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Advantages of Moxifloxacin and Levofloxacin-based triple therapy for second-line treatments of persistent Helicobacter pylori infection: a meta analysis

Vorteile einer Moxifloxazin beziehungsweise Laevofloxazin basierten Triple Therapie als Second-line Behandlung einer persistenten Infektion mit Helicobacter pylori: Eine Metaanalyse

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Zusammenfassung

ZIEL: Das wesentliche Ziel der vorliegenden Meta Analyse war es, die Wirksamkeit und Sicherheit einer Therapie einer persistierenden Helicobacter pylori Infektion mit entweder einer Clarithromycin und 2. Generation Fluorquinolon-basierten Tripel Therapie mit einer Bismuth basierten Quadrupel Therapie zu vergleichen. METHODIK: Es wurde eine systematische Literatur Recherche nach Artikel und Abstracts des Zeitraums 1981–2009 durchgeführt. Durchforstet wurden Medline, PubMed, EMBase, Google Scholar sowie CNKI (chinesisch), Wanfang (chinesisch) Digital Database und recent Digestive Disease Week, United European Gastroenterology Week sowie Konferenzen der European Helicobacter Study Group. Die stufenweise Einengung oder Erweiterung der Recherche erfolgte durch Boolean operators (NOT, AND, OR). 16 Artikel und 4 Abstracts erfüllten die Einschlusskriterien und wurden in die Meta Analyse (Review Manager 4.2.8) einbezogen. ERGEBNISSE: Die berichteten Eradikationsraten zeigten, dass die Clarithromycin basierte Triple Therapie der Bismuth basierten Quadrupel Therapie unterlegen zu sein scheint (OR = 0,53; 95 % CI: 0,35–0,80; P = 0,002). 13 RCTs verglichen eine Laevofloxacin basierte Triple Therapie mit einer Bismuth basierten Quadrupel Therapie – diese 2 Therapiearten unterschieden sich bezüglich ihres Eradikationserfolges nicht signifikant (OR = 1,43; 95 % CI: 0,82–2,51; P = 0,21). Allerdings waren die Eradikationsraten der 10-tägigen Laevofloxacin basierte Triple Therapie einer 7tägigen Bismuth basierten Quadrupel Therapie signifikant überlegen (OR = 4,79; 95 % CI: 2,95–7,79; P < 0,00001). Die Laevofloxacin basierte Tripel Therapie wurde besser vertragen als die Bismuth basierte Quadrupel Therapie (OR = 0,41; 95 % CI: 0,27–0,61; P < 0,0001) und musste auch seltener wegen Nebenwirkungen abgebrochen werden (OR = 0,13; 95 % CI: 0,06–0,33; P < 0,0001). Außerdem lässt das Ergebnis unserer Meta Analyse vermuten, dass die Eradiaktionsraten der Moxifloxacin-basierten Tripel Therapie der Bismuth basierten Quadrupel Therapie geringfügig – allerdings ohne statistische Signifikanz – überlegen ist. SCHLUSSFOLGERUNG: Eine 2. Generation Fluoroquinolon- basierte Tripel Therapie – vor allem das 10tägige Regime mit Laevofloxacin – kann als Behandlungsart 1. Wahl zur Eradikation einer persistierenden Helicobacter pylori Infektion empfohlen werden.

Summary

OBJECTIVE: The main aim of this meta-analysis was to compare the efficacy and safety of clarithromycin and second-generation fluoroquinolone-based triple therapy vs. bismuth-based quadruple therapy for the treatment of persistent Helicobacter pylori infection. METHODS: A systematic literature search was conducted for articles and abstracts from 1981 to March 2009 using Medline, PubMed, EMBase, Google Scholar and CNKI (Chinese), Wanfang (Chinese) digital database and recent Digestive Disease Week, United European Gastroenterology Week, and European Helicobacter Study