Discontinuation Rates of <i>Helicobacter pylori</i> Treatment Regimens: A Meta‐Analysis

Buring, Shauna M.; Winner, Lawrence H.; Hatton, Randy C.; Doering, Paul L.

doi:10.1592/phco.19.4.324.30939

Cited by 27 publications

(31 citation statements)

References 46 publications

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“…Of host-related variables, adherence was identifi ed as an important factor predicting H. pylori eradication in an early report of a triple bismuth-tetracycline-metronidazole combination ( 145 ). Subsequent studies have found that drop-out rates in clinical trials are linked to the number of medication doses given per day ( 146 ). Th e likelihood and severity of adverse events also infl uence adherence.…”

Section: Question 4: What Factors Predict Successful Eradication Whenmentioning

confidence: 99%

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,272

1,505

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Helicobacter pylori ( H. pylori ) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-infl ammatory medication, unexplained iron defi ciency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori , patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process. For fi rst-line treatment, clarithromycin triple therapy should be confi ned to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongst H. pylori isolates is known to be low. Most patients will be better served by fi rst-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole. When fi rst-line therapy fails, a salvage regimen should avoid antibiotics that were previously used. If a patient received a fi rst-line treatment containing clarithromycin, bismuth quadruple therapy or levofl oxacin salvage regimens are the preferred treatment options. If a patient received fi rst-line bismuth quadruple therapy, clarithromycin or levofl oxacin-containing salvage regimens are the preferred treatment options. Details regarding the drugs, doses and durations of the recommended and suggested fi rst-line and salvage regimens can be found in the guideline. Asia and Central and South America ( 8,22 ). Th ere is, however, preliminary evidence that it may be falling in some previously high prevalence areas ( 22 ). People immigrating to North America from Asia and other parts of the world have a much higher prevalence of the infection than people born in North America ( 23 ). In one study, the seroprevalence among immigrants from East Asia was 70.1% ( 24 ). Hispanic immigrants to North America have higher rates of the infection than fi rst-or second-generation Hispanics who were born here ( 25 ). QUESTION 2: WHAT ARE THE INDICATIONS TO TEST FOR, AND TO TREAT, H. PYLORI INFECTION? RecommendationsSince all patients with a positive test of active infection with H. pylori should be off ered treatment, the critical issue is which patients should be tested for the infection (strong recommendation, quality of evidence: not applicable), All patients with active peptic ulcer disease (PUD), a past history of PUD (unless previous cure of H. pylori infection has been documented), low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma, or a history of endoscopic resection of early gastric cancer (EGC) should be tested for H. pylori infection. Th ose who test positive should be off ered treatment for the infection (strong recommendation, quality of evidence: high for active or history of PUD, low for MALT lymphoma, low for history of endoscopic resection of EGC).In patients with uninvestigated d...

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Section: Question 4: What Factors Predict Successful Eradication Whenmentioning

confidence: 99%

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Chey

Leontiadis

Howden

et al. 2017

American Journal of Gastroenterology

1,272

1,505

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“…Simplifying the dosage regimen can be one of technical solutions for retreated patients with chronic hepatitis C to increase the compliance to therapy. Most reviewers who studied the adherence to treatment in a variety of medical disorders and pathologies arrived at the same conclusion that a less frequent dosage results in better adherence [8,[9][10][11][12][13]. The only one exception to this rule is depression; the number of anti-depressant drugs does not seem to be related to the number of drop-outs [13,14].…”

Section: Discussionmentioning

confidence: 99%

“…The only one exception to this rule is depression; the number of anti-depressant drugs does not seem to be related to the number of drop-outs [13,14]. On a meta-analysis on adherence of 56 primary studies who explored the adherence related to number of tablets taken per day, Buring et al showed that adherence rates were higher with regimens containing three or fewer doses a day, compared to four to six doses a day (p = 0.001), seven to eleven (p = 0.009) or 12 or more (p < 0.0001) [9,14]. Adherence appears to decline as the number of daily doses increase.…”

Section: Discussionmentioning

confidence: 99%

Major drivers influencing adherence and quality of life during antiviral triple therapy in patients with chronic hepatitis C

