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World J Gastroenterol. Oct 28, 2014; 20(40): 14973-14985
Published online Oct 28, 2014. doi: 10.3748/wjg.v20.i40.14973
Standard triple therapy for Helicobacter pylori infection in China: A meta-analysis
Ben Wang, Zhi-Fa Lv, You-Hua Wang, Hui Wang, Xiao-Qun Liu, Yong Xie, Xiao-Jiang Zhou
Ben Wang, Zhi-Fa Lv, You-Hua Wang, Hui Wang, Xiao-Qun Liu, Yong Xie, Xiao-Jiang Zhou, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China
Author contributions: Wang B and Lv ZF contributed equally to this work; Wang B and Lv ZF designed the study, analyzed the data and wrote the manuscript; Wang B, Lv ZF and Wang YH designed the research; Wang B, Lv ZF, Wang YH, Wang H and Liu XQ performed the research; Xie Y and Zhou XJ designed the study and edited the manuscript as corresponding author.
Supported by National Science and Technology Major Projects for “Major New Drugs Innovation and Development” of China, No. 2011ZX09302-007-03
Correspondence to: Yong Xie, MD, PhD, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 Yongzhengwai Street, Donghu District, Nanchang 330000, Jiangxi Province, China.
Telephone: +86-791-88692507 Fax: +86-791-88623153
Received: February 28, 2014
Revised: May 8, 2014
Accepted: May 25, 2014
Published online: October 28, 2014

AIM: To assess the efficacy and safety of standard triple therapy compared with other pre-existing and new therapies in China.

METHODS: Literature searches were conducted in the following databases: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, the VIP database, the China National Knowledge Infrastructure database, and the Chinese Biomedical Database. A meta-analysis of all randomized controlled trials (RCTs) comparing standard triple therapy for the eradication of Helicobacter pylori with pre-existing and new therapies in China was performed using Comprehensive Meta-Analysis 2.0. There were 49 studies that met our criteria and the qualities of these studies were assessed using the Jadad scale. The Mantel-Haenszel method was used for pooling dichotomous data. We also conducted subgroup analyses according to age, duration of treatment and drug type. Sensitivity analyses and a cumulative meta-analysis were also performed with CMA 2.0. Publication bias was evaluated using Egger’s test, Begg’s test or a funnel plot.

RESULTS: A total of 49 RCTs including 8332 patients were assessed. This meta-analysis showed that standard triple therapy with proton pump inhibitors (PPIs), amoxicillin (AMO) and clarithromycin (CLA) was inferior to sequential therapy [relative risk (RR) = 0.863; 95% confidence interval (CI): 0.824-0.904], but was not superior to quadruple therapy (RR = 1.073; 95%CI: 0.849-1.357) or other triple therapies (RR = 1.01; 95%CI: 0.936-1.089). The meta-analysis also suggested that standard triple therapy is slightly more effective than dual therapy (RR = 1.14; 95%CI: 0.99-1.31). However, the differences were not statistically significant. We removed the only trial with a regimen lasting 14 d by sensitivity analysis and found that 7-d standard triple therapy was superior to 7-d dual therapy (RR = 1.222; 95%CI: 1.021-1.461). Moreover, a sub-analysis based on the duration of quadruple therapy indicated that the 7-d and 10-d standard triple therapies were inferior to sequential therapy (RR = 0.790; 95%CI: 0.718-0.868; RR = 0.917; 95%CI: 0.839-1.002, respectively). Additionally, there were no significant differences in cure rate or adverse events among standard triple therapy, quadruple therapy, and other triple therapies (RR = 0.940; 95%CI: 0.825-1.072; RR = 1.081; 95%CI: 0.848-1.378, respectively). Standard triple therapy had a higher occurrence of side effects than sequential therapy (RR = 1.283; 95%CI: 1.066-1.544).

CONCLUSION: The eradication rates with a standard triple therapy consisting of PPI, AMO, and CLA are suboptimal in China, and new treatment agents need to be developed.

Keywords: Helicobacter pylori, Eradication, Combination drug therapy, Amoxicillin, Clarithromycin, Adverse effects, Meta-analysis

Core tip: This study compared the efficiency of standard triple therapy with other pre-existing and new therapies on the Chinese mainland and examined the eradication rates for Helicobacter pylori in China. The results showed that the standard triple therapy including proton pump inhibitors, amoxicillin and clarithromycin might not be suitable for first-line therapy.