Ethical Considerations of Comparing Sequential and Traditional Anti–Helicobacter pylori Therapy

TO THE EDITOR:

Vaira and colleagues (1) recently reported that a sequential therapy regimen led to high cure rates and was better than legacy triple therapy (proton-pump inhibitor, amoxicillin, and clarithromycin) for eradicating Helicobacter pylori infection in Italian patients with dyspepsia or peptic ulcers. The sequential regimen was much more effective than triple therapy among patients with clarithromycin-resistant bacteria (1). These investigators and others have compared identical or very similar regimens and have reported similar high cure rates (Figure[2–6]).

While one might question the decision to repetitively compare identical or very similar sequential and triple therapy regimens in Italian populations, we certainly think that Vaira and colleagues should have modified their study when the results of the other studies became known. At study onset (2003), the superiority of sequential therapy was not definitively proven. However, as the study progressed through 2006, the superiority of sequential therapy was firmly established primarily …