Pharmacological regimens for eradication of Helicobacter pylori: an overview of systematic reviews and network meta-analysis

Xin, Yiqiao; Manson, Jan; Govan, Lindsay; Harbour, Robin; Bennison, Jenny; Watson, Eleanor; Wu, Olivia

doi:10.1186/s12876-016-0491-7

Table 4 Characteristics of systematic reviews comparing triple therapy versus bismuth-based therapy (n = 9)

From: Pharmacological regimens for eradication of Helicobacter pylori: an overview of systematic reviews and network meta-analysis

Author, Year, country	Last search date	Disease	Countries of included RCTs^f	Triple therapy	Bismuth-based Quadruple therapy	No. of studies in MA	No. of patients in MA	Eradication rates by ITT	Eradication rates odds ratio (95 % CI) by ITT^d	Quality assessment^e
Gene et al. 2003 Spain [38]	Aug 2002	HP infection; naïve to therapy; PUD/NUD	Spain (2), US/Canada, unknown	PPI (ome/panto) + clarithromycin + amoxicillin	Bismuth + PPI(ome/panto) + tetracycline + metronidazole	4	981	78 % vs. 81 %	0.83 (0.61–1.14)^a	0
Gisbert et al. 2005 Spain [27]	Sep 2004	HP infection; NUD+/−PUD; previous treatment failures	Croatia, Spain (6), Belgium, Italy (4), Greece, China	PPI (ome/lanso/panto) + clarithromycin + amoxicillin/nitroimidazole	RBC + clarithromycin + amoxicillin	14	2205	78 % vs. 79 %	Bismuth vs. triple 1.11 (0.88–1.40)	+
			Croatia, Italy (6), Spain, Norway, Unknown (2), The Netherlands, China	PPI (ome/lanso/panto/rabe) + clarithromycin + amoxicillin/nitroimidazole	RBC + clarithromycin + nitroimidazole	13	1777	80 % vs. 87 %	Bismuth vs. triple 1.65 (1.15–2.37)
			Taiwan, China, UK	PPI (ome) + clarithromycin + amoxicillin/nitroimidazole	RBC + nitroimidazole + amoxicillin	3	451	75 % vs. 73 %	Bismuth vs. triple 0.92 (0.60–1.41)
Gisbert et al. 2006 Spain [28]	Jul 2005	HP infection; Previous treatment failures	Italy (5), China, Spain, unknown	Levofloxacin-containing: levofloxacin + PPI(panto/rabe/esome/ome) + amoxicillin/rifabutin	Bismuth + PPI(panto/rabe/ome) + tetracycline + metronidazole; or RBC+ tetracycline + metronidazole	8	996	81 % vs. 70 %	1.80 (0.9–3.5)	0
Gisbert et al. 2006 Spain [28]	Jul 2005	HP infection; Previous treatment failures	Not reported	Levofloxacin + amoxicillin + PPI(panto/rabe/esome/ome)	Bismuth + PPI(panto/rabe/ome) + tetracycline + metronidazole; or RBC+ tetracycline + metronidazole	not specified	Not specified	Not reported	1.7 (0.71–4.0)	0
Saad et al. 2006 US [29]	Apr 2005	HP infection; failed prior course(s) of standard triple therapy	Italy (5), China	Levofloxacin-containing : levofloxacin+ +amoxicillin+	Bismuth − + metronidazole + tetracycline+	6	854	87 % vs. 60 %	1.18 (1.08–1.29)^b	0
Saad et al. 2006 US [29]	Apr 2005		Italy (5), China	+ same PPI (ome/esome/rabe/panto)		6	854	87 % vs. 60 %	1.18 (1.08–1.29)^b	0
Li et al. 2010 China [30]	1981-Mar 2009 (Published date)	HP infection; previous treatment failures	Germany (2), Ireland	Clarithromycin-containing: clarithromycin + amoxicillin+	Bismuth+ +metronidazole + tetracycline+	3	411	46.5 % vs. 61.9 %	0.53 (0.35–0.80)	0
			Germany (2), Ireland	+ same PPI (ome/not specified)		3	411	46.5 % vs. 61.9 %	0.53 (0.35–0.80)
			Korea (2), Croatia	Moxifloxacin-containing: moxifloxacin + amoxicillin/metronidazole+	Bismuth + metronidazole + tetracycline+	3	437	Not reported	1.78 (0.98–3.22)
			Korea (2), Croatia	+PPI(esome/ome)		3	437	Not reported	1.78 (0.98–3.22)
