Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2016; 22(19): 4766-4775
Published online May 21, 2016. doi: 10.3748/wjg.v22.i19.4766
Hybrid, sequential and concomitant therapies for Helicobacter pylori eradication: A systematic review and meta-analysis
Zhi-Qiang Song, Li-Ya Zhou
Zhi-Qiang Song, Li-Ya Zhou, Department of Gastroenterology, Peking University Third Hospital, Beijing 100191, China
Author contributions: Song ZQ contributed to article retrieval, data extraction, analysis and interpretation of data, statistical analyses, and manuscript preparation; Zhou LY contributed to study conception and design, analysis and interpretation of data, manuscript revision; both authors have read and approved the final manuscript.
Supported by National Science and Technology Pillar Program of 12th Five-Year Plan in China, No. 2012BAI06B02; Clinical Key Projects of Peking University Third Hospital, No. Y76493-03; Key Laboratory for Helicobacter pylori Infection and Upper Gastrointestinal Diseases in Beijing, No. BZ0371.
Conflict-of-interest statement: The authors deny any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Li-Ya Zhou, BS, Department of Gastroenterology, Peking University Third Hospital, No 49, North Garden Road, Haidian District, Beijing 100191, China. liyazhou3352@sina.com
Telephone: +86-18910192576 Fax: +86-10-82265021
Received: December 9, 2015
Peer-review started: December 10, 2015
First decision: December 30, 2015
Revised: January 14, 2016
Accepted: January 30, 2016
Article in press: January 30, 2016
Published online: May 21, 2016
Processing time: 159 Days and 17 Hours
Abstract

AIM: To compare hybrid therapy (HT) with traditional sequential therapy (ST) and concomitant therapy (CT) for Helicobacter pylori (H. pylori) eradication.

METHODS: We performed an electronic search of PubMed, Embase, and the CENTRAL database. Randomized controlled trials (RCTs) of HT were included in the meta-analysis. The primary outcome was the eradication rate of H. pylori. The secondary outcomes included the compliance rate and adverse event rate. Effect estimates were pooled using the random-effects model.

RESULTS: Twelve studies were included. Pooled results showed no significant differences in eradication rate between HT and ST in per-protocol (PP) analysis (RR = 1.03, 95%CI: 0.94-1.12, P = 0.59) or in intention-to-treat (ITT) analysis (RR = 1.00, 95%CI: 0.89-1.12, P = 0.94). HT and ST showed similarly high compliance rate (96% vs 98%, P = 0.55) and acceptable adverse event rate (30.3% vs 28.2%, P = 0.63). No significant results were seen in the eradication rate between HT and CT in PP analysis (RR = 1.01, 95%CI: 0.96-1.05, P = 0.76) or in ITT analysis (RR = 0.99, 95%CI: 0.95-1.03, P = 0.47). HT displayed a slightly higher compliance rate than CT (95.8% vs 93.2%, P < 0.05). The adverse event rates of HT and CT were similar (39.5% vs 44.2%, P = 0.24).

CONCLUSION: Compared with ST or CT, HT yields a similar eradication rate, high compliance rate, and acceptable safety profiles.

Keywords: Hybrid therapy; Sequential therapy; Concomitant therapy; Helicobacter pylori; Meta-analysis

Core tip: This meta-analysis of randomized controlled trials compared the novel hybrid therapy with sequential and concomitant therapy in the treatment of Helicobacter pylori. The eradication rate, compliance rate and the adverse event rate were investigated as the main outcomes and were compared. Overall, similar results were shown regarding these outcomes by hybrid and sequential therapy, and by hybrid and concomitant therapy. Hybrid therapy could be an effective and safe alternative to sequential or concomitant therapy.