Efficacy of a tailored PCR-guided triple therapy in the treatment of Helicobacter pylori infection

Delchier, Jean Charles; Bastuji‐Garin, Sylvie; Raymond, Josette; Mégraud, Françis; Amiot, Aurélien; Cambau, Emmanuelle; Burucoa, Christophe; Baloul, Samia; Barrioz, Thierry; Bizouard, Geoffray; Breuil, J.; Buzaglo, Gaëlle; Chryssostalis, Ariane; Deforges, Lionel; Doumet, Sylva; Dray, Xavier; Durand‐Zaleski, Isabelle; Ghaleh, Bijan; Grattard, Florence; Corvoisier, Philippe Le; Mangeol, Alain; Mion, François; Nahon, Stéphane; Noussair, Latifa; Podglajen, Isabelle; Raskine, Laurent; Roure-Sobas, C.; Samaha, Elia; Zerbib, F.

doi:10.1016/j.medmal.2019.06.001

Cited by 30 publications

(43 citation statements)

References 31 publications

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“…A total of 187 full-text articles were retrieved and 16 eligible studies were included. [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] The risk of bias was moderate to low in most studies, with the notable exception that blinding of participants was lacking in all studies (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

“…23,24,26 Of the three studies, which included previously treated subjects, two studies included subjects with one prior treatment failure, 23,26 and one study included subjects with at least two prior treatment failures. 24 An additional three studies (19%) included both naive and experienced subjects 18,20,25 ; however, in two of these, >90% were treatment naive. 18,20 Susceptibility testing was performed with bacterial culture in 14 studies (89%), and with molecular methods in five studies (31%).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Susceptibility‐guided versus empirical treatment for Helicobacter pylori infection: A systematic review and meta‐analysis

Gingold‐Belfer

Niv

Schmilovitz‐Weiss

et al. 2021

J of Gastro and Hepatol

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Background and Aim: Empirical therapy for Helicobacter pylori infection is limited by increasing antibiotic resistance and suboptimal eradication rates. Studies of the relative effectiveness of susceptibility-guided therapy have produced conflicting results. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to determine whether susceptibility-guided therapy is superior to empirical therapy for H. pylori infection. Methods: We searched articles listed in PubMed, MEDLINE, EMBASE, and Web of Science through May 25, 2020, RCTs comparing susceptibility-guided versus empirical therapy for H. pylori infection. Outcomes, including effectiveness and safety, were analyzed in a meta-analysis. Results: Our final analysis included 16 studies, comprising 2374 patients who received susceptibility-guided therapy and 2451 patients who received empirical treatment. In previously untreated subjects, susceptibility-guided therapy was slightly more effective than empirical therapy (intent to treat risk ratio [RR], 1.14; 95% confidence interval [CI], 1.07-1.21; P < 0.0001, I 2 ¼ 75%). Susceptibility-guided therapy was superior to first-line clarithromycin-based triple therapy only when clarithromycin resistance exceeded 20% (RR, 1.18; 95% CI, 1.07-1.30; P ¼ 0.001, I 2 ¼ 81%). Susceptibility-guided therapy was not more effective than empirical quadruple therapy (RR, 1.02; 95% CI, 0.92-1.13; P ¼ 0.759, I 2 ¼ 80%). Three RCTs were performed exclusively among previously treated subjects, and were highly heterogeneous. Conclusions: Our findings suggest that susceptibility-guided treatment may be slightly superior to empirical first line triple therapy. Susceptibility-guided treatment does not appear to be superior to empirical first-line quadruple therapy or empirical rescue therapy.

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Section: Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Susceptibility‐guided versus empirical treatment for Helicobacter pylori infection: A systematic review and meta‐analysis

Gingold‐Belfer

Niv

Schmilovitz‐Weiss

et al. 2021

J of Gastro and Hepatol

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“…Recent international guidelines have discouraged empirical clarithromycin-based triple therapy in geographical areas with a significantly high prevalence (Ͼ15%) of clarithromycin resistance (4). Antibiotic susceptibility testing was subsequently recommended and proved to be highly effective and superior to empirical treatments, thereby justifying recommendation of its use (12,13,(34)(35)(36)(37). This approach necessitates culture-or PCR-based tests for detection and resistance characterization.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of a Noninvasive Test for Detection of Helicobacter pylori and Resistance to Clarithromycin in Stool by the Amplidiag H. pylori+ClariR Real-Time PCR Assay