			Taiwan, Korea, China (5), Italy (2)	Levofloxacin-containing: levofloxacin + amoxicillin/rifabutin+	Bismuth + metronidazole + tetracycline+	9	928	Not reported	1.43 (0.82–2.51)
			Taiwan, Korea, China (5), Italy (2)	+ same PPI(esome/panto/lanso/rabe)		9	928	Not reported	1.43 (0.82–2.51)
Luther et al. 2010 US [50]	1990–2008 (Published date)	HP infection	Spain (2), Greece, Australia/New Zealand, India, US/Canada, Korea, Turkey, UK	Clarithromycin-containing: clarithromycin + amoxicillin+	Bismuth + metronidazole + tetracycline +	9	1679	77.0 % vs. 78.3 %	Bismuth vs. triple 1.00 (0.94–1.07^b	0
Luther et al. 2010 US [50]	1990–2008 (Published date)	HP infection		+PPI (ome/panto/lanso/not specified)		9	1679	77.0 % vs. 78.3 %	Bismuth vs. triple 1.00 (0.94–1.07^b	0
Wu et al. 2011 China [31]	Dec 2010	HP infection; previous treatment failures	China (4), Korea (2), Croatia	Moxifloxacin-containing: Moxifloxacin + + amoxicillin/metronidazole+	Bismuth + metronidazole/furazolidone + tetracycline/amoxicillin/clarithromycin+	7	787	74.9 % vs. 61.4 %	1.89 (1.38–2.58)	++
Wu et al. 2011 China [31]	Dec 2010	HP infection; previous treatment failures	China (4), Korea (2), Croatia	+ PPI (esome/ome/rabe)		7	787	74.9 % vs. 61.4 %	1.89 (1.38–2.58)	++
Di Caro et al. 2012 UK [32]	Oct 2010	HP infection; previous treatment failures	Italy (4), Spain (2), China (4), Korea (2), Taiwan, Unknown	Levofloxacin + amoxicillin-containing: levofloxacin + amoxicillin + PPI(panto/rabe/esome/ome/lanso)	Bismuth quadruple therapy (not specified)	14	1331	76.5 % vs. 67.4 %	1.59 (0.98–2.58)	0
Venerito et al. 2013 Germany [39]	Nov 2011	HP infection; naïve to therapy; PUD/NUD/others	Spain (2), Australia/New Zealand, Greece, US/Canada, India, Korea, Turkey (2), UK, China, multi European countries	Clarithromycin-containing: clarithromycin + amoxicillin+	Bismuth + tetracycline + metronidazole+	12	2467	68.9 % vs. 77.6 %	Bismuth vs. triple 0.06 (−0.01–0.13)^c	+
Venerito et al. 2013 Germany [39]	Nov 2011	HP infection; naïve to therapy; PUD/NUD/others		+PPI(ome/panto/lanso/not specified)		12	2467	68.9 % vs. 77.6 %	Bismuth vs. triple 0.06 (−0.01–0.13)^c	+

HP H.pylori, PPI proton pump inhibitor, esome esomeprazole, lanso lansoprazole, ome omeprazole, panto pantoprazole, rabe rabeprazole, PUD peptic ulcer disease, NUD non-ulcer dyspepsia, MA meta-analysis, ITT intention to treat, CI confidence interval, RCT randomized controlled trials, RBC ranitidine bismuth citrate
^a Peto OR is reported here
^b Relative risk is reported here
^c Risk difference is reported here
^d OR > 1 indicates that triple therapy is associated with greater effectiveness than bismuth-based therapy and vice versa. When “Bismuth vs. triple” is specified in the form, OR > 1 indicates bismuth-based therapy is associated with greater effectiveness than triple therapy and vice versa
^e Quality assessment: high quality (++): majority of criteria met, little or no risk of bias and results unlikely to be changed by further research. Acceptable (+): most criteria met, some flaws in the study with an associated risk of bias and conclusions may change in the light of further studies. Low quality (0): either most criteria not met or significant flaws relating to key aspects of study design, and conclusions likely to change in the light of further studies
^f Countries of included RCTs: the number in the bracket represents the number of trials from the same country if more than one trials exist

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