Theodore Rokkas1, Javier P Gisbert2, Peter Malfertheiner3, Yaron Niv4, Antonio Gasbarrini5, Marcis Leja6, Francis Megraud7, Colm O'Morain8, David Y Graham9. 1. Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece; Medical School, European University of Cyprus, Nicosia, Cyprus. Electronic address: sakkor@otenet.gr. 2. Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain. 3. Ludwig Maximilian Universität, Med Klinik II, München, Otto v Guericke Universität, Magdeburg, Germany. 4. Ariel University, Ministry of Health, Ariel, Israel. 5. Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario A. Gemelli Istituto Di Ricovero E Cura A Carattere Scientifico, Universita Cattolica Del Sacro Cuore, Roma, Italy. 6. Institute of Clinical and Preventive Medicine and Faculty of Medicine, University of Latvia, Riga, Latvia. 7. Inserm U1053, Université de Bordeaux and Laboratoire de Bactétiologie, Hôpital Pellegrin, Bordeaux, France. 8. Gastroenterology Clinic, Trinity College Dublin, Dublin, Ireland. 9. Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas.
Abstract
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 first-line 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.
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 first-line 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.
Authors: Theodore Rokkas; Sotirios Georgopoulos; Spyros Michopoulos; Vasiliki Ntouli; Christos Liatsos; Ignasi Puig; Olga P Nyssen; Francis Mégraud; Colm O'Morain; Javier P Gisbert Journal: Ann Gastroenterol Date: 2021-10-12
Authors: Luis Fernández-Salazar; Ana Campillo; Luis Rodrigo; Ángeles Pérez-Aisa; Jesús M González-Santiago; Xavier Segarra Ortega; Maja Denkovski; Natasa Brglez Jurecic; Luis Bujanda; Blas José Gómez Rodríguez; Juan Ortuño; Sotirios Georgopoulos; Laimas Jonaitis; Ignasi Puig; Olga P Nyssen; Francis Megraud; Colm O'Morain; Javier P Gisbert Journal: J Clin Med Date: 2022-06-20 Impact factor: 4.964