High-dose dual therapy bismuth-containing quadruple therapy for eradication: a systematic review and meta-analysis with trial sequential analysis
Background and objective: Recently, a large number of trials on proton pump inhibitor-amoxicillin-containing high-dose dual therapy (HDDT) versus bismuth-containing quadruple therapy (BQT) for Helicobacter pylori ( H. pylori ) eradication have been published with controversial and inconsistent concl...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2023-01-01
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| Series: | Therapeutic Advances in Gastroenterology |
| Online Access: | https://doi.org/10.1177/17562848221147756 |
| _version_ | 1797955780137189376 |
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| author | Ben-Gang Zhou Yu-Zhou Mei Min Zhang Xin Jiang Yao-Yao Li Yan-Bing Ding |
| author_facet | Ben-Gang Zhou Yu-Zhou Mei Min Zhang Xin Jiang Yao-Yao Li Yan-Bing Ding |
| author_sort | Ben-Gang Zhou |
| collection | DOAJ |
| description | Background and objective: Recently, a large number of trials on proton pump inhibitor-amoxicillin-containing high-dose dual therapy (HDDT) versus bismuth-containing quadruple therapy (BQT) for Helicobacter pylori ( H. pylori ) eradication have been published with controversial and inconsistent conclusions. The aim of this meta-analysis was to determine the effects of HDDT for H. pylori eradication compared to BQT. Design: A systematic review and meta-analysis was conducted. Methods: PubMed, Embase, and the Cochrane library database were searched to collect all randomized controlled trials (RCTs) assessing the effects of HDDT versus BQT to H. pylori eradication from inception to September 2022. Meta-analysis was conducted to estimate the pooled relative risk (RR) with 95% confidence intervals (CIs) using a random-effects model. Quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluation system. Trial sequential analysis (TSA) was performed to determine the reliability and conclusiveness. Results: A total of 14 RCTs with 5121 patients were included. The results of meta-analysis showed that there was no statistical significance in the eradication rate between HDDT and BQT (intention-to-treat analysis: 86.7% versus 85.1%, RR = 1.01, 95% CI: 0.98–1.04; per-protocol analysis: 89.9% versus 89.4%, RR = 1.01, 95% CI: 0.98–1.03; moderate-quality evidence). The incidence of total adverse effects in HDDT group was significantly lower than in BQT group (5.9% versus 34.1%, RR = 0.42, 95% CI: 0.34–0.50; low-quality evidence). No statistical significance was observed in compliance between HDDT and BQT (RR = 1.01, 95% CI, 1.00–1.03, p = 0.07; low-quality evidence). The TSA result for H. pylori eradication rate indicated that the effect was conclusive. Conclusions: Evidence from our updated meta-analysis suggests that HDDT is as effective as BQT in eradicating H. pylori , with fewer adverse effects and similar compliance. Registration: Open Science Framework registries (No: osf.io/th4vd) |
| first_indexed | 2024-04-10T23:38:31Z |
| format | Article |
| id | doaj.art-97789e1f5a324d72afdd1af8344b31e1 |
| institution | Directory Open Access Journal |
| issn | 1756-2848 |
| language | English |
| last_indexed | 2024-04-10T23:38:31Z |
| publishDate | 2023-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Gastroenterology |
| spelling | doaj.art-97789e1f5a324d72afdd1af8344b31e12023-01-11T14:33:37ZengSAGE PublishingTherapeutic Advances in Gastroenterology1756-28482023-01-011610.1177/17562848221147756High-dose dual therapy bismuth-containing quadruple therapy for eradication: a systematic review and meta-analysis with trial sequential analysisBen-Gang ZhouYu-Zhou MeiMin ZhangXin JiangYao-Yao LiYan-Bing DingBackground and objective: Recently, a large number of trials on proton pump inhibitor-amoxicillin-containing high-dose dual therapy (HDDT) versus bismuth-containing quadruple therapy (BQT) for Helicobacter pylori ( H. pylori ) eradication have been published with controversial and inconsistent conclusions. The aim of this meta-analysis was to determine the effects of HDDT for H. pylori eradication compared to BQT. Design: A systematic review and meta-analysis was conducted. Methods: PubMed, Embase, and the Cochrane library database were searched to collect all randomized controlled trials (RCTs) assessing the effects of HDDT versus BQT to H. pylori eradication from inception to September 2022. Meta-analysis was conducted to estimate the pooled relative risk (RR) with 95% confidence intervals (CIs) using a random-effects model. Quality of evidence was appraised using Grading of Recommendations, Assessment, Development and Evaluation system. Trial sequential analysis (TSA) was performed to determine the reliability and conclusiveness. Results: A total of 14 RCTs with 5121 patients were included. The results of meta-analysis showed that there was no statistical significance in the eradication rate between HDDT and BQT (intention-to-treat analysis: 86.7% versus 85.1%, RR = 1.01, 95% CI: 0.98–1.04; per-protocol analysis: 89.9% versus 89.4%, RR = 1.01, 95% CI: 0.98–1.03; moderate-quality evidence). The incidence of total adverse effects in HDDT group was significantly lower than in BQT group (5.9% versus 34.1%, RR = 0.42, 95% CI: 0.34–0.50; low-quality evidence). No statistical significance was observed in compliance between HDDT and BQT (RR = 1.01, 95% CI, 1.00–1.03, p = 0.07; low-quality evidence). The TSA result for H. pylori eradication rate indicated that the effect was conclusive. Conclusions: Evidence from our updated meta-analysis suggests that HDDT is as effective as BQT in eradicating H. pylori , with fewer adverse effects and similar compliance. Registration: Open Science Framework registries (No: osf.io/th4vd)https://doi.org/10.1177/17562848221147756 |
| spellingShingle | Ben-Gang Zhou Yu-Zhou Mei Min Zhang Xin Jiang Yao-Yao Li Yan-Bing Ding High-dose dual therapy bismuth-containing quadruple therapy for eradication: a systematic review and meta-analysis with trial sequential analysis Therapeutic Advances in Gastroenterology |
| title | High-dose dual therapy bismuth-containing quadruple therapy for eradication: a systematic review and meta-analysis with trial sequential analysis |
| title_full | High-dose dual therapy bismuth-containing quadruple therapy for eradication: a systematic review and meta-analysis with trial sequential analysis |
| title_fullStr | High-dose dual therapy bismuth-containing quadruple therapy for eradication: a systematic review and meta-analysis with trial sequential analysis |
| title_full_unstemmed | High-dose dual therapy bismuth-containing quadruple therapy for eradication: a systematic review and meta-analysis with trial sequential analysis |
| title_short | High-dose dual therapy bismuth-containing quadruple therapy for eradication: a systematic review and meta-analysis with trial sequential analysis |
| title_sort | high dose dual therapy bismuth containing quadruple therapy for eradication a systematic review and meta analysis with trial sequential analysis |
| url | https://doi.org/10.1177/17562848221147756 |
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