Journal
GASTROENTEROLOGY
Volume 161, Issue 2, Pages 495-+Publisher
W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1053/j.gastro.2021.04.012
Keywords
Helicobacter pylori; Treatment; First-Line Regimens; Efficacy; Network Meta-Analysis
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Funding
- Office of Research and Development Medical Research Service Department of Veterans Affairs, Public Health Service [DK56338]
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The study compared the effectiveness of different first-line regimens for Helicobacter pylori infection through a network meta-analysis. Results showed that vonoprazan triple therapy and reverse hybrid therapy achieved high eradication rates above 90%, with levofloxacin triple therapy performing best in Western countries. Standard triple therapy was found to be the least efficacious in this analysis.
BACKGROUND & AIMS: A number of double, triple, and quadruple therapies have been proposed as first-line empiric treatments for Helicobacter pylori infection. However, knowledge of their worldwide and regional comparative efficacy is lacking. We examined the comparative effectiveness of all empirically used first-line regimens tested against standard triple treatment using a network meta-analysis of published randomized controlled trials. METHODS: Data extracted from eligible randomized controlled trials were entered into a Bayesian network meta-analysis to investigate the comparative efficacy of H pylori infection empiric first-line regimens and to explore their effectiveness rank order. The ranking probability for each regimen was evaluated by means of surfaces under cumulative ranking values. RESULTS: Sixty-eight eligible randomized controlled trials were included, giving a total of 92 paired comparisons with 22,975 patients randomized to 8 firstline regimens. The overall results showed that only vonoprazan triple therapy and reverse hybrid therapy achieved cure rates of >90%. Levofloxacin triple therapy performed best in Western countries (eradication rate 88.5%). The comparative effectiveness ranking showed that vonoprazan triple therapy had the best results, whereas standard triple therapy was the least efficacious regimen (surfaces under cumulative ranking 92.4% vs 4.7% respectively; odds ratio, 3.80; 95% credible interval, 1.62-8.94). CONCLUSIONS: For first-line empiric treatment of H pylori infection, vonoprazan triple therapy and reverse hybrid therapy achieved high eradication rates of >90%. Levofloxacin triple therapy achieved the highest eradication rates in Western countries. Standard triple therapy was the least efficacious regimen in this network meta-analysis.
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