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Systematic review, meta-analysis, and meta-regression: Successful second-line treatment for Helicobacter pylori.
Muñoz, Neus; Sánchez-Delgado, Jordi; Baylina, Mireia; Puig, Ignasi; López-Góngora, Sheila; Suarez, David; Calvet, Xavier.
Afiliação
  • Muñoz N; Internal Medicine Department, Corporació Sanitària Universtiària ParcTauli, Sabadell, Spain.
  • Sánchez-Delgado J; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Baylina M; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Puig I; Digestive Diseases Unit, Corporació Sanitària Universitària ParcTaulí, Sabadell, Spain.
  • López-Góngora S; Internal Medicine Department, Corporació Sanitària Universtiària ParcTauli, Sabadell, Spain.
  • Suarez D; Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • Calvet X; Althaia Xarxa Assistencial Universitària de Manresa, Barcelona, Spain.
Helicobacter ; 23(3): e12488, 2018 Jun.
Article em En | MEDLINE | ID: mdl-29663581
BACKGROUND: Multiple Helicobacter pylori second-line schedules have been described as potentially useful. It remains unclear, however, which are the best combinations, and which features of second-line treatments are related to better cure rates. The aim of this study was to determine that second-line treatments achieved excellent (>90%) cure rates by performing a systematic review and when possible a meta-analysis. A meta-regression was planned to determine the characteristics of treatments achieving excellent cure rates. METHODS: A systematic review for studies evaluating second-line Helicobacter pylori treatment was carried out in multiple databases. A formal meta-analysis was performed when an adequate number of comparative studies was found, using RevMan5.3. A meta-regression for evaluating factors predicting cure rates >90% was performed using Stata Statistical Software. RESULTS: The systematic review identified 115 eligible studies, including 203 evaluable treatment arms. The results were extremely heterogeneous, with 61 treatment arms (30%) achieving optimal (>90%) cure rates. The meta-analysis favored quadruple therapies over triple (83.2% vs 76.1%, OR: 0.59:0.38-0.93; P = .02) and 14-day quadruple treatments over 7-day treatments (91.2% vs 81.5%, OR; 95% CI: 0.42:0.24-0.73; P = .002), although the differences were significant only in the per-protocol analysis. The meta-regression did not find any particular characteristics of the studies to be associated with excellent cure rates. CONCLUSION: Second-line Helicobacter pylori treatments achieving>90% cure rates are extremely heterogeneous. Quadruple therapy and 14-day treatments seem better than triple therapies and 7-day ones. No single characteristic of the treatments was related to excellent cure rates. Future approaches suitable for infectious diseases-thus considering antibiotic resistances-are needed to design rescue treatments that consistently achieve excellent cure rates.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por Helicobacter / Inibidores da Bomba de Prótons / Antiulcerosos / Antibacterianos Tipo de estudo: Clinical_trials / Guideline / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções por Helicobacter / Inibidores da Bomba de Prótons / Antiulcerosos / Antibacterianos Tipo de estudo: Clinical_trials / Guideline / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Ano de publicação: 2018 Tipo de documento: Article