Meta-analysis

Sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment

Nadim S. Jafri, Carlton A. Hornung, Colin Howden

Research output: Contribution to journalArticle

244 Citations (Scopus)

Abstract

Background: Standard proton-pump inhibitor-based therapy for Helicobacter pylori infection fails in up to one quarter of patients. Sequential therapy may be more efficacious. Purpose: To compare sequential therapy with standard triple therapy for H. pylori infection. Data Sources: MEDLINE, EMBASE (1981 to October 2007), the Cochrane Central Register of Controlled Trials, and Google Scholar. PubMed and Ovid were the search engines used. Study Selection: Randomized, controlled trials (RCTs) comparing sequential and standard triple therapies in treatment-naive patients with documented H. pylori infection. Data Extraction: 3 reviewers independently assessed trial eligibility and quality and extracted data on eradication. Data Synthesis: The crude rates of H. pylori eradication in 10 RCTs involving 2747 patients were 93.4% (95% CI, 91.3% to 95.5%) for sequential therapy (n = 1363) and 76.9% (CI, 71.0% to 82.8%) for standard triple therapy (n = 1384) (relative risk reduction, 71% [CI, 64% to 77%]; absolute risk reduction, 16 percentage points [CI, 14 to 19 percentage points]). The median rates of adherence were 97.4% (range, 90.0% to 98.9%) for sequential therapy and 96.8% (range, 93.0% to 100%) for standard therapy. Sequential therapy appeared superior in prespecified sensitivity (subgroup) analyses stratified by trial quality; smoking status; diagnosis (ulcer disease or nonulcer dyspepsia); resistance to clarithromycin, imidazoles, or both; duration of triple therapy; and method of diagnosis. Both treatments had similar side effect profiles. Limitations: Only 1 study was double-blinded. Most patients were from Italy. There was clear evidence of publication bias. Conclusion: Sequential therapy appears superior to standard triple therapy for eradication of H. pylori infection. If RCTs in other countries confirm these findings, 10-day sequential therapy could become a standard treatment for H. pylori infection in treatment-naive patients.

Original languageEnglish (US)
Pages (from-to)923-931
Number of pages9
JournalAnnals of internal medicine
Volume148
Issue number12
DOIs
StatePublished - Jun 17 2008
Externally publishedYes

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Helicobacter Infections
Helicobacter pylori
Meta-Analysis
Therapeutics
Randomized Controlled Trials
Imidazoles
Search Engine
Numbers Needed To Treat
Publication Bias
Clarithromycin
Proton Pump Inhibitors
Dyspepsia
Information Storage and Retrieval
Risk Reduction Behavior
PubMed

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Meta-analysis : Sequential therapy appears superior to standard therapy for Helicobacter pylori infection in patients naive to treatment. / Jafri, Nadim S.; Hornung, Carlton A.; Howden, Colin.

In: Annals of internal medicine, Vol. 148, No. 12, 17.06.2008, p. 923-931.

Research output: Contribution to journalArticle

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abstract = "Background: Standard proton-pump inhibitor-based therapy for Helicobacter pylori infection fails in up to one quarter of patients. Sequential therapy may be more efficacious. Purpose: To compare sequential therapy with standard triple therapy for H. pylori infection. Data Sources: MEDLINE, EMBASE (1981 to October 2007), the Cochrane Central Register of Controlled Trials, and Google Scholar. PubMed and Ovid were the search engines used. Study Selection: Randomized, controlled trials (RCTs) comparing sequential and standard triple therapies in treatment-naive patients with documented H. pylori infection. Data Extraction: 3 reviewers independently assessed trial eligibility and quality and extracted data on eradication. Data Synthesis: The crude rates of H. pylori eradication in 10 RCTs involving 2747 patients were 93.4{\%} (95{\%} CI, 91.3{\%} to 95.5{\%}) for sequential therapy (n = 1363) and 76.9{\%} (CI, 71.0{\%} to 82.8{\%}) for standard triple therapy (n = 1384) (relative risk reduction, 71{\%} [CI, 64{\%} to 77{\%}]; absolute risk reduction, 16 percentage points [CI, 14 to 19 percentage points]). The median rates of adherence were 97.4{\%} (range, 90.0{\%} to 98.9{\%}) for sequential therapy and 96.8{\%} (range, 93.0{\%} to 100{\%}) for standard therapy. Sequential therapy appeared superior in prespecified sensitivity (subgroup) analyses stratified by trial quality; smoking status; diagnosis (ulcer disease or nonulcer dyspepsia); resistance to clarithromycin, imidazoles, or both; duration of triple therapy; and method of diagnosis. Both treatments had similar side effect profiles. Limitations: Only 1 study was double-blinded. Most patients were from Italy. There was clear evidence of publication bias. Conclusion: Sequential therapy appears superior to standard triple therapy for eradication of H. pylori infection. If RCTs in other countries confirm these findings, 10-day sequential therapy could become a standard treatment for H. pylori infection in treatment-naive patients.",
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