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Meta-analysis: Sequential Therapy Appears Superior to Standard Therapy for Helicobacter pylori Infection in Patients Naive to Treatment
- Nadim S. Jafri, MD, MSc;
- Carlton A. Hornung, PhD, MPH; and
- Colin W. Howden, MD
- From University of Louisville, Louisville, Kentucky, and Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Abstract
Background: Standard proton-pump inhibitor–based therapy for Helicobacter pylori infection fails in up to one quarter of patients. Sequential therapy may be more efficacious.
Purpose: To compare sequential therapy with standard triple therapy for H. pylori infection.
Data Sources: MEDLINE, EMBASE (1981 to October 2007), the Cochrane Central Register of Controlled Trials, and Google Scholar. PubMed and Ovid were the search engines used.
Study Selection: Randomized, controlled trials (RCTs) comparing sequential and standard triple therapies in treatment-naive patients with documented H. pylori infection.
Data Extraction: 3 reviewers independently assessed trial eligibility and quality and extracted data on eradication.
Data Synthesis: The crude rates of H. pylori eradication in 10 RCTs involving 2747 patients were 93.4% (95% CI, 91.3% to 95.5%) for sequential therapy (n = 1363) and 76.9% (CI, 71.0% to 82.8%) for standard triple therapy (n = 1384) (relative risk reduction, 71% [CI, 64% to 77%]; absolute risk reduction, 16 percentage points [CI, 14 to 19 percentage points]). The median rates of adherence were 97.4% (range, 90.0% to 98.9%) for sequential therapy and 96.8% (range, 93.0% to 100%) for standard therapy. Sequential therapy appeared superior in prespecified sensitivity (subgroup) analyses stratified by trial quality; smoking status; diagnosis (ulcer disease or nonulcer dyspepsia); resistance to clarithromycin, imidazoles, or both; duration of triple therapy; and method of diagnosis. Both treatments had similar side effect profiles.
Limitations: Only 1 study was double-blinded. Most patients were from Italy. There was clear evidence of publication bias.
Conclusion: Sequential therapy appears superior to standard triple therapy for eradication of H. pylori infection. If RCTs in other countries confirm these findings, 10-day sequential therapy could become a standard treatment for H. pylori infection in treatment-naive patients.
Article and Author Information
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Potential Financial Conflicts of Interest: Consultancies: C.W. Howden (Meretek, TAP, Takeda, Santarus, Novartis); Honoraria: C.W. Howden (AstraZeneca, Meretek, Santarus); Grants received: C.W. Howden (AstraZeneca).
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Requests for Single Reprints: Colin W. Howden, MD, Division of Gastroenterology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 1400, Chicago, IL 60611; e-mail, c-howden{at}northwestern.edu.
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Current Author Addresses: Dr. Jafri: University of Louisville, 550 South Jackson Street, ACB 3rd Floor, Louisville, KY 40202.
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Dr. Hornung: University of Louisville School of Public Heath and Information Sciences, 4063 K Building, 555 South Floyd Street, Louisville, KY 40202.
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Dr. Howden: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 1400, Chicago, IL 60611.
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