title: Standard triple therapy for Helicobacter pylori infection in China: a meta-analysis.
abstract: OBJECTIVE
  To assess the efficacy and safety of standard triple therapy compared with other pre-existing and new therapies in China.
  
  
  METHODS
  Literature searches were conducted in the following databases: PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, the VIP database, the China National Knowledge Infrastructure database, and the Chinese Biomedical Database. A meta-analysis of all randomized controlled trials (RCTs) comparing standard triple therapy for the eradication of Helicobacter pylori with pre-existing and new therapies in China was performed using Comprehensive Meta-Analysis 2.0. There were 49 studies that met our criteria and the qualities of these studies were assessed using the Jadad scale. The Mantel-Haenszel method was used for pooling dichotomous data. We also conducted subgroup analyses according to age, duration of treatment and drug type. Sensitivity analyses and a cumulative meta-analysis were also performed with CMA 2.0. Publication bias was evaluated using Egger's test, Begg's test or a funnel plot.
  
  
  RESULTS
  A total of 49 RCTs including 8332 patients were assessed. This meta-analysis showed that standard triple therapy with proton pump inhibitors (PPIs), amoxicillin (AMO) and clarithromycin (CLA) was inferior to sequential therapy [relative risk (RR) = 0.863; 95% confidence interval (CI): 0.824-0.904], but was not superior to quadruple therapy (RR = 1.073; 95%CI: 0.849-1.357) or other triple therapies (RR = 1.01; 95%CI: 0.936-1.089). The meta-analysis also suggested that standard triple therapy is slightly more effective than dual therapy (RR = 1.14; 95%CI: 0.99-1.31). However, the differences were not statistically significant. We removed the only trial with a regimen lasting 14 d by sensitivity analysis and found that 7-d standard triple therapy was superior to 7-d dual therapy (RR = 1.222; 95%CI: 1.021-1.461). Moreover, a sub-analysis based on the duration of quadruple therapy indicated that the 7-d and 10-d standard triple therapies were inferior to sequential therapy (RR = 0.790; 95%CI: 0.718-0.868; RR = 0.917; 95%CI: 0.839-1.002, respectively). Additionally, there were no significant differences in cure rate or adverse events among standard triple therapy, quadruple therapy, and other triple therapies (RR = 0.940; 95%CI: 0.825-1.072; RR = 1.081; 95%CI: 0.848-1.378, respectively). Standard triple therapy had a higher occurrence of side effects than sequential therapy (RR = 1.283; 95%CI: 1.066-1.544).
  
  
  CONCLUSIONS
  The eradication rates with a standard triple therapy consisting of PPI, AMO, and CLA are suboptimal in China, and new treatment agents need to be developed.
authors.affiliation: Ben Wang, Zhi-Fa Lv, You-Hua Wang, Hui Wang, Xiao-Qun Liu, Yong Xie, Xiao-Jiang Zhou, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China.
authors.forename: Ben
authors.initials: B
authors.lastname: Wang
authors.affiliation: Ben Wang, Zhi-Fa Lv, You-Hua Wang, Hui Wang, Xiao-Qun Liu, Yong Xie, Xiao-Jiang Zhou, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China.
authors.forename: Zhi-Fa
authors.initials: ZF
authors.lastname: Lv
authors.affiliation: Ben Wang, Zhi-Fa Lv, You-Hua Wang, Hui Wang, Xiao-Qun Liu, Yong Xie, Xiao-Jiang Zhou, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China.
authors.forename: You-Hua
authors.initials: YH
authors.lastname: Wang
authors.affiliation: Ben Wang, Zhi-Fa Lv, You-Hua Wang, Hui Wang, Xiao-Qun Liu, Yong Xie, Xiao-Jiang Zhou, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Wang
authors.affiliation: Ben Wang, Zhi-Fa Lv, You-Hua Wang, Hui Wang, Xiao-Qun Liu, Yong Xie, Xiao-Jiang Zhou, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China.
authors.forename: Xiao-Qun
authors.initials: XQ
authors.lastname: Liu
authors.affiliation: Ben Wang, Zhi-Fa Lv, You-Hua Wang, Hui Wang, Xiao-Qun Liu, Yong Xie, Xiao-Jiang Zhou, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Ben Wang, Zhi-Fa Lv, You-Hua Wang, Hui Wang, Xiao-Qun Liu, Yong Xie, Xiao-Jiang Zhou, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, Jiangxi Province, China.
authors.forename: Xiao-Jiang
authors.initials: XJ
authors.lastname: Zhou
mesh_terms: D000658:Amoxicillin / Q000009:adverse effects / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D044466:Asian People; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D024881:Drug Resistance, Bacterial; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D016017:Odds Ratio; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D000658:Amoxicillin; D017291:Clarithromycin
keywords: Adverse effects; Amoxicillin; Clarithromycin; Combination drug therapy; Eradication; Helicobacter pylori; Meta-analysis