摘要
AIM: To assess the efficacy and safety of standard triple therapy compared with other pre-existing and new therapies in China.
AIM:To assess the efficacy and safety of standard triple therapy compared with other pre-existing and new therapies in China.METHODS:Literature searches were conducted in the following databases:PubMed,EMBASE,the Cochrane Central Register of Controlled Trials,the VIP database,the China National Knowledge Infrastructure database,and the Chinese Biomedical Database.A meta-analysis of all randomized controlled trials(RCTs)comparing standard triple therapy for the eradication of Helicobacter pylori with pre-existing and new therapies in China was performed using Comprehensive Meta-Analysis 2.0.There were 49 studies that met our criteria and the qualities of these studies were assessed using the Jadad scale.The Mantel-Haenszel method was used for pooling dichotomous data.We also conducted subgroupanalyses according to age,duration of treatment and drug type.Sensitivity analyses and a cumulative metaanalysis were also performed with CMA 2.0.Publication bias was evaluated using Egger’s test,Begg’s test or a funnel plot.RESULTS:A total of 49 RCTs including 8332 patients were assessed.This meta-analysis showed that standard triple therapy with proton pump inhibitors(PPIs),amoxicillin(AMO)and clarithromycin(CLA)was inferior to sequential therapy[relative risk(RR)=0.863;95%confidence interval(CI):0.824-0.904],but was not superior to quadruple therapy(RR=1.073;95%CI:0.849-1.357)or other triple therapies(RR=1.01;95%CI:0.936-1.089).The meta-analysis also suggested that standard triple therapy is slightly more effective than dual therapy(RR=1.14;95%CI:0.99-1.31).However,the differences were not statistically significant.We removed the only trial with a regimen lasting14 d by sensitivity analysis and found that 7-d standard triple therapy was superior to 7-d dual therapy(RR=1.222;95%CI:1.021-1.461).Moreover,a sub-analysis based on the duration of quadruple therapy indicated that the 7-d and 10-d standard triple therapies were inferior to sequential therapy(RR=0.790;95%CI:0.718-0.868;RR=0.917;95%CI:0.839-1.002,respectively).Additionally,there were no significant differences in cure rate or adverse events among standard triple therapy,quadruple therapy,and other triple therapies(RR=0.940;95%CI:0.825-1.072;RR=1.081;95%CI:0.848-1.378,respectively).Standard triple therapy had a higher occurrence of side effects than sequential therapy(RR=1.283;95%CI:1.066-1.544).CONCLUSION:The eradication rates with a standard triple therapy consisting of PPI,AMO,and CLA are suboptimal in China,and new treatment agents need to be developed.
基金
Supported by National Science and Technology Major Projects for"Major New Drugs Innovation and Development"of China,No.2011ZX09302-007-03
