BACKGROUND AND AIM: The eradication rate of Helicobacter 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 Helicobacter pylori (H. pylori) eradication therapies and determine the optimum regimen. METHODS: We searched electronic databases from January 2005 to Feb 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 (NMA) 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 GRADE guidance. RESULTS: Twenty-six trials with 3,628 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, SUCRA 0.95) and 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. CONCLUSIONS: Quinolone-based bismuth-containing quadruple therapies for 10 days or more are the optimum regimens for H. pylori eradication.
Date:
2019-01
Relation:
Journal of Gastroenterology and Hepatology. 2019 Jan;34(1):59-67.
