Sequential therapy or triple therapy for Helicobacter pylori infection in Asians: systematic review and meta-analysis

Eradication rate of Helicobacter pylori infection with triple therapy (TT) has declined in part to increased antibiotic resistance. Sequential therapy (ST) has shown promise in several meta-analyses. However, most of the studies included in previous meta-analyses were from Italy. The aim of this study was to compare the efficacy of ST with that of TT in Asia by performing a meta-analysis of studies from Asia.

We performed a comprehensive literature search for studies comparing the efficacy of ST with TT. Randomised controlled trials investigated in the Asian population were included. The odds ratios (OR) of eradicating H. pylori infection after ST compared with TT were pooled. The eradication rates were considered both on an intention-to-treat (ITT) and on a per-protocol basis (PP).

A total of nine studies provided data on 3074 adult patients. The odds ratio (OR) for eradication of H. pylori with ST compared with TT was 1.768 (95% CI: 1.476-2.117, P=0.000) for ITT analysis and 1.997 (95% CI: 1.607-2.480, P=0.000) for PP analysis. The pooled eradication rates of ITT analysis was 81.3% (95% CI: 76.5-85.3) for the ST group and 70.8% (95% CI: 64.6-76.4) for the TT group. The pooled eradication rates of PP analysis was 87.6% (95% CI: 84.1-90.5) for the ST group and 77.1% (95% CI: 70.9-82.3) for the TT group. There was no difference in the rate of adverse events between ST and TT (OR 0.945, 95% CI: 0.874-1.238, P=0.658).

ST appears to be better than TT in the eradication of H. pylori in Asia. These results suggest that ST may be a reasonable choice for first line therapy in Asia.