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Sequential versus concomitant therapy for treatment of Helicobacter pylori infection: an updated systematic review and meta-analysis

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Abstract

Background

Sequential and concomitant therapies are two innovative therapies for Helicobacter pylori (H. pylori) eradication. However, the comparative efficacy and safety of these treatments are controversial. Therefore, we aimed to conduct an updated systematic review and meta-analysis of studies that compared these two treatments.

Methods

A search of PubMed, Embase, the Cochrane Library, and Web of Science was carried out. Randomized controlled trials (RCTs) that compared sequential with concomitant therapies were selected for meta-analysis.

Results

Twenty RCTs were included in the analysis. The eradication rate of 10-day sequential therapy was superior to that of 5-day concomitant therapy (82.09 versus 77.79%, relative risk (RR) 1.052 (95% confidence interval (CI) 1.004–1.103), P = 0.035)), similar to that of 7-day concomitant therapy (82.40 versus 86.99%, RR 0.959 (95% CI 0.874–1.053), P = 0.382), and inferior to that of 10-day concomitant therapy (78.39 versus 83.32%, RR 0.945 (95% CI 0.907–0.984, P = 0.006); the occurrence of diarrhea was higher in 10-day concomitant therapy than that in 10-day sequential therapy. Compared with the eradication rate of sequential therapy, that of concomitant therapy was higher in metronidazole-resistant strains (RR 0.912 (95% CI 0.844–0.986, P = 0.020)) and strains resistant to metronidazole and clarithromycin (RR 0.542 (95% CI 0.308–0.956, P = 0.035)).

Conclusion

The efficacy of concomitant therapy was duration dependent, and 10-day concomitant therapy was superior to 10-day sequential therapy. Compared to sequential therapy, concomitant therapy was more efficacious for metronidazole-resistant strains and metronidazole plus clarithromycin-resistant strains. However, diarrhea was more frequent with concomitant therapy than with sequential therapy.

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Funding

This work was supported by the National Key Research and Development Program of China (no. 2016YFC1302201), the National Natural Science Foundation of China (81460115), the Science and Technology Projects of Jiangxi province (2014BBG70019), and Special funds of the graduate student innovation project in Jiangxi province in 2014 (no: YC2014-S081).

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Author notes

  1. Youhua Wang and Rulin Zhao contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17 yongwai street, Nanchang, Jiangxi Province, 330000, China

    Youhua Wang, Rulin Zhao, Ben Wang, Qiaoyun Zhao, Liya Zhu-ge, Wenzhu Yin & Yong Xie

  2. Institute of Molecular Medicine, Jiangxi Academy of Medical Sciences, Nanchang, China

    Rulin Zhao

  3. Department of Medical College, Nanchang University, Nanchang, Jiangxi Province, China

    Zhen Li

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  1. Youhua Wang
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Contributions

Yong Xie designed the concept. Youhua Wang and Rulin Zhao acquired the data. Youhua Wang and Rulin Zhao performed the analysis and interpretation of the data. You-hua Wang drafted the manuscript. Ben Wang, Qiaoyun Zhao, Zhen Li, Liya Zhu-ge, and Wenzhu Yin provided a critical revision of the manuscript for important intellectual content. Youhua Wang and Ben Wang performed the statistical analysis, and Yong Xie provided study supervision.

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Correspondence to Yong Xie.

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All authors approved the final version of the manuscript and declare no conflict of interest. This study was not funded by the pharmaceutical industry.

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Wang, Y., Zhao, R., Wang, B. et al. Sequential versus concomitant therapy for treatment of Helicobacter pylori infection: an updated systematic review and meta-analysis. Eur J Clin Pharmacol 74, 1–13 (2018). https://doi.org/10.1007/s00228-017-2347-7

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