Zhang Li, Li Bo-Ren, Guo Si-Tong, Li Yan
Department of Pharmacy, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Front Pharmacol. 2024 Oct 10;15:1462057. doi: 10.3389/fphar.2024.1462057. eCollection 2024.
() infection poses a global health challenge, necessitating diverse treatment strategies. This network meta-analysis aimed to assess various treatment regimens for in East and Southeast Asian populations.
A systematic search was conducted in PubMed, Embase, and the Cochrane Library databases from inception to 20 Dec 2023, to identify relevant randomized controlled trials (RCTs) on treatment interventions in East Asian and Southeast Asian populations. The primary outcome focused on effectiveness, specifically the rate of eradication, while the secondary outcome evaluated overall safety, including the incidence of total and serious adverse effects. Network geometry plots were generated to illustrate direct and indirect treatment comparisons, using triple therapy (TT) as the reference standard. Odds Ratios (ORs) and 95% confidence intervals (CIs) were calculated using random-effects models to account for study heterogeneity and consistency models for indirect comparisons. The treatment hierarchy was assessed using the ranking probabilities and surface under the cumulative ranking curve (SUCRA) values.
79 studies met the inclusion criteria, with 99 paired comparisons. The included studies, conducted in Southeast Asia and among East Asian populations, included 29,903 patients. Significant outcomes in treat effectiveness were observed in various comparisons, such as sequential therapy vs. TT, bismuth quadruple therapy (BQT) vs. TT, high-dose dual therapy (HDDT) vs. TT, concomitant therapy vs. TT, P-CAB-based therapy vs. TT, and R-HT/HT vs. TT. R-HT/HT was the top choice based on rankograms and SUCRA values (SUCRA = 96.5). Regarding overall safety, significant results were noted in comparisons involving BQT, HDDT, concomitant therapy, sequential therapy, and P-CAB-based therapy. HDDT achieved the highest overall safety based on rankograms and SUCRA values (SUCRA = 0.0). HDDT demonstrated the lowest incidence of serious adverse events, according to global rankograms and SUCRA values (SUCRA = 19.7).
This network meta-analysis highlights the complexity of treating in East and Southeast Asia. R-HT/HT emerged as the most effective regimen, while HDDT proved to be the safest, with the lowest incidence of serious adverse events. These findings are crucial for optimizing treatment protocols in these regions.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023435318.
（）感染构成全球健康挑战，需要多种治疗策略。这项网络荟萃分析旨在评估东亚和东南亚人群中针对（）的各种治疗方案。
从数据库建立至2023年12月20日，在PubMed、Embase和Cochrane图书馆数据库中进行系统检索，以识别有关东亚和东南亚人群（）治疗干预的相关随机对照试验（RCT）。主要结局聚焦于有效性，具体为（）根除率，次要结局评估总体安全性，包括总不良反应和严重不良反应的发生率。生成网络几何图以说明直接和间接治疗比较，使用三联疗法（TT）作为参考标准。使用随机效应模型计算比值比（OR）和95%置信区间（CI）以考虑研究异质性，并使用一致性模型进行间接比较。使用排序概率和累积排序曲线下面积（SUCRA）值评估治疗层次。
79项研究符合纳入标准，有99对比较。纳入的研究在东南亚和东亚人群中开展，共纳入29,903例患者。在各种比较中观察到治疗有效性的显著结果，如序贯疗法与TT、铋剂四联疗法（BQT）与TT、高剂量双联疗法（HDDT）与TT、伴随疗法与TT、基于P-CAB的疗法与TT以及R-HT/HT与TT的比较。根据排序图和SUCRA值（SUCRA = 96.5），R-HT/HT是首选。关于总体安全性，在涉及BQT、HDDT、伴随疗法、序贯疗法和基于P-CAB的疗法的比较中注意到显著结果。根据排序图和SUCRA值（SUCRA = 0.0），HDDT总体安全性最高。根据全球排序图和SUCRA值（SUCRA = 19.7），HDDT严重不良事件发生率最低。
这项网络荟萃分析突出了东亚和东南亚地区（）治疗的复杂性。R-HT/HT是最有效的方案，而HDDT被证明是最安全的，严重不良事件发生率最低。这些发现对于优化这些地区的治疗方案至关重要。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023435318。
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