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Systematic review, meta‐analysis, and meta‐regression: Successful second‐line treatment for Helicobacter pylori

Background Multiple Helicobacter pylori second‐line schedules have been described as potentially useful. It remains unclear, however, which are the best combinations, and which features of second‐line treatments are related to better cure rates. The aim of this study was to determine that second‐lin...

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Published in:Helicobacter (Cambridge, Mass.) Mass.), 2018-06, Vol.23 (3), p.e12488-n/a
Main Authors: Muñoz, Neus, Sánchez‐Delgado, Jordi, Baylina, Mireia, Puig, Ignasi, López‐Góngora, Sheila, Suarez, David, Calvet, Xavier
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container_title Helicobacter (Cambridge, Mass.)
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Sánchez‐Delgado, Jordi
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description Background Multiple Helicobacter pylori second‐line schedules have been described as potentially useful. It remains unclear, however, which are the best combinations, and which features of second‐line treatments are related to better cure rates. The aim of this study was to determine that second‐line treatments achieved excellent (>90%) cure rates by performing a systematic review and when possible a meta‐analysis. A meta‐regression was planned to determine the characteristics of treatments achieving excellent cure rates. Methods A systematic review for studies evaluating second‐line Helicobacter pylori treatment was carried out in multiple databases. A formal meta‐analysis was performed when an adequate number of comparative studies was found, using RevMan5.3. A meta‐regression for evaluating factors predicting cure rates >90% was performed using Stata Statistical Software. Results The systematic review identified 115 eligible studies, including 203 evaluable treatment arms. The results were extremely heterogeneous, with 61 treatment arms (30%) achieving optimal (>90%) cure rates. The meta‐analysis favored quadruple therapies over triple (83.2% vs 76.1%, OR: 0.59:0.38‐0.93; P = .02) and 14‐day quadruple treatments over 7‐day treatments (91.2% vs 81.5%, OR; 95% CI: 0.42:0.24‐0.73; P = .002), although the differences were significant only in the per‐protocol analysis. The meta‐regression did not find any particular characteristics of the studies to be associated with excellent cure rates. Conclusion Second‐line Helicobacter pylori treatments achieving>90% cure rates are extremely heterogeneous. Quadruple therapy and 14‐day treatments seem better than triple therapies and 7‐day ones. No single characteristic of the treatments was related to excellent cure rates. Future approaches suitable for infectious diseases—thus considering antibiotic resistances—are needed to design rescue treatments that consistently achieve excellent cure rates.
doi_str_mv 10.1111/hel.12488
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It remains unclear, however, which are the best combinations, and which features of second‐line treatments are related to better cure rates. The aim of this study was to determine that second‐line treatments achieved excellent (&gt;90%) cure rates by performing a systematic review and when possible a meta‐analysis. A meta‐regression was planned to determine the characteristics of treatments achieving excellent cure rates. Methods A systematic review for studies evaluating second‐line Helicobacter pylori treatment was carried out in multiple databases. A formal meta‐analysis was performed when an adequate number of comparative studies was found, using RevMan5.3. A meta‐regression for evaluating factors predicting cure rates &gt;90% was performed using Stata Statistical Software. Results The systematic review identified 115 eligible studies, including 203 evaluable treatment arms. The results were extremely heterogeneous, with 61 treatment arms (30%) achieving optimal (&gt;90%) cure rates. The meta‐analysis favored quadruple therapies over triple (83.2% vs 76.1%, OR: 0.59:0.38‐0.93; P = .02) and 14‐day quadruple treatments over 7‐day treatments (91.2% vs 81.5%, OR; 95% CI: 0.42:0.24‐0.73; P = .002), although the differences were significant only in the per‐protocol analysis. The meta‐regression did not find any particular characteristics of the studies to be associated with excellent cure rates. Conclusion Second‐line Helicobacter pylori treatments achieving&gt;90% cure rates are extremely heterogeneous. Quadruple therapy and 14‐day treatments seem better than triple therapies and 7‐day ones. No single characteristic of the treatments was related to excellent cure rates. Future approaches suitable for infectious diseases—thus considering antibiotic resistances—are needed to design rescue treatments that consistently achieve excellent cure rates.</description><identifier>ISSN: 1083-4389</identifier><identifier>EISSN: 1523-5378</identifier><identifier>DOI: 10.1111/hel.12488</identifier><identifier>PMID: 29663581</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Anti-Bacterial Agents - pharmacology ; Anti-Bacterial Agents - therapeutic use ; Anti-Ulcer Agents - pharmacology ; Anti-Ulcer Agents - therapeutic use ; Antibiotics ; Comparative studies ; Drug Therapy, Combination ; Extreme values ; Helicobacter Infections - drug therapy ; Helicobacter pylori ; Helicobacter pylori - drug effects ; Humans ; Infectious diseases ; Meta-analysis ; Proton Pump Inhibitors - pharmacology ; Proton Pump Inhibitors - therapeutic use ; Randomized Controlled Trials as Topic ; Regression analysis ; Reviews ; Salvage Therapy - statistics &amp; numerical data ; Schedules ; second‐line treatments ; Statistical analysis ; Systematic review ; Treatment Outcome</subject><ispartof>Helicobacter (Cambridge, Mass.), 2018-06, Vol.23 (3), p.e12488-n/a</ispartof><rights>2018 John Wiley &amp; Sons Ltd</rights><rights>2018 John Wiley &amp; Sons Ltd.