Yee Hui Yeo1,2, Chia-Chen Hsu3, Chiao-Chin Lee3, Hsiu J Ho1, Jaw-Town Lin4,5, Ming-Shiang Wu6, Jyh-Ming Liou6, Chun-Ying Wu1,4,7,8,9,10. 1. Division of Gastroenterology and Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan. 2. Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA. 3. Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. 4. Center for Health Policy Research and Development, National Cancer Institute, National Health Research Institutes, Miaoli, Taiwan. 5. School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan. 6. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 7. Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan. 8. Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan. 9. Department of Public Health and Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan. 10. Department of Life Sciences and Rong Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan.
Abstract
BACKGROUND AND AIM: The eradication rate of Helicobacter pylori (H. pylori) has been declining over the past decades. A rescue plan is needed for increasing populations with treatment failure. However, the optimum second-line eradication regimen remains inconclusive. We conducted a network meta-analysis to assess the comparative effectiveness of second-line H. pylori eradication therapies and determine the optimum regimen. METHODS: We searched electronic databases from January 2005 to February 2018 for randomized controlled trials assessing the effectiveness of second-line regimens in patients with persistent H. pylori infection after first-line treatment. Bayesian network meta-analysis was performed to combine the direct and indirect evidence and to investigate the rank order of second-line therapies. We also appraised the quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation guidance. RESULTS: Twenty-six trials with 3628 participants who received second-line eradication therapy were identified. All regimens showed pooled eradication rates < 90%. Compared with 7-day triple therapy, quinolone-based (odds ratio [OR] 4.29, 95% credible interval [CrI] 1.67-12.12, surface under the cumulative ranking [SUCRA] 0.95), non-quinolone-based bismuth-containing quadruple therapies for 10 days or more (OR 2.25, 95% CrI 1.10-4.62, SUCRA 0.78), and sequential therapy (OR 2.91, 95% CrI 1.16-7.65, SUCRA 0.66) showed significantly higher effectiveness. Overall, regimens with longer duration demonstrated higher eradication rates but higher rates of adverse events. More adverse events were reported in those patients treated with concomitant therapy. CONCLUSIONS: Quinolone-based bismuth-containing quadruple therapies for 10 days or more are the optimum second-line regimens for H. pylori eradication.
BACKGROUND AND AIM: The eradication rate of Helicobacter pylori (H. pylori) has been declining over the past decades. A rescue plan is needed for increasing populations with treatment failure. However, the optimum second-line eradication regimen remains inconclusive. We conducted a network meta-analysis to assess the comparative effectiveness of second-line H. pylori eradication therapies and determine the optimum regimen. METHODS: We searched electronic databases from January 2005 to February 2018 for randomized controlled trials assessing the effectiveness of second-line regimens in patients with persistent H. pylori infection after first-line treatment. Bayesian network meta-analysis was performed to combine the direct and indirect evidence and to investigate the rank order of second-line therapies. We also appraised the quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation guidance. RESULTS: Twenty-six trials with 3628 participants who received second-line eradication therapy were identified. All regimens showed pooled eradication rates < 90%. Compared with 7-day triple therapy, quinolone-based (odds ratio [OR] 4.29, 95% credible interval [CrI] 1.67-12.12, surface under the cumulative ranking [SUCRA] 0.95), non-quinolone-based bismuth-containing quadruple therapies for 10 days or more (OR 2.25, 95% CrI 1.10-4.62, SUCRA 0.78), and sequential therapy (OR 2.91, 95% CrI 1.16-7.65, SUCRA 0.66) showed significantly higher effectiveness. Overall, regimens with longer duration demonstrated higher eradication rates but higher rates of adverse events. More adverse events were reported in those patients treated with concomitant therapy. CONCLUSIONS:Quinolone-based bismuth-containing quadruple therapies for 10 days or more are the optimum second-line regimens for H. pylori eradication.