Korean J Gastroenterol.  2018 Jan;71(1):31-37. 10.4166/kjg.2018.71.1.31.

Concomitant or Sequential Therapy as the First-line Therapy for Eradication of Helicobacter pylori Infection in Korea: A Systematic Review and Meta-analysis

• Bae HJ
• Kim JS
• Kim BW
• Nam YJ

• KMID: 2402803
• DOI: http://doi.org/10.4166/kjg.2018.71.1.31

Abstract

BACKGROUND/AIMS
In Korea, increasing clarithromycin resistance has led to the need for an alternative first-line therapy for the eradication of Helicobacter pylori (H. pylori) infection. Concomitant therapy (CT) and sequential therapy (ST) have been proposed as alternative regimens. The aim of this study was to compare the eradication rate from using CT and ST in Korea.
METHODS
A literature review was performed on studies comparing the efficacy of CT and ST in Korea. Data were pooled to obtain the odds ratio (OR) of the eradication rate with 95% confidence intervals (CIs). The eradication rates were considered both on an intention-to-treat (ITT) and a per-protocol (PP) bases.
RESULTS
Six studies provided data on 1,897 Korean adult patients. The pooled OR was 1.382 (95% CI: 1.031-1.853, p=0.031) for ITT analysis and 2.114 (95% CI: 1.502-2.974, p < 0.001) for PP analysis. There was no difference in the rate of adverse events and compliances between the two regimens.
CONCLUSIONS
The efficacy of CT was superior to ST in both ITT and PP analyses. Therefore, CT could be an excellent alternative regimen for the eradication of H. pylori as a first-line therapy in Korea.

Keyword

Helicobacter pylori; Concomitant therapy; Sequential therapy; Meta-analysis

MeSH Terms

Adult
Clarithromycin
Helicobacter pylori*
Helicobacter*
Humans
Korea*
Odds Ratio
Clarithromycin

Figure

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  Fig. 1 Flow diagram of studies included in this meta-analysis. RCT, randomized controlled trial.

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  Fig. 2 Forest plot of intention-to-treat analysis of CT compared with ST. CI, confidence interval; ST, sequential therapy; CT, concomitant therapy.

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  Fig. 3 Forest plot of per-protocol analysis of CT compared with ST. CI, confidence interval; ST, sequential therapy; CT, concomitant therapy.

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  Fig. 4 Funnel plot asymmetry test for the detection of bias within the studies for the eradication rate of concomitant therapy compared with sequential therapy.

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  Fig. 5 Forest plot of adverse events of concomitant therapy CT compared with sequential therapy ST. CI, confidence interval; ST, sequential therapy; CT, concomitant therapy.

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