</rights><rights>Copyright © 2018 John Wiley &amp; Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3538-9491d50e562fb42cb2739d435a8830e15620e08973e84ff1ab747f8299d257d23</citedby><cites>FETCH-LOGICAL-c3538-9491d50e562fb42cb2739d435a8830e15620e08973e84ff1ab747f8299d257d23</cites><orcidid>0000-0002-9059-8602</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29663581$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Muñoz, Neus</creatorcontrib><creatorcontrib>Sánchez‐Delgado, Jordi</creatorcontrib><creatorcontrib>Baylina, Mireia</creatorcontrib><creatorcontrib>Puig, Ignasi</creatorcontrib><creatorcontrib>López‐Góngora, Sheila</creatorcontrib><creatorcontrib>Suarez, David</creatorcontrib><creatorcontrib>Calvet, Xavier</creatorcontrib><title>Systematic review, meta‐analysis, and meta‐regression: Successful second‐line treatment for Helicobacter pylori</title><title>Helicobacter (Cambridge, Mass.)</title><addtitle>Helicobacter</addtitle><description>Background Multiple Helicobacter pylori second‐line schedules have been described as potentially useful. It remains unclear, however, which are the best combinations, and which features of second‐line treatments are related to better cure rates. The aim of this study was to determine that second‐line treatments achieved excellent (&gt;90%) cure rates by performing a systematic review and when possible a meta‐analysis. A meta‐regression was planned to determine the characteristics of treatments achieving excellent cure rates. Methods A systematic review for studies evaluating second‐line Helicobacter pylori treatment was carried out in multiple databases. A formal meta‐analysis was performed when an adequate number of comparative studies was found, using RevMan5.3. A meta‐regression for evaluating factors predicting cure rates &gt;90% was performed using Stata Statistical Software. Results The systematic review identified 115 eligible studies, including 203 evaluable treatment arms. The results were extremely heterogeneous, with 61 treatment arms (30%) achieving optimal (&gt;90%) cure rates. The meta‐analysis favored quadruple therapies over triple (83.2% vs 76.1%, OR: 0.59:0.38‐0.93; P = .02) and 14‐day quadruple treatments over 7‐day treatments (91.2% vs 81.5%, OR; 95% CI: 0.42:0.24‐0.73; P = .002), although the differences were significant only in the per‐protocol analysis. The meta‐regression did not find any particular characteristics of the studies to be associated with excellent cure rates. Conclusion Second‐line Helicobacter pylori treatments achieving&gt;90% cure rates are extremely heterogeneous. Quadruple therapy and 14‐day treatments seem better than triple therapies and 7‐day ones. No single characteristic of the treatments was related to excellent cure rates. Future approaches suitable for infectious diseases—thus considering antibiotic resistances—are needed to design rescue treatments that consistently achieve excellent cure rates.</description><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Anti-Ulcer Agents - pharmacology</subject><subject>Anti-Ulcer Agents - therapeutic use</subject><subject>Antibiotics</subject><subject>Comparative studies</subject><subject>Drug Therapy, Combination</subject><subject>Extreme values</subject><subject>Helicobacter Infections - drug therapy</subject><subject>Helicobacter pylori</subject><subject>Helicobacter pylori - drug effects</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Meta-analysis</subject><subject>Proton Pump Inhibitors - pharmacology</subject><subject>Proton Pump Inhibitors - therapeutic use</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Regression analysis</subject><subject>Reviews</subject><subject>Salvage Therapy - statistics &amp; 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It remains unclear, however, which are the best combinations, and which features of second‐line treatments are related to better cure rates. The aim of this study was to determine that second‐line treatments achieved excellent (&gt;90%) cure rates by performing a systematic review and when possible a meta‐analysis. A meta‐regression was planned to determine the characteristics of treatments achieving excellent cure rates. Methods A systematic review for studies evaluating second‐line Helicobacter pylori treatment was carried out in multiple databases. A formal meta‐analysis was performed when an adequate number of comparative studies was found, using RevMan5.3. A meta‐regression for evaluating factors predicting cure rates &gt;90% was performed using Stata Statistical Software. Results The systematic review identified 115 eligible studies, including 203 evaluable treatment arms. The results were extremely heterogeneous, with 61 treatment arms (30%) achieving optimal (&gt;90%) cure rates. The meta‐analysis favored quadruple therapies over triple (83.2% vs 76.1%, OR: 0.59:0.38‐0.93; P = .02) and 14‐day quadruple treatments over 7‐day treatments (91.2% vs 81.5%, OR; 95% CI: 0.42:0.24‐0.73; P = .002), although the differences were significant only in the per‐protocol analysis. The meta‐regression did not find any particular characteristics of the studies to be associated with excellent cure rates. Conclusion Second‐line Helicobacter pylori treatments achieving&gt;90% cure rates are extremely heterogeneous. Quadruple therapy and 14‐day treatments seem better than triple therapies and 7‐day ones. No single characteristic of the treatments was related to excellent cure rates. Future approaches suitable for infectious diseases—thus considering antibiotic resistances—are needed to design rescue treatments that consistently achieve excellent cure rates.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29663581</pmid><doi>10.1111/hel.12488</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-9059-8602</orcidid></addata></record>
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subjects Anti-Bacterial Agents - pharmacology
Anti-Bacterial Agents - therapeutic use
Anti-Ulcer Agents - pharmacology
Anti-Ulcer Agents - therapeutic use
Antibiotics
Comparative studies
Drug Therapy, Combination
Extreme values
Helicobacter Infections - drug therapy
Helicobacter pylori
Helicobacter pylori - drug effects
Humans
Infectious diseases
Meta-analysis
Proton Pump Inhibitors - pharmacology
Proton Pump Inhibitors - therapeutic use
Randomized Controlled Trials as Topic
Regression analysis
Reviews
Salvage Therapy - statistics & numerical data
Schedules
second‐line treatments
Statistical analysis
Systematic review
Treatment Outcome
title Systematic review, meta‐analysis, and meta‐regression: Successful second‐line treatment for Helicobacter pylori
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