Division of Gastroenterology and Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, California, USA.
J Gastroenterol Hepatol. 2019 Jan;34(1):59-67. doi: 10.1111/jgh.14462. Epub 2018 Oct 11.
The eradication rate of Helicobacter pylori (H. pylori) has been declining over the past decades. A rescue plan is needed for increasing populations with treatment failure. However, the optimum second-line eradication regimen remains inconclusive. We conducted a network meta-analysis to assess the comparative effectiveness of second-line H. pylori eradication therapies and determine the optimum regimen.
We searched electronic databases from January 2005 to February 2018 for randomized controlled trials assessing the effectiveness of second-line regimens in patients with persistent H. pylori infection after first-line treatment. Bayesian network meta-analysis was performed to combine the direct and indirect evidence and to investigate the rank order of second-line therapies. We also appraised the quality of evidence using Grading of Recommendations Assessment, Development, and Evaluation guidance.
Twenty-six trials with 3628 participants who received second-line eradication therapy were identified. All regimens showed pooled eradication rates < 90%. Compared with 7-day triple therapy, quinolone-based (odds ratio [OR] 4.29, 95% credible interval [CrI] 1.67-12.12, surface under the cumulative ranking [SUCRA] 0.95), non-quinolone-based bismuth-containing quadruple therapies for 10 days or more (OR 2.25, 95% CrI 1.10-4.62, SUCRA 0.78), and sequential therapy (OR 2.91, 95% CrI 1.16-7.65, SUCRA 0.66) showed significantly higher effectiveness. Overall, regimens with longer duration demonstrated higher eradication rates but higher rates of adverse events. More adverse events were reported in those patients treated with concomitant therapy.
Quinolone-based bismuth-containing quadruple therapies for 10 days or more are the optimum second-line regimens for H. pylori eradication.
在过去几十年中，幽门螺杆菌（H. pylori）的根除率一直在下降。需要制定一个补救计划来提高治疗失败人群的比例。然而，最佳的二线根除方案仍不确定。我们进行了一项网络荟萃分析，以评估二线 H. pylori 根除疗法的比较效果，并确定最佳方案。
我们从 2005 年 1 月至 2018 年 2 月检索电子数据库，以评估一线治疗后持续性 H. pylori 感染患者二线方案的有效性。进行贝叶斯网络荟萃分析以合并直接和间接证据，并调查二线治疗的等级顺序。我们还使用推荐评估、制定与评价指南评估证据质量。
共确定了 26 项涉及 3628 名接受二线根除治疗的患者的试验。所有方案的总体根除率均<90%。与 7 天三联疗法相比，含喹诺酮类药物（比值比 [OR] 4.29，95%可信区间 [CrI] 1.67-12.12，累积排序概率曲线下面积 [SUCRA] 0.95）、10 天或以上的不含喹诺酮类药物的铋四联疗法（OR 2.25，95% CrI 1.10-4.62，SUCRA 0.78）和序贯疗法（OR 2.91，95% CrI 1.16-7.65，SUCRA 0.66）显示出更高的有效性。总体而言，持续时间更长的方案显示出更高的根除率，但不良反应发生率更高。同时接受治疗的患者报告了更多的不良反应。
10 天或以上的含喹诺酮类药物的铋四联疗法是治疗 H. pylori 根除的最佳二线方案。
