Comparative Effectiveness of Multiple Different First-Line Treatment Regimens for Helicobacter pylori Infection: a Network Meta-Analysis.

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A number of double, triple and quadruple therapies have been proposed as first line H. pylori infection empiric treatments. However, knowledge of their worldwide and regional comparative efficacy is lacking. We examined the comparative effectiveness of all empirically used first line regimens tested against standard triple treatment, using a network meta-analysis (NWM) of published RCTs.Data extracted from eligible RCTs were entered into a Bayesian NWM to investigate the comparative efficacy of H. pylori infection empiric first line regimens and to explore their effectiveness rank order. The ranking probability for each regimen, was evaluated by means of SUCRA (surfaces under cumulative ranking) values.Sixty-eight eligible RCTs were included, giving a total of 92 paired comparisons with 22,975 patients, randomized to 8 first line regimens. The overall results showed that only vonoprazan triple therapy and reverse hybrid therapy achieved cure rates of more than 90%. Levofloxacin triple therapy performed best in Western countries (eradication rate 88.5%). The comparative effectiveness ranking showed that vonoprazan triple therapy had the best results, whereas standard triple therapy was the least efficacious regimen [SUCRA 92.4% vs 4.7% respectively, ORs (95% CrI 3.80(1.62-8.94)].For first line empiric H. pylori infection treatment, vonoprazan triple therapy and reverse hybrid therapy achieved high eradication rates of more than 90%. Levofloxacin triple therapy achieved the highest eradication rates in Western countries. Standard triple therapy was the least efficacious regimen in this NWM.

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Authors: Theodore Rokkas, Javier P Gisbert, Peter Malfertheiner, Yaron Niv, Antonio Gasbarrini, Marcis Leja, Francis Megraud, Colm O’Morain, David Y Graham