From the findings of a network meta-analysis, it was concluded that among the Asian population, HDDT for 14 days is to the most optimal first-line therapy for eradicating H. pylori.

It causes fewer adverse events and has comparable efficacy and compliance with other therapies such as bismuth-based quadruple therapy (BQT), sequential therapy (ST), concomitant therapy (CT), and hybrid therapy (HT). A network meta-analysis was conducted to explore the effectiveness of first-line treatments including HDDT, BQT, ST, CT, and HT in patients infected with H. pylori.

From inception to 1 September 2019, an extensive literature search was conducted on Web of Science, PubMed, Cochrane Library, and Embase. Utilizing Stata 14.0 and Revman 5.2, a network analysis of randomized controlled trials comparing first-line therapies were conducted. By omitting non-Asian studies, a sensitivity analysis was also carried out.

Overall, 41 RCTs with 14 119 patients were incorporated. Compared to CT for 10 or 14 days (CT ≥ 10), the ST for 10 days (ST-10) was remarkably lower in terms of eradication rate. Sensitivity analysis revealed that among all the interventions, ST-10 illustrated the lowest effectiveness among the Asian population.

The ranking results based on probability demonstrated that HDDT ranked first for the eradication rate. Regardless of duration, adverse events were considerably less for HDDT in comparison with BQT and CT. BQT for 14 days depicted elevated adverse events in comparison with ST, HT, and CT ≥ 10. Among all the therapies, HDDT ranked first.

Thus, among the Asian population, HDDT for 14 days is the most optimal first-line therapy to treat H.pylori infection.