Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 12959-12970
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.12959
Comparative effectiveness of first-line therapies for eradication of antibiotic-resistant Helicobacter pylori strains: A network meta-analysis
Shu-Peng Zou, Qian Cheng, Cheng-Yang Feng, Chan Xu, Ming-Hui Sun
Shu-Peng Zou, Qian Cheng, Cheng-Yang Feng, Chan Xu, Ming-Hui Sun, Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Author contributions: Zou SP and Cheng Q performed the research as well as screening, inclusion, and exclusion of randomized controlled trials, and wrote the paper; Sun MH designed the study; Feng CY and Xu C reviewed the data extracted from the study.
Conflict-of-interest statement: All the authors disclose no conflicts of interest for this paper.
PRISMA 2009 Checklist statement: The scheme of the study was successfully registered at PROSPERO (registration number: 42022326460).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ming-Hui Sun, PhD, Professor, Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No.1095 Jiefang Avenue, Wuhan 430000, Hubei Province, China. tjzoushupeng@163.com
Received: August 16, 2022
Peer-review started: August 16, 2022
First decision: September 26, 2022
Revised: October 8, 2022
Accepted: November 30, 2022
Article in press: November 30, 2022
Published online: December 16, 2022
Abstract
BACKGROUND

As a first-line treatment regimen for Helicobacter pylori (H. pylori) infection, antibiotic therapy is widely used worldwide. However, the question of increasing antibiotic resistance must be considered. Given this issue, we need to find ways to reduce drug resistance. This study examined all currently available first-line regimens and compared them with standard triple treatment through a network meta-analysis of randomized controlled trials (RCTs).

AIM

To compare first-line treatment regimens for eradication of antibiotic-resistant H. pylori strains.

METHODS

To compare the effectiveness of the first-line regimens for treating H. pylori infection, a Bayesian network meta-analysis was applied to process data extracted from RCTs. The plausible ranking for each regimen was assessed by the surface under the cumulative ranking curve (SUCRA). In addition, we conducted a relevant search by reference citation analysis.

RESULTS

Twenty-five RCTs involving 12029 participants [including 1602 infected with clarithromycin (CAM)-resistant strains and 1716 infected with metronidazole (MNZ)-resistant strains] were included, in which a total of seven regimens were used for H. pylori eradication. The results showed that dual therapy containing a high-dose proton pump inhibitor (HDDT) [odds ratio (OR): 4.20, 95% confidence interval (CI): 2.29-8.13] was superior to other therapies for all patients, including those with CAM/MNZ-resistant H. pylori infection. In the comparative effectiveness ranking, for CAM-resistant H. pylori, HDDT (OR: 96.80, 95%CI: 22.46-521.9) had the best results, whereas standard triple therapy ranked last (SUCRA: 98.7% vs 0.3%). In the subgroup of high cure rates (≥ 90%), HDDT was also generally better than other therapies.

CONCLUSION

For the eradication of CAM- and MNZ-resistant H. pylori strains, HDDT exhibited considerable advantages. The studies of CAM-resistant H. pylori were based on small samples due to a lack of antibiotic sensitivity tests in many RCTs, but the results showed that all patients, including those with CAM-resistant H. pylori infection, had a concordant trend. Overall, HDDT may be a reference for RCTs and other studies of H. pylori eradication.

Keywords: Helicobacter pylori, Clarithromycin resistance, First-line therapy, Proton pump inhibitors

Core Tip: This is the first study to compare currently available first-line treatment regimens for eradication of antibiotic-resistant Helicobacter pylori strains. For clarithromycin-resistant and metronidazole-resistant strains, dual therapy containing a high-dose proton pump inhibitor (HDDT) shows an absolute advantage over other first-line therapies. There was a difference in the effectiveness of HDDT between all patients and patients with clarithromycin-resistant Helicobacter pylori infection. In the subgroup of high cure rates (≥ 90%), HDDT was also generally better than other therapies. The use of fewer antibiotics may be better to prevent global antibiotic resistance effectively.