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Review
. 2015 Aug 19:351:h4052.
doi: 10.1136/bmj.h4052.

Comparative effectiveness and tolerance of treatments for Helicobacter pylori: systematic review and network meta-analysis

Bao-Zhu Li  1 , Diane Erin Threapleton  2 , Ji-Yao Wang  3 , Jian-Ming Xu  4 , Jin-Qiu Yuan  2 , Chao Zhang  1 , Peng Li  1 , Qian-Ling Ye  5 , Biao Guo  6 , Chen Mao  7 , Dong-Qing Ye  8
Affiliations
Review

Comparative effectiveness and tolerance of treatments for Helicobacter pylori: systematic review and network meta-analysis

Bao-Zhu Li et al. BMJ. .

Abstract

Objective: To determine the most efficacious treatment for eradication of Helicobacter pylori with the lowest likelihood of some common adverse events among pre-recommended and newer treatment regimens.

Design: Systematic review and network meta-analysis.

Data sources: Cochrane Library, PubMed, and Embase without language or date restrictions.

Study selection: Full text reports of randomised controlled trials that compared different eradication treatments for H pylori among adults.

Results: Of the 15,565 studies identified, 143 were eligible and included. Data on 14 kinds of treatments were available. Of 91 possible comparisons for the efficacy outcome, 34 were compared directly and the following treatments performed better: seven days of concomitant treatment (proton pump inhibitor and three kinds of antibiotics administered together), 10 or 14 days of concomitant treatment, 10 or 14 days of probiotic supplemented triple treatment (standard triple treatment which is probiotic supplemented), 10 or 14 days of levofloxacin based triple treatment (proton pump inhibitor, levofloxacin, and antibiotic administered together), 14 days of hybrid treatment (proton pump inhibitor and amoxicillin used for seven days, followed by a proton pump inhibitor, amoxicillin, clarithromycin, and 5-nitroimidazole for another seven days), and 10 or 14 days of sequential treatment (five or seven days of a proton pump inhibitor plus amoxicillin, followed by five or seven additional days of a proton pump inhibitor plus clarithromycin and 5-nitroimidazole or amoxicillin). In terms of tolerance, all treatments were considered tolerable, but seven days of probiotic supplemented triple treatment and seven days of levofloxacin based triple treatment ranked best in terms of the proportion of adverse events reported.

Conclusion: Comparison of different eradication treatments for H pylori showed that concomitant treatments, 10 or 14 days of probiotic supplemented triple treatment, 10 or 14 days of levofloxacin based triple treatment, 14 days of hybrid treatment, and 10 or 14 days of sequential treatment might be better alternatives for the eradication of H pylori.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: this work was funded by the Chinese national high level personnel special support plan; there were no financial relationships with any organization that might have an interest in the submitted work in the previous three years and no relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Network of eligible comparisons for treatment efficacy network meta-analysis. The width of lines is proportional to the number of studies compared in every pair of treatments, and the size of nodes is proportional to the total sample size of each treatment
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Fig 2 Forest plot of network meta-analysis results for treatment efficacy outcomes compared with seven days of standard triple treatment
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Fig 3 Network of eligible comparisons for treatment tolerance network meta-analysis. The width of lines is proportional to the number of studies compared in every pair of treatments, and the size of nodes is proportional to the total sample size of each treatment
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Fig 4 Forest plot of network meta-analysis results for treatment tolerance outcomes compared with seven days of standard triple treatment
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Fig 5 Efficacy and tolerance profile for all eradication treatments according to network meta-analyses (treatments are ordered based on efficacy ranking)
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Fig 6 Ranking for effectiveness and tolerance of Helicobacter pylori treatments in network meta-analyses
See this image and copyright information in PMC

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