Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12954-12962
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12954
Hybrid therapy for Helicobacter pylori infection: A systemic review and meta-analysis
Ping-I Hsu, Pei-Chin Lin, David Y Graham
Ping-I Hsu, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital and National Yang-Ming University, Kaohsiung 813, Taiwan
Pei-Chin Lin, Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
Pei-Chin Lin, College of Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan
David Y Graham, Department of Medicine/Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, and Baylor College of Medicine, Houston, TX 77030, United States
Author contributions: Hsu PI designed the study, reviewed the articles, analyzed the data and drafted the manuscript; Lin PC reviewed the articles and analyzed the data; and Graham DY designed the study and reviewed the manuscript.
Supported by Research Foundation of the Kaohsiung Veterans General Hospital, No. VGHKS103-58.
Conflict-of-interest statement: Hsu PI and Lin PC disclose no conflict of interest; Graham DY is an unpaid consultant for Novartis in relation to vaccine development for treatment or prevention of Helicobacter pylori (H. pylori) infection; Graham DY is also a paid consultant for RedHill Biopharma regarding novel H. pylori therapies and for Otsuka Pharmaceuticals regarding diagnostic testing; and Graham DY has received royalties from Baylor College of Medicine patents covering materials related to 13C-urea breath test.
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: David Y Graham, Professor, Department of Medicine/Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, and Baylor College of Medicine, Room 3A-320, 2002 Holcombe Blvd., Houston, TX 77030, United States. dgraham@bcm.tmc.edu
Telephone: +1-713-7950232 Fax: +1-713-7901040
Received: April 29, 2015
Peer-review started: May 12, 2015
First decision: July 19, 2015
Revised: August 7, 2015
Accepted: September 30, 2015
Article in press: September 30, 2015
Published online: December 7, 2015
Abstract

AIM: To compare the effectiveness of hybrid therapy with other recommended regimens using meta-analysis.

METHODS: Bibliographical searches for randomized trials comparing hybrid and other therapies were performed in PubMed, the Cochrane Library and relevant congresses up to February 2015 using the following keywords (all fields and/or MeSH): (“Helicobacter pylori” or “H. pylori”) and (“hybrid therapy” or “sequential-concomitant therapy”). Meta-analyses were performed with Cochrane Review Manager 5.1. The random effect model proposed by DerSimonian and Laird and the Mantel-Haenszel method were used to estimate the pooled relative risk and 95%CI of the efficacy outcomes between hybrid therapy and other eradication therapies.

RESULTS: Eight studies (2516 subjects) met entry criteria. The antimicrobial resistance in the study groups ranged from 6.9% to 23.5%. The mean cure rates of hybrid therapy by intention-to-treat (ITT) and per-protocol analyses were 88.5% (n = 1207; range: 80.0% to 97.4%) and 93.3% (n = 1109; range: 85.7% to 99.1%), respectively. Meta-analysis showed there was no significant difference in ITT eradication rate between hybrid and sequential therapy (relative risk: 1.01; 95%CI: 0.92-1.11). Subgroup analysis revealed hybrid therapy was more effective than sequential therapy in the non-Italian populations (95%CI: 1.01-1.18) and was only less effective in one, Italian population (95%CI: 0.83-0.98). There was no significant difference in eradication rate between hybrid therapy and concomitant therapy (95%CI: 0.93-1.02). No head-to-head comparisons of hybrid therapy and standard triple therapy or bismuth quadruple therapy were found. However, a multicenter, randomized trial showed that reverse hybrid therapy was superior to standard triple therapy (95.5% vs 88.6% ITT; P = 0.011).

CONCLUSION: Hybrid therapy appears to be an effective, safe, and well-tolerated treatment for H. pylori infection in the era of increasing antibiotic resistance.

Keywords: Helicobacter pylori, Concomitant therapy, Hybrid therapy, Sequential therapy, Triple therapy

Core tip: This article is aimed to review current evidences of hybrid therapy for Helicobacter pylori infection. The mean cure rates of hybrid therapy by intention-to-treat and per-protocol analyses were 88.5% and 93.3%, respectively. Meta-analysis showed that hybrid therapy was more effective than sequential therapy in the non-Italian population. In contrast, it was less effective than sequential therapy in the Italian population. There was no significant difference in eradication rate between hybrid therapy and concomitant therapy. Reverse hybrid therapy is a new one-step tow-phase treatment, achieving a higher eradication rate than standard triple therapy with similar tolerability and less pharmaceutical cost.