https://scholars.lib.ntu.edu.tw/handle/123456789/584948
標題: | Systematic review with Meta-Analysis: Concomitant Therapy vs. Triple Therapy for the First-Line Treatment of Helicobacter pylori Infection | 作者: | MEI-JYH CHEN CHIEN-CHUAN CHEN YEN-NIEN CHEN CHIEH-CHANG CHEN YU-JEN FANG Lin J.-T. MING-SHIANG WU JYH-MING LIOU for the Taiwan Gastrointestinal Disease Helicobacter Consortium |
公開日期: | 2018 | 出版社: | Nature Publishing Group | 卷: | 113 | 期: | 10 | 起(迄)頁: | 1444-1457 | 來源出版物: | American Journal of Gastroenterology | 摘要: | Background: Whether concomitant therapy is superior to triple therapy of various treatment lengths for the first-line treatment of H. pylori remains controversial. The objective of this study is to compare the efficacy of concomitant therapy and triple therapy given for 5–14 days. Methods: Randomized control trials (RCTs) comparing the efficacy of concomitant therapy for 5–14 days and proton pump inhibitor–amoxicillin–clarithromycin (PAC)-based triple therapy for 5–14 days in the first-line treatment of adult patients with H. pylori infection published from 1990 to January 2018 were searched from the PubMed, Cochrane Library, and Embase. Abstracts from international annual conferences were also searched. The primary and secondary outcomes were the eradication rate according to the intention-to-treat analysis and the adverse effects, respectively. Subgroup analyses were also performed according to treatment length. This study is registered with PROSPERO, number CRD42017081328. Results: Of the 639 articles identified, 23 RCTs including 3305 patients in the concomitant therapy group and 3327 patients in the triple therapy group were eligible. Overall, concomitant therapy was superior to triple therapy [risk ratio (RR): 1.15; 95% confidence interval (CI): 1.09–1.21; p < 0.001]. However, there were significant heterogeneity (I2 = 74.0%, p < 0.001). In the subgroup analysis, 5-day concomitant therapy was superior to 5-day triple therapy (RR: 1.30; 95% CI: 1.04–1.62; p = 0.02), 5- or 7-day concomitant therapy was superior to 7-day triple therapy (RR: 1.16; 95% CI: 1.12–1.21; p < 0.001), and 5- or 7-, or 10- or 14-day concomitant therapy was superior to 10-day triple therapy (RR: 1.15; 95% CI: 1.08–1.23; p < 0.001). However, 5- or 10-day concomitant therapy was not superior to 14-day triple therapy (RR: 1.02; 95% CI: 0.89–1.16; p = 0.796). The frequency of adverse effects was significantly higher in concomitant therapy than triple therapy (RR: 1.19; 95% CI: 1.06–1.34; P = 0.004). Conclusions: Concomitant therapy given for 5 or 10 days was superior to 5- or 7-, or 10-day PAC-based triple therapy, but was not superior to 14-day triple therapy. ? 2018, American College of Gastroenterology. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85053293547&doi=10.1038%2fs41395-018-0217-2&partnerID=40&md5=0071227e17d6297ea669c90b4f341e2c https://scholars.lib.ntu.edu.tw/handle/123456789/584948 |
ISSN: | 0002-9270 | DOI: | 10.1038/s41395-018-0217-2 | SDG/關鍵字: | amoxicillin; clarithromycin; metronidazole; proton pump inhibitor; tinidazole; amoxicillin; antiinfective agent; clarithromycin; metronidazole; proton pump inhibitor; tinidazole; adverse event; bacterial clearance; comparative effectiveness; drug efficacy; drug tolerability; Helicobacter infection; human; intention to treat analysis; long term care; meta analysis; priority journal; randomized controlled trial (topic); Review; systematic review; treatment outcome; combination drug therapy; comparative study; disease eradication; drug administration; drug effect; Helicobacter infection; Helicobacter pylori; isolation and purification; microbiology; procedures; Amoxicillin; Anti-Bacterial Agents; Clarithromycin; Disease Eradication; Drug Administration Schedule; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Intention to Treat Analysis; Metronidazole; Proton Pump Inhibitors; Randomized Controlled Trials as Topic; Tinidazole; Treatment Outcome |
顯示於: | 醫學院附設癌醫中心醫院(臺大癌醫) |
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