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Equivalent efficacies of reverse hybrid and concomitant therapies in first-line treatment of Helicobacter pylori infection.
- Source :
-
Journal of gastroenterology and hepatology [J Gastroenterol Hepatol] 2020 Oct; Vol. 35 (10), pp. 1731-1737. Date of Electronic Publication: 2020 Mar 31. - Publication Year :
- 2020
-
Abstract
- Background and Aim: Concomitant therapy is a recommended first-line treatment for Helicobacter pylori infection in most national or international consensuses. Reverse hybrid therapy is a modified 14-day concomitant therapy without clarithromycin and metronidazole in the final 7 days. This study aims to test whether 14-day reverse hybrid therapy is non-inferior to 14-day concomitant therapy in the first-line treatment of H. pylori infection.<br />Methods: Helicobacter pylori-infected adult patients were randomly assigned to receive either reverse hybrid therapy (dexlansoprazole 60 mg o.d. plus amoxicillin 1 g b.d. for 14 days, and clarithromycin 500 mg plus metronidazole 500 mg b.d. for initial 7 days) or concomitant therapy (dexlansoprazole 60 mg once o.d. plus amoxicillin 1 g, clarithromycin 500 mg, and metronidazole 500 mg b.d. for 14 days). H. pylori status was assessed 6 weeks after the end of treatment.<br />Results: Helicobacter pylori-infected participants (n = 248) were randomized to receive either 14-day reverse hybrid therapy (n = 124) or 14-day concomitant therapy (n = 124). Intention-to-treat analysis demonstrated that the two therapies had comparable eradication rate (95.2% vs 93.5%; 95% confidence interval, -4.0% to 7.4%; P = 0.582). However, reverse hybrid therapy had a much lower frequency of adverse events than concomitant therapy (20.2% vs 38.7%, P = 0.001). The two therapies exhibited comparable drug adherence (93.5% vs 87.9%, P = 0.125).<br />Conclusions: Fourteen-day reverse hybrid therapy and 14-day concomitant therapy are equivalent in efficacy for the first-line treatment of H. pylori infection. However, reverse hybrid therapy has fewer adverse events compared with concomitant therapy.<br /> (© 2020 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)
- Subjects :
- Adult
Aged
Amoxicillin adverse effects
Anti-Bacterial Agents adverse effects
Clarithromycin adverse effects
Dexlansoprazole adverse effects
Drug Administration Schedule
Drug Therapy, Combination methods
Female
Humans
Male
Metronidazole adverse effects
Middle Aged
Treatment Outcome
Amoxicillin administration & dosage
Anti-Bacterial Agents administration & dosage
Clarithromycin administration & dosage
Dexlansoprazole administration & dosage
Gastritis drug therapy
Gastritis microbiology
Helicobacter Infections
Helicobacter pylori
Metronidazole administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1440-1746
- Volume :
- 35
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of gastroenterology and hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 32167605
- Full Text :
- https://doi.org/10.1111/jgh.15034