylori is >40%. Second, the adherence to medications might be suboptimal in the real world 25 ; thus, the high efficacy for H. pylori treatment in a clinical trial may not be reflected in real-world practice. Third, considering multiple comparisons across adverse events, only the frequencies of dizziness but not vomiting were significantly different between the two groups after Bonferroni correction (Bonferroni corrected alpha level 0.0036).…”