Retrospective analysis of the use of quadruple therapy with bismuth (Pylera®) in real-life clinical practice in Spain

Agudo-Fernández, Sandra; Blanco, Ana González

doi:10.1016/j.gastre.2018.05.017

Cited by 8 publications

(11 citation statements)

References 15 publications

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“…Overall, of the 57 relevant references initially identified, 30 studies met the inclusion criteria and were included in the systematic review and meta‐analysis (Figure ). During the full‐text review stage, the authors of five primary studies were contacted for data clarification.…”

Section: Resultsmentioning

confidence: 99%

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Meta‐analysis of three‐in‐one single capsule bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori

2019

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Background Bismuth‐containing quadruple therapy has been suggested as first‐line and rescue alternative for Helicobacter pylori eradication. Our objective was to perform a meta‐analysis evaluating the efficacy and safety of single capsule Pylera® (bismuth, metronidazole, and tetracycline) plus a proton‐pump inhibitor (PPI) in any line of treatment. Methods Studies were selected up to October 2018. Outcomes were eradication and adverse events (AEs) rates pooled using the generic inverse variance method. Results In total, 30 studies (6482 patients) were included in the systematic review. The intention‐to‐treat (ITT) efficacy was 90% (95% CI: 87%‐92%, 21 studies, I2 = 88%) in first‐line therapy, 89% (95% CI: 86%‐93%, 12 studies, I2 = 78%) in second‐line and 82% (95% CI: 78%‐87%, nine studies, I2 = 60%) in third‐line; with no differences by the type or dosage of PPI used. For metronidazole‐resistant infection, the ITT efficacy as first‐line therapy was 93% (95% CI: 90%‐96%, six studies, I2 = 0%). In second‐line therapies where patients had been previously treated with clarithromycin, the ITT efficacy was 90% (95% CI: 87%‐93%, 11 studies, I2 = 78%). The overall incidence of AEs was 43% (95% CI: 35%‐50%, 24 studies, I2 = 92%) and they were mostly mild. In nearly 3% of the cases, treatment was interrupted due to AEs. Conclusions A 10‐day treatment with Pylera® achieved an effective eradication rate of approximately 90% both in first‐ and second‐line therapy. This applies regardless of the type and dose of the PPI, in patients with clarithromycin‐ or metronidazole‐resistant strains, and in those previously treated with clarithromycin.

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Section: Resultsmentioning

confidence: 99%

“…In almost 3% of the cases, treatment was discontinued due to AEs. [16][17][18]27,[30][31][32]34,35,37,38,[42][43][44][45]47…”

Section: Safety Of Pylera ®mentioning

confidence: 99%

Meta‐analysis of three‐in‐one single capsule bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori

2019

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“…These are summarized inTable 2 52,53. No significant difference between the eradication rates was achieved by both regimens (86% vs 87%).…”

mentioning

confidence: 90%

“…These are summarized in Table 2. 52,53 Two separate meta-analyses published in the last year examined the role of bismuth-based therapy. One found that a 10day treatment with Pylera ® achieved an effective eradication rate of 90% both in first-and second-line therapy, regardless of the type and dose of the PPI, in patients with clarithromycin-or metronidazole-resistant strains, and in those previously treated with clarithromycin.…”

Section: B Is Muth -Ba S Ed Ther Apymentioning

confidence: 99%

Review: Treatment of Helicobacter pylori Infection 2019

et al. 2019

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This review summarizes important studies regarding Helicobacter pylori therapy published from May 2018 to May 2019. The main themes that emerge involve studies assessing the efficacy of bismuth‐based regimens. While in recent years the efficacy of bismuth‐based quadruple therapy as a second‐line therapy has been clearly established, there is now substantial evidence that it is the best performing first‐line therapy. Antibiotic resistance was again intensely studied this year, and a clear and dramatic increase in resistance is noted for clarithromycin and levofloxacin; most notably, it may not be possible to support these therapies in most regions of the world much longer without testing. The utility of vonoprazan as an alternative to proton‐pump inhibitor therapy, especially in resistant and difficult to treat groups, has also been considered in greater detail this year, as well as means of supporting and enhancing adherence to therapy. Several studies showed that the diversity of gut microbiota was significantly altered shortly after H pylori eradication. However, the diversity was restored to pre‐treatment state after 2 months in patients treated with triple therapy. More studies are warranted to assess the long‐term changes of gut microbiota after H pylori eradication.

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“…35 이와 유사한 연 구가 스페인에서도 있었는데 제균율이 1차 치료 78%, 2차 치 료 85%, 3차 치료 61%였다. 36 10일간의 단일제형 캡슐을 이용한 BMT 사제요법에 대한 메 타분석에서 PPI 용량, CLR이나 MNZ 내성, 과거 CLR 사용 여 부에 관계없이 1차와 2차 제균율이 모두 90%에 달하였다. 37 67 이란에서 esomeprazole 40 mg, tinidazole 1 g 그리고 LFX 500 mg 하루 1회 복용과 STT의 14일 투약을 비교한 연구에 서 제균율은 유의한 차이가 없었고 순응도가 유의하게 개선되었 다.…”

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Helicobacter pylori Eradication Therapy - Recent Trend in Research

Kim¹

2020

Korean J Helicobacter Up Gastrointest Res

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It is well known that Helicobacter pylori (H. pylori) can cause peptic ulcer, mucosa-associated lymphoid tissue lymphoma, atrophic gastritis, intestinal metaplasia, and ultimately, gastric cancer. Various studies have proven that H. pylori, which attaches to the gastric mucosa, is the cause of gastric cancer and can be eradicated using appropriate antibiotics. Since 2013, Japan has been carrying out national-led eradication treatment of H. pylori for the whole population. However, as drug exposure increases, the resistance rate to some antibiotics increases, and the pattern of antibiotic resistance varies from region to region. Therefore, the development of individualized antimicrobial therapies has become important since antibiotic resistance to H. pylori eradication is a problem worldwide. To help overcome this, remedies such as selection of antibiotics through susceptibility testing, selection of empirical treatment combinations appropriate for the region, dual therapy with high doses of amoxicillin, and the use of rifabutin or sitafloxacin with low antibiotic resistance have been studied. Potassium-competitive acid blocker has been reported to be more potent in inhibiting acid secretion than proton pump inhibitor, and its role in H. pylori eradication is expected. Drug formulations and regimens that are easy to take are being developed to increase compliance. New treatments such as spraying antibiotics directly to the gastric mucosa are being developed and studied.

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Retrospective analysis of the use of quadruple therapy with bismuth (Pylera®) in real-life clinical practice in Spain

Cited by 8 publications

References 15 publications

Meta‐analysis of three‐in‐one single capsule bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori

Meta‐analysis of three‐in‐one single capsule bismuth‐containing quadruple therapy for the eradication of Helicobacter pylori

Review: Treatment of Helicobacter pylori Infection 2019

Helicobacter pylori Eradication Therapy - Recent Trend in Research

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