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Tailored molecular therapy may outperform empirical triple therapy but might not show superiority to empirical quadruple therapy for H. pylori elimination.
A systematic review and meta-analysis revealed that tailored treatment using molecular techniques could potentially provide superior effectiveness compared to empirical triple therapy. However, it might not outperform empirical quadruple therapy when it comes to eliminating Helicobacter pylori (H. pylori) infection. Researchers sought to assess whether tailored treatment based on genotypic resistance is more effective than standard therapy for H. pylori management.
Relevant studies were sourced from the Cochrane Library, Embase, and PubMed. The major endpoint was the elimination rate of H. pylori, while the occurrence of adverse events (AEs) served as the secondary endpoint. A random-effect model was employed to contrast the pooled risk ratios (RRs) and their respective 95% confidence intervals.
A total of 12 eligible randomized controlled trials (RCTs) involving 3940 subjects were identified. The pooled elimination rates for tailored therapy based on genotypic resistance consistently showed a tendency to be greater than those in the empirical treatment group, although this difference was not statistically significant. In the context of triple therapy, the tailored group achieved a notably greater eradication rate compared to the empirical group when analyzed using both the intention-to-treat (ITT) (RR: 1.20) and per-protocol (PP) approaches (RR: 1.20).
In the context of quadruple therapy, the empirical group showed a greater eradication rate (RR: 0.93; RR: 0.95). This outcome held true for both non-bismuth quadruple therapy (BQT) and BQT. As for the overall AEs, the pooled rate was 37% in the empirical group and, 34% in the tailored group with no significant difference between the two groups (RR: 0.88).
Tailored treatment using molecular techniques could potentially provide improved effectiveness compared to empirical triple therapy for H. pylori infection. However, it may not necessarily outperform standard quadruple therapy in completely eliminating the infection. To enhance clinical decision-making, it is essential to conduct larger and more personalized RCTs.
Therapeutic Advances in Gastroenterology
Empirical versus tailored therapy based on genotypic resistance detection for Helicobacter pylori eradication: a systematic review and meta-analysis
Meng Li et al.
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