Suceveanu¹,

Mazilu

Aramă

et al. 2016

ARS Medica Tomitana

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Background & Aims. Triple therapy with Peg-IFNs, Ribavirin and protease inhibitors raise the treatment success for hepatitis C up to 83%, but also bring together with the significantly higher rates of sustained virologic response (SVR) more side effects, interfering with patient's quality of life (QoL) and work productivity. We aimed to analyze the factors influencing the adherence and the QoL during triple therapy using Peg-IFNs, Ribavirin and protease inhibitors in 50 patients diagnosed with chronic hepatitis C with first line therapy failure. Multivariate Cox proportional hazards regression was used to analyze determinants of retreatment initiation and treatment compliance, according to patient features. Results: We identified as major drivers of retreatment initiation the younger age, the female gender, the urban provenience, the high income, and the psychiatric and alcohol or drugs abuse history. The adherence and the QoL during retreatment therapy were similar, despite the regimen used, and obvious lower in patients with history of previous abandon, drugs and alcohol abuse or hematologic/ psychiatric decompensation. A lower capacity to work and a temporary withdrawal from job necessary to continue the therapy were seen similar in patients taking Boceprevir/Telaprevir. Abandon of therapy without a

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“…9,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] The consensus opinion is that for a drug therapy to be considered effective, it should achieve cure rates Ͼ90% by per protocol analysis and Ͼ80% by intention-to-treat analysis. 59 There are a wide range of different drug regimens for H.pylori eradication studied in the literature (different drugs and drug combinations, variable dosages and varying durations of therapy).…”

Section: Drug Therapy For Eradication Of Helicobacter Pylorimentioning

confidence: 99%

“…9,[27][28][29]34,35,[37][38][39] Regimens containing ranitidine bismuth citrate plus two antibiotics possibly may be more effective against antibiotic-resistant strains. 28 Frequent side effects for bismuth-based triple therapies limit compliance, 24,27,31,35,37 whilst the requirement for more frequent daily dosing over a longer period might affect success. 31,37 Bismuthbased dual therapies (a bismuth compound plus one antibiotic) give lower eradication rates than bismuthbased triple therapies.…”

Section: Drug Therapy For Eradication Of Helicobacter Pylorimentioning

confidence: 99%

The management of Helicobacter pylori infection in primary care: a systematic review of the literature

Childs

Roberts²,

Meineche-Schmidt³

et al. 2000

Family Practice

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Childs SM, Roberts AP, Meineche-Schmidt V, de Wit NJ and Rubin GP. The management of Helicobacter pylori infection in primary care: a systematic review of the literature. Family Practice 2000; 17: S6-S11. Objective. The aim of the present study was to provide evidence from the literature to inform the production of guidelines by the European Society for Primary Care Gastroenterology (ESPCG) for the management of Helicobacter pylori infection in primary care. Methods. A systematic review was conducted, searching MEDLINE, EMBASE and the Cochrane Library. The systematic review was designed to answer a number of questions: the role of H.pylori in the aetiology of peptic ulcer disease (PUD), gastric cancer (GC), non-ulcer dyspepsia (NUD) and oesophagitis; non-invasive testing for H.pylori and post-treatment testing; eradication therapy; and cost issues. Selection of records concentrated on the highest quality studies, i.e. systematic reviews, meta-analyses and cost analyses. Results.Helicobacter pylori infection is a causal factor in PUD and GC but not in NUD or oesophagitis. Serological tests and urea breath tests (UBTs) can be used for the detection of H.pylori, but UBT is the preferred choice for post-treatment testing. Proton pump inhibitor (PPI)-based triple regimens are the preferred eradication therapy. Eradication therapy is more costeffective than long-term maintenance therapy.Conclusions. Strong evidence is available for answering questions on the aetiology of stomach ulcers and GU, eradication therapies and cost issues. Weaker evidence is available for answering the questions on the aetiology of NUD and non-invasive testing. No evidence is available for answering the question on the role of H.pylori in the aetiology of oesophagitis.

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Discontinuation Rates of Helicobacter pylori Treatment Regimens: A Meta‐Analysis

Cited by 27 publications

References 46 publications

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Major drivers influencing adherence and quality of life during antiviral triple therapy in patients with chronic hepatitis C

The management of Helicobacter pylori infection in primary care: a systematic review of the literature

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