Tailored eradication strategy <i>vs</i> concomitant therapy for <i>Helicobacter pylori</i> eradication treatment in Korean patients

Choi, Youn I; Chung, Jun‐Won; Kim, Kyoung Oh; Kwon, Kwang An; Kim, Yoon Jae; Kim, Jung Ho; Seo, Ja Young; Park, Dong Kyun

doi:10.3748/wjg.v27.i31.5247

Cited by 11 publications

(12 citation statements)

References 54 publications

(67 reference statements)

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“…After removing duplicates, a total of 13,941 citations were screened. After reviewing the abstracts and full texts, 47 studies (Romano et al, 2000 , 2003 ; Toracchio et al, 2000 ; Avidan et al, 2001 ; Street et al, 2001 ; Lamouliatte et al, 2003 ; Miwa et al, 2003 ; Neri et al, 2003 ; Marzio et al, 2006 ; Yahav et al, 2006 ; Furuta et al, 2007 ; Kawai et al, 2008 ; Wang et al, 2008 ; Zhou et al, 2010 , 2016 ; Bontems et al, 2011 ; Molina-Infante et al, 2012 ; Cosme et al, 2013 , 2016 ; Lee et al, 2013 ; Martos et al, 2014 ; Park et al, 2014 ; Dong et al, 2015 ; Zhuo et al, 2015 ; Kwon et al, 2016 ; Miyaki et al, 2016 ; Ferenc et al, 2017 ; Gweon et al, 2018 ; Huang et al, 2018 ; Liou et al, 2018 ; Mascellino et al, 2018 ; Tanabe et al, 2018 ; Byambajav et al, 2019 ; Chen et al, 2019 ; Cho et al, 2019 ; Choi et al, 2019 , 2021 ; Delchier et al, 2019 ; Ong et al, 2019 ; Pan et al, 2020 ; Saracino et al, 2020 ; Zhang et al, 2020 ; Bonoso Criado et al, 2021 ; Cha et al, 2021 ; Chang et al, 2021 ; Choe et al, 2021 ) were finally included in the present systematic review. A total of 54 different treatment comparisons were evaluated both in the quantitative and qualitative synthesis since some studies assessed more than one treatment comparison.…”

Section: Resultsmentioning

confidence: 99%

Empirical vs. Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

2022

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BackgroundTreating Helicobacter pylori infection according to antibiotic resistance has been frequently recommended. However, information on its real effectiveness is scarce.AimThe aim of this study is to perform a meta-analysis comparing empirical vs. susceptibility-guided treatment of H. pylori.MethodsSelection of studies: Studies comparing empirical versus susceptibility-guided treatment were selected. Search strategy: electronic and manual up to August 2021. Data synthesis: by intention-to-treat (random-effects model).ResultsOverall, 54 studies were included (6,705 patients in the susceptibility-guided group and 7,895 in the empirical group). H. pylori eradication rate was 86 vs. 76%, respectively (RR: 1.12; 95% CI: 1.08–1.17; I2: 83%). Similar results were found when only RCTs were evaluated (24 studies; RR: 1.16; 95% CI: 1.11–1.22; I2: 71%) and when susceptibility testing was assessed by culture (RR: 1.12; 95% CI: 1.06–1.18) or PCR (RR: 1.14; 95% CI: 1.05–1.23). For first-line treatments (naïve patients; 30 studies), better efficacy results were obtained with the susceptibility-guided strategy (RR: 1.15; 95% CI: 1.11–1.20; I2: 79%). However, for empirical first-line quadruple regimens, in particular (both with and without bismuth, excluding the suboptimal triple therapies), not based on CYP2C19 gene polymorphism, no differences in efficacy were found compared with the susceptibility-guided group (RR: 1.04; 95% CI: 0.99–1.09); this lack of difference was confirmed in RCTs (RR: 1.05; 95% CI: 0.99–1.12). For rescue therapies (13 studies, most 2nd-line), similar results were demonstrated for both strategies, including all studies (RR: 1.09; 95% CI: 0.97–1.22; I2: 82%) and when only RCTs were considered (RR: 1.15; 95% CI: 0.97–1.36).ConclusionThe benefit of susceptibility-guided treatment over empirical treatment of H. pylori infection could not be demonstrated, either in first-line (if the most updated quadruple regimens are prescribed) or in rescue therapies.

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Section: Resultsmentioning

confidence: 99%

Empirical vs. Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

2022

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“…A flow chart explaining the study selection is shown in Figure 1. Of the 2156 titles initially found by the literature searches, 34 studies were found suitable for meta‐analysis 28–61 . Two studies 50,61 had 3 arms comparing the tailored treatment regimen with two different empiric regimens.…”

Section: Resultsmentioning

confidence: 99%

“…Therefore, these two studies contained 2 sets of data each, making the total number of pair comparisons in the meta‐analysis 36. There were 25 randomized control trials (RCTs) 28,29,31,35,37,38,40–45,49–57,59,61 and 9 non‐randomized trials (NRT) 30,32–34,36,39,46,58,60 . Thirty‐two of the enrolled studies 29–57,59–61 contained adult population, and 2 studies 28,58 contained children.…”

Section: Resultsmentioning

confidence: 99%

“…There were 25 randomized control trials (RCTs) 28,29,31,35,37,38,[40][41][42][43][44][45][49][50][51][52][53][54][55][56][57]59,61 and 9 non-randomized trials (NRT). 30,[32][33][34]36,39,46,58,60 Thirty-two of the enrolled studies [59][60][61] contained adult population, and 2 studies 28,58 contained children. All 34 studies contained a total of 9613 patients allocated to tailored regimens (4875 patients) and to empirical regimens (4738 patients).…”

Section: Sensitivity Analyses and Publication Biasmentioning

confidence: 99%

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Current role of tailored therapy in treating Helicobacter pylori infections. A systematic review, meta‐analysis and critical analysis

2022

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Background and Aims Recent guidelines dictate that all Helicobacter pylori (H. pylori) infected subjects should receive curative therapy. The efficacy of empirical regimens for H. pylori eradication might decline with bacterial, drug, and host factors. The necessity of a tailored therapy still remains controversial. Here we provide a meta‐analysis of the current status of susceptibility‐based (tailored) therapy in which susceptibility‐based therapies were compared to the currently accepted choice of empiric therapy. In this rapidly closing era, neither the susceptibility nor empiric therapies were routinely optimized, such that we report the outcome of comparisons on the efficacy of unoptimized tailored vs. locally preferred empiric treatments. Methods PubMed, Medline, and Embase databases were searched using suitable keywords. Individual and pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using the fixed‐ or random‐effects model as appropriate. Heterogeneity was calculated employing the Cochrane Q test and I2 values, whereas the possibility of publication bias was examined by constructing funnel plots. Additionally, subgroup and sensitivity analyses were performed. Results Thirty‐four studies were included with a total of 9613 patients. Tailored therapy proved superior to empiric treatment [OR 2.07 (95% CI 1.53–2.79)]. However, tailored therapy achieved eradication rates >90% in only 15 (44%) studies and >95% in only 6 (17.6%). Conclusions Although tailored therapy performed better than empiric treatment, the lack of optimization of therapies failed to reliably achieve high cure rates (>90%). These results emphasize that H. pylori infection, like other infectious diseases, should utilize the principles of antimicrobial stewardship in relation to treatment guidance.

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“…Table A1 shows the randomized clinical trials published in the last 10 years, comparing tailored and empirical therapies in first-line eradication treatment [12,[43][44][45][46][47][48][49][50][51]. Although tailored therapy is widely considered as superior to empirical therapy in first-line treatment, the overall results are diverse, in which some studies showed no difference at all between the two therapy groups.…”

Section: Tailored Therapymentioning

confidence: 99%

Personalized Approach in Eradication of Helicobacter pylori Infection

et al. 2022

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The increase in antibiotic resistance to Helicobacter pylori (H. pylori) is associated with a decrease in the effectiveness of eradication therapy. Although some success has been achieved by adjusting therapeutic regimens according to local data on resistance to certain antibiotics, a new approach is needed to ensure a better therapeutic response. Tailored therapy, based on sensitivity tests to antibiotics, is increasingly proving to be a superior therapeutic option, even as a first-line therapy. Moreover, the recently published Maastricht VI guidelines emphasize utilizing a susceptibility-guided strategy in respect to antibiotic stewardship as the first choice for eradication therapy. In addition, polymerase chain reaction (PCR) technology is becoming a standard tool in the diagnosis of H. pylori infections through non-invasive testing, which further optimizes the eradication process. We provide a review regarding the current position of the individualized approach in eradication therapy and its future prospects. Based on novel understandings, the personalized approach is an effective strategy to increase the successful eradication of H. pylori infections.

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

Cited by 11 publications

References 54 publications

Empirical vs. Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

Empirical vs. Susceptibility-Guided Treatment of Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

Current role of tailored therapy in treating Helicobacter pylori infections. A systematic review, meta‐analysis and critical analysis

Personalized Approach in Eradication of Helicobacter pylori Infection

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