Gastroenterology Clinic, Henry Dunant Hospital, Athens, Greece; Medical School, European University of Cyprus, Nicosia, Cyprus.
Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.
Gastroenterology. 2021 Aug;161(2):495-507.e4. doi: 10.1053/j.gastro.2021.04.012. Epub 2021 Apr 8.
BACKGROUND & AIMS: A number of double, triple, and quadruple therapies have been proposed as first-line empiric treatments for Helicobacter pylori infection. However, knowledge of their worldwide and regional comparative efficacy is lacking. We examined the comparative effectiveness of all empirically used first-line regimens tested against standard triple treatment using a network meta-analysis of published randomized controlled trials.
Data extracted from eligible randomized controlled trials were entered into a Bayesian network meta-analysis to investigate the comparative efficacy of H pylori infection empiric first-line regimens and to explore their effectiveness rank order. The ranking probability for each regimen was evaluated by means of surfaces under cumulative ranking values.
Sixty-eight eligible randomized controlled trials were included, giving a total of 92 paired comparisons with 22,975 patients randomized to 8 first-line regimens. The overall results showed that only vonoprazan triple therapy and reverse hybrid therapy achieved cure rates of >90%. Levofloxacin triple therapy performed best in Western countries (eradication rate 88.5%). The comparative effectiveness ranking showed that vonoprazan triple therapy had the best results, whereas standard triple therapy was the least efficacious regimen (surfaces under cumulative ranking 92.4% vs 4.7% respectively; odds ratio, 3.80; 95% credible interval, 1.62-8.94).
For first-line empiric treatment of H pylori infection, vonoprazan triple therapy and reverse hybrid therapy achieved high eradication rates of >90%. Levofloxacin triple therapy achieved the highest eradication rates in Western countries. Standard triple therapy was the least efficacious regimen in this network meta-analysis.
许多双联、三联和四联疗法被提议作为幽门螺杆菌感染的一线经验性治疗。然而，我们缺乏对这些疗法在全球和地区的比较疗效的了解。我们通过对已发表的随机对照试验进行网络荟萃分析，检查了所有经验性一线治疗方案与标准三联治疗相比的相对疗效。
从合格的随机对照试验中提取的数据被输入到贝叶斯网络荟萃分析中，以调查幽门螺杆菌感染经验性一线治疗方案的相对疗效，并探索它们的疗效等级顺序。通过累积排序值曲面评估每种方案的排名概率。
纳入了 68 项合格的随机对照试验，共包含 92 对比较，共有 22975 名患者随机分配到 8 种一线方案中。总体结果表明，只有沃诺拉赞三联疗法和反向杂交疗法的治愈率超过 90%。左氧氟沙星三联疗法在西方国家的疗效最好（根除率为 88.5%）。比较疗效排名显示，沃诺拉赞三联疗法的效果最好，而标准三联疗法是最无效的方案（累积排序曲面分别为 92.4%和 4.7%；比值比为 3.80；95%置信区间为 1.62-8.94）。
对于幽门螺杆菌感染的一线经验性治疗，沃诺拉赞三联疗法和反向杂交疗法的根除率超过 90%。左氧氟沙星三联疗法在西方国家的根除率最高。在本网络荟萃分析中，标准三联疗法是最无效的方案。
