Empirical first-line treatment use and effectiveness trends in Europe in the period 2013- 2021: results from the European registry on H. pylori management (HP-EUREG)

Introduction: The impact of consensus, prescription choices and efficacy trends on clinical practice over time has not been studied in depth.Aims & Methods: International multicenter prospective non-intervention-al registry aimed to evaluate the decisions and outcomes of H. pyloriman-agement by European gastroenterologists. All infected adult patients were systematically registered at AEG-REDCap e-CRF from 2013 to December 2021. Variables included: previous eradication attempts, prescribed treatment, adverse events, and outcomes. Modified intention- to-treat (mITT) and time trend analyses were performed. Data were subject to quality review.Results: So far 49, 739 patients from 29 European countries have been in-cluded, and 35, 203 (71%) were first-line empirical prescriptions. Overall, the most common prescribed treatments in the 2013-21 period were triple therapies ; however, a shift in antibiotic regimens was identi-fied. Triple therapies decreased from over 50% of prescription in 2013/15 to less than 25% in 2020/21 ; likewise, non-bismuth concomitant therapy use decreased from 21% in 2013/14 to 13% in 2020/21, while three-in-one single- capsuleincreased from 0- 1% in 2014/2015 to 17% in 2020/21. An increase in the average duration of treatments from 9.8 days in 2013 to 13 days in 2021 was identified, as well as the daily high- dose of PPIs increasing from 16% in 2013 to 50% in 2021. Detailed description of most common treatments is shown in Table 1. Re-garding the effectiveness of each specific treatment, no trend was identi-fied (data now shown) ; however, there was a 10% overall improvement in first-line mITT overall effectiveness from 2013 to 2021. Conclusion: European gastroenterological practice is constantly adapting to the newest published evidence and recommendations (reducing the use of triple therapies and increasing both the duration of treatment and the dose of PPIs), with a subsequent progressive improvement in overall effectiveness.