First-lineHelicobacter pylorieradication therapies in countries with high and low clarithromycin resistance: a systematic review and network meta-analysis.
To determine the optimal regimen of different first-lineHelicobacter pylorieradication therapies according to the clarithromycin resistance rate.



Electronic search for articles published between January 2005 and April 2016. Randomised, controlled trials that reported the effectiveness of first-line eradication therapies in treatment-naïve adults were included. Two independent reviewers performed articles screening and data extraction. Network and traditional meta-analyses were conducted using the random effect model. Subgroup analyses were performed to determine the ranking of regimens in countries with high (>15%) and low (<15%) clarithromycin resistance. Data including adverse events and therapeutic cure rate were also extracted and analysed.



117 trials (totally 32 852 patients) for 17H. pylorieradication regimens were eligible for inclusion. Compared with 7-day clarithromycin-based triple therapy, sequential therapy (ST) for 14 days had the highest effectiveness (OR=3.74, 95% CrI 2.37 to 5.96). ST-14 (OR=6.53, 95% CrI 3.23 to 13.63) and hybrid therapy (HY) for 10 days or more (OR=2.85, 95% CrI 1.58 to 5.37) represented the most effective regimen in areas with high and low clarithromycin resistance, respectively. The effectiveness of standard triple therapy was below therapeutic eradication rate in most of the countries. Longer duration was associated with higher eradication rate, but with a higher risk of events that lead to discontinuation.



ST and HY appeared to be the most effective therapies in countries with high and low clarithromycin resistance, respectively. The clinical decision for optimal regimen can be supported by referring to the rank ordering of relative efficacies stratified by local eradication rates, antibiotic resistance and safety profile.



CRD42015025445.
Division of Gastroenterology and Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan.|Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Yee Hui
0000-0002-2703-5954
YH
Yeo
Division of Gastroenterology and Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan.
Sz-Iuan
SI
Shiu
Division of Gastroenterology and Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan.
Hsiu J
HJ
Ho
Blatvatnik School of Government, University of Oxford, Oxford, UK.
Biyao
B
Zou
School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.|Center for Health Policy Research and Development, Miaoli, Taiwan.
Jaw-Town
JT
Lin
National Cancer Institute, National Health Research Institutes, Miaoli, Taiwan.
Ming-Shiang
MS
Wu
National Cancer Institute, National Health Research Institutes, Miaoli, Taiwan.
Jyh-Ming
JM
Liou
Division of Gastroenterology and Hepatology, Taichung Veterans General Hospital, Taichung, Taiwan.|National Cancer Institute, National Health Research Institutes, Miaoli, Taiwan.|Faculty of Medicine and Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Public Health and Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.|Department of Life Sciences and Rong Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan.
Chun-Ying
CY
Wu
D000900:Anti-Bacterial Agents / Q000009:adverse effects / Q000627:therapeutic use*; D017291:Clarithromycin / Q000009:adverse effects / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents; D017291:Clarithromycin
ANTIBIOTICS; HELICOBACTER PYLORI - TREATMENT; META-ANALYSIS