Abstract OBJECTIVES: Eradication rates with triple therapy (TT) for Helicobacter pylori infection have declined to unacceptable levels. Sequential therapy (ST) is a novel treatment that has shown promise in several controlled trials. Our aim was to assess the effi cacy of ST in adults and children compared with that of TT by performing a systematic review and meta-analysis. METHODS: We performed an electronic search of the following: Cochrane Trial Register (until Issue 4, 2008), MEDLINE (1966 to 21 October 2008), EMBASE (1980 to 21 October 2008), and abstracts from the major US, European, and Asian gastroenterology conferences. Randomized controlled trials (RCTs) and controlled clinical trials with a parallel group design comparing the ST with a TT lasting at least 7 days were used. RESULTS: Ten RCTs enrolled 3,006 adult patients and the odds ratio (OR) for eradication of H. pylori with ST compared with TT was 2.99 (95 % confi dence interval (CI): 2.47 – 3.62), giving a number needed to treat (NNT) of 6 (95 % CI: 5 – 7) favoring ST. There was no publication bias. The OR for eradication with ST compared with 10-day TT was 2.92 (95 % CI: 1.95 – 4.38), yielding an NNT of 8 (95 % CI: 6 – 12), favoring ST. In patients with clarithromycin resistance, the OR for eradication with ST was 10.21 (95 % CI: 3.01 – 34.58) compared with TT, but the numbers studied are small. Three RCTs enrolled 260 children and adolescents, and the OR for eradication was 1.98 (95 % CI: 0.96 – 4.07). There was no difference in the rate of side effects between the ST and the TT (OR, 1.01; 95 % CI: 0.78 – 1.30). CONCLUSIONS: ST appears to be better than TT in the eradication of H . pylori . This is a promising therapy, but further trials are needed in other European countries and North America before it can be recommended as a fi rst-line treatment.

Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children / Gatta, L; Vakil, N; Leandro, G; DI MARIO, Francesco; Vaira, D.. - In: THE AMERICAN JOURNAL OF GASTROENTEROLOGY. - ISSN 0002-9270. - 104:(2009), pp. 3069-3079. [10.1038/ajg.2009.555]

Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children.

DI MARIO, Francesco;
2009-01-01

Abstract

Abstract OBJECTIVES: Eradication rates with triple therapy (TT) for Helicobacter pylori infection have declined to unacceptable levels. Sequential therapy (ST) is a novel treatment that has shown promise in several controlled trials. Our aim was to assess the effi cacy of ST in adults and children compared with that of TT by performing a systematic review and meta-analysis. METHODS: We performed an electronic search of the following: Cochrane Trial Register (until Issue 4, 2008), MEDLINE (1966 to 21 October 2008), EMBASE (1980 to 21 October 2008), and abstracts from the major US, European, and Asian gastroenterology conferences. Randomized controlled trials (RCTs) and controlled clinical trials with a parallel group design comparing the ST with a TT lasting at least 7 days were used. RESULTS: Ten RCTs enrolled 3,006 adult patients and the odds ratio (OR) for eradication of H. pylori with ST compared with TT was 2.99 (95 % confi dence interval (CI): 2.47 – 3.62), giving a number needed to treat (NNT) of 6 (95 % CI: 5 – 7) favoring ST. There was no publication bias. The OR for eradication with ST compared with 10-day TT was 2.92 (95 % CI: 1.95 – 4.38), yielding an NNT of 8 (95 % CI: 6 – 12), favoring ST. In patients with clarithromycin resistance, the OR for eradication with ST was 10.21 (95 % CI: 3.01 – 34.58) compared with TT, but the numbers studied are small. Three RCTs enrolled 260 children and adolescents, and the OR for eradication was 1.98 (95 % CI: 0.96 – 4.07). There was no difference in the rate of side effects between the ST and the TT (OR, 1.01; 95 % CI: 0.78 – 1.30). CONCLUSIONS: ST appears to be better than TT in the eradication of H . pylori . This is a promising therapy, but further trials are needed in other European countries and North America before it can be recommended as a fi rst-line treatment.
2009
Sequential therapy or triple therapy for Helicobacter pylori infection: systematic review and meta-analysis of randomized controlled trials in adults and children / Gatta, L; Vakil, N; Leandro, G; DI MARIO, Francesco; Vaira, D.. - In: THE AMERICAN JOURNAL OF GASTROENTEROLOGY. - ISSN 0002-9270. - 104:(2009), pp. 3069-3079. [10.1038/ajg.2009.555]
File in questo prodotto:
File Dimensione Formato  
Sequential Therapy or Triple Therapy for Helicobacter pylori Infection- Systematic Review and Meta-Analysis of Randomized Controlled Trials in Adults and Children.pdf

non disponibili

Tipologia: Documento in Post-print
Licenza: Creative commons
Dimensione 223.68 kB
Formato Adobe PDF
223.68 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11381/2308069
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 259
  • ???jsp.display-item.citation.isi??? 222
social impact