Olga P Nyssen1, Adrian G McNicholl1, Javier P Gisbert1. 1. Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Universidad Autónoma de Madrid (UAM), Madrid, Spain.
Abstract
BACKGROUND: Bismuth-containing quadruple therapy has been suggested as first-line and rescue alternative for Helicobacter pylori eradication. Our objective was to perform a meta-analysis evaluating the efficacy and safety of single capsule Pylera® (bismuth, metronidazole, and tetracycline) plus a proton-pump inhibitor (PPI) in any line of treatment. METHODS: Studies were selected up to October 2018. Outcomes were eradication and adverse events (AEs) rates pooled using the generic inverse variance method. RESULTS: In total, 30 studies (6482 patients) were included in the systematic review. The intention-to-treat (ITT) efficacy was 90% (95% CI: 87%-92%, 21 studies, I2 = 88%) in first-line therapy, 89% (95% CI: 86%-93%, 12 studies, I2 = 78%) in second-line and 82% (95% CI: 78%-87%, nine studies, I2 = 60%) in third-line; with no differences by the type or dosage of PPI used. For metronidazole-resistant infection, the ITT efficacy as first-line therapy was 93% (95% CI: 90%-96%, six studies, I2 = 0%). In second-line therapies where patients had been previously treated with clarithromycin, the ITT efficacy was 90% (95% CI: 87%-93%, 11 studies, I2 = 78%). The overall incidence of AEs was 43% (95% CI: 35%-50%, 24 studies, I2 = 92%) and they were mostly mild. In nearly 3% of the cases, treatment was interrupted due to AEs. CONCLUSIONS: A 10-day treatment with Pylera® achieved an effective eradication rate of approximately 90% both in first- and second-line therapy. This applies regardless of the type and dose of the PPI, in patients with clarithromycin- or metronidazole-resistant strains, and in those previously treated with clarithromycin.
BACKGROUND:Bismuth-containing quadruple therapy has been suggested as first-line and rescue alternative for Helicobacter pylori eradication. Our objective was to perform a meta-analysis evaluating the efficacy and safety of single capsule Pylera® (bismuth, metronidazole, and tetracycline) plus a proton-pump inhibitor (PPI) in any line of treatment. METHODS: Studies were selected up to October 2018. Outcomes were eradication and adverse events (AEs) rates pooled using the generic inverse variance method. RESULTS: In total, 30 studies (6482 patients) were included in the systematic review. The intention-to-treat (ITT) efficacy was 90% (95% CI: 87%-92%, 21 studies, I2 = 88%) in first-line therapy, 89% (95% CI: 86%-93%, 12 studies, I2 = 78%) in second-line and 82% (95% CI: 78%-87%, nine studies, I2 = 60%) in third-line; with no differences by the type or dosage of PPI used. For metronidazole-resistant infection, the ITT efficacy as first-line therapy was 93% (95% CI: 90%-96%, six studies, I2 = 0%). In second-line therapies where patients had been previously treated with clarithromycin, the ITT efficacy was 90% (95% CI: 87%-93%, 11 studies, I2 = 78%). The overall incidence of AEs was 43% (95% CI: 35%-50%, 24 studies, I2 = 92%) and they were mostly mild. In nearly 3% of the cases, treatment was interrupted due to AEs. CONCLUSIONS: A 10-day treatment with Pylera® achieved an effective eradication rate of approximately 90% both in first- and second-line therapy. This applies regardless of the type and dose of the PPI, in patients with clarithromycin- or metronidazole-resistant strains, and in those previously treated with clarithromycin.
Authors: María Caldas; Ángeles Pérez-Aisa; Manuel Castro-Fernández; Luis Bujanda; Alfredo J Lucendo; Luis Rodrigo; Jose M Huguet; Jorge Pérez-Lasala; Javier Molina-Infante; Jesús Barrio; Luis Fernández-Salazar; Ángel Lanas; Mónica Perona; Manuel Domínguez-Cajal; Juan Ortuño; Blas José Gómez-Rodríguez; Pedro Almela; Josep María Botargués; Óscar Núñez; Inés Modolell; Judith Gómez; Rafael Ruiz-Zorrilla; Cristóbal De la Coba; Alain Huerta; Eduardo Iyo; Liliana Pozzati; Rosario Antón; Mercé Barenys; Teresa Angueira; Miguel Fernández-Bermejo; Ana Campillo; Javier Alcedo; Ramón Pajares-Villaroya; Marianela Mego; Fernando Bermejo; José Luis Dominguez-Jiménez; Llúcia Titó; Nuria Fernández; Manuel Pabón-Carrasco; Ángel Cosme; Pilar Mata-Romero; Noelia Alcaide; Inés Ariño; Tommaso Di Maira; Ana Garre; Ignasi Puig; Olga P Nyssen; Francis Megraud; Colm O'Morain; Javier P Gisbert Journal: Antibiotics (Basel) Date: 2020-12-25
Authors: Giuseppe Losurdo; Ilaria Lacavalla; Francesco Russo; Giuseppe Riezzo; Irene Vita Brescia; Maria Rendina; Enzo Ierardi; Alfredo Di Leo Journal: Antibiotics (Basel) Date: 2022-01-10
Authors: Olga P Nyssen; Angeles Perez-Aisa; Manuel Castro-Fernandez; Rinaldo Pellicano; Jose M Huguet; Luis Rodrigo; Juan Ortuñ; Blas J Gomez-Rodriguez; Ricardo M Pinto; Miguel Areia; Monica Perona; Oscar Nuñez; Marco Romano; Antonietta G Gravina; Liliana Pozzati; Miguel Fernandez-Bermejo; Marino Venerito; Peter Malfertheiner; Luis Fernanadez-Salazar; Antonio Gasbarrini; Dino Vaira; Ignasi Puig; Francis Megraud; Colm O'Morain; Javier P Gisbert Journal: United European Gastroenterol J Date: 2021-02-11 Impact factor: 4.623