Kim Joon Sung, Park Sung Min, Kim Byung-Wook
Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
J Gastroenterol Hepatol. 2015 Sep;30(9):1338-45. doi: 10.1111/jgh.12984.
Eradication of Helicobacter pylori (H. pylori) infection with triple therapy (TT) has declined in many countries prompting the search for alternative regimens. Sequential therapy (ST) and concomitant therapy (CT) have been suggested as first-line regimens in areas of high clarithromycin resistance. We performed a meta-analysis to compare the eradication rates of CT with ST for H. pylori.
A comprehensive literature search for studies comparing the efficacy of CT with ST was performed. Dichotomous data were pooled to obtain the odds ratio (OR) of the eradication rate with 95% confidence intervals (CIs). The eradication rates were considered both on an intention-to-treat (ITT) and on a per-protocol (PP) bases.
A total of 7 studies provided data on 2412 adult patients. Pooled estimates of the studies revealed no significant differences between CT and ST. The pooled OR was 1.116 (95% CI: 0.795-1.567, P = 0.526) for ITT analysis and 1.153 (95% CI: 0.793-1.677, P = 0.455) for PP analysis. There was no difference in the rate of adverse events (OR: 1.229, 95% CI: 0.971-1.556, P = 0.086) and compliance (OR: 0.945, 95% CI: 0.722-1.237, P = 0.681) between the two regimens. Subgroup analysis was performed to compare CT of 10 days and 5 days with ST of 10 days. The pooled OR was 1.518 for CT of 10 days and 0.636 for CT of 5 days.
CT regimens did not achieve higher eradication rates compared with the ST regimen. The adverse events and adherence to medications were not different between the two regimens.
在许多国家，三联疗法（TT）根除幽门螺杆菌（H. pylori）感染的比例有所下降，这促使人们寻找替代方案。在克拉霉素耐药率较高的地区，序贯疗法（ST）和联合疗法（CT）已被建议作为一线治疗方案。我们进行了一项荟萃分析，以比较CT和ST对幽门螺杆菌的根除率。
对比较CT和ST疗效的研究进行全面的文献检索。汇总二分数据以获得根除率的比值比（OR）及95%置信区间（CI）。根除率按意向性分析（ITT）和符合方案分析（PP）进行考量。
共有7项研究提供了2412例成年患者的数据。研究的汇总估计显示CT和ST之间无显著差异。ITT分析的汇总OR为1.116（95%CI：0.795 - 1.567，P = 0.526），PP分析的汇总OR为1.153（95%CI：0.793 - 1.677，P = 0.455）。两种治疗方案在不良事件发生率（OR：1.229，95%CI：0.971 - 1.556，P = 0.086）和依从性（OR：0.945，95%CI：0.722 - 1.237，P = ）方面没有差异。进行亚组分析以比较10天的CT和5天的CT与10天的ST。10天CT的汇总OR为1.518，5天CT的汇总OR为0.636。
与ST方案相比，CT方案并未实现更高的根除率。两种方案在不良事件和药物依从性方面没有差异。