et al. 2020

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The noninvasive detection of Helicobacter pylori and its resistance to clarithromycin could revolutionize the management of H. pylori-infected patients by tailoring eradication treatment without any need for endoscopy when histology is not necessary. Several real-time PCR tests performed on stools have been proposed, but their performances were either poor or they were tested on too few patients to be properly evaluated. We conducted a prospective, multicenter study including 1,200 adult patients who were addressed for gastroduodenal endoscopy with gastric biopsies and who were naive for eradication treatment in order to evaluate the performance of the Amplidiag H. pylori+ClariR assay recently developed by Mobidiag (Espoo, Finland). The results of the Amplidiag H. pylori+ClariR assay performed on DNA from stools (automatic extraction with the EasyMag system [bioMérieux]) were compared with those of culture/Etest and quadruplex real-time PCRs performed on two gastric biopsy samples (from the antrum and corpus) to detect the H. pylori glmM gene and mutations in the 23S rRNA genes conferring clarithromycin resistance. The sensitivity and specificity of the detection of H. pylori were 96.3% (95% confidence interval [CI], 92 to 98%) and 98.7% (95% CI, 97 to 99%), respectively. The positive and negative predictive values were evaluated to be 92.2% (95% CI, 92 to 98%) and 99.3% (95% CI, 98 to 99%), respectively. In this cohort, 160 patients (14.7%) were found to be infected (positive by culture and/or PCR). The sensitivity and specificity for detecting resistance to clarithromycin were 100% (95% CI, 88 to 100%) and 98.4% (95% CI, 94 to 99%), respectively.

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“…However, MTZ resistance was not significantly associated with the ESR of PBMT even in MTZ-resistant strains as compared to that in MTZ-sensitive strains[ 43 ]. Therefore, confirming CLR susceptibility before eradication in order to use a tailored eradication was closely associated with an improved ESR as compared to that of the empirically chosen conventional triple regimen, regardless of the MTZ resistance test results[ 19 - 21 , 41 , 45 - 47 ].…”

Section: Discussionmentioning

confidence: 99%

Tailored eradication strategy vs concomitant therapy for Helicobacter pylori eradication treatment in Korean patients

Choi¹,

Chung²,

Kim³

et al. 2021

WJG

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BACKGROUND Antibiotic resistance to Helicobacter pylori (H. pylori ) infection, which ultimately results in eradication failure, has been an emerging issue in the clinical field. Recently, to overcome this problem, an antibiotic sensitivity-based tailored therapy (TT) for H. pylori infection has received attention. AIM To investigate the efficacy and safety profiles of TT for H. pylori infection treatment compared to a non-bismuth quadruple therapy, concomitant therapy (CT) regimen. METHODS We included patients (> 18 years) with an H. pylori infection and without a history of Helicobacter eradication who visited the Gil Medical Center between March 2016 and October 2020. After being randomly assigned to either the TT or CT treatment group in 1 to 1 manner, patient compliance, eradication success rate (ESR), and patient-reported side effects profiles were assessed and compared between the two groups. H. pylori infection was diagnosed using a rapid urease test, Giemsa stain, or dual priming oligonucleotide polymerase chain reaction (DPO-PCR). Tailored eradication strategy based through the presence of a 23S ribosomal RNA point mutation. For the TT group, a DPO-PCR test, which detected A2142G and/or A2143G point mutations, and a clarithromycin resistance test were performed. Patients in the clarithromycin-resistant group were treated with a bismuth-containing quadruple combination therapy, while those with sensitive results were treated with the standard triple regimen. RESULTS Of the 217 patients with a treatment naive H. pylori infection, 110 patients [mean age: 58.66 ± 13.03, men, n = 55 (50%)] were treated with TT, and 107 patients [mean age: 56.67 ± 10.88, men, n = 52 (48.60%)] were treated with CT. The compliance (TT vs CT, 100% vs 98.13%, P = 0.30), and follow-up loss rates (8.18% vs 9.35%, P = 0.95) were not significantly different between the groups. The ESR after treatment was also not statistically different between the groups (TT vs CT, 82.73% vs 82.24%, P = 0.95). However, the treatment-related and patient-reported side effects were significantly lower in the TT group than in the CT group (22.77% vs 50.52%, P < 0.001). CONCLUSION The DPO-based TT regimen shows promising results in efficacy and safety profiles as a first-line Helicobacter eradication regimen in Korea, especially when physicians are confronted with increased antibiotic resistanc...

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Efficacy of a tailored PCR-guided triple therapy in the treatment of Helicobacter pylori infection

Cited by 30 publications

References 31 publications

Susceptibility‐guided versus empirical treatment for Helicobacter pylori infection: A systematic review and meta‐analysis

Susceptibility‐guided versus empirical treatment for Helicobacter pylori infection: A systematic review and meta‐analysis

Diagnostic Accuracy of a Noninvasive Test for Detection of Helicobacter pylori and Resistance to Clarithromycin in Stool by the Amplidiag H. pylori+ClariR Real-Time PCR Assay

Tailored eradication strategy vs concomitant therapy for Helicobacter pylori eradication treatment in Korean patients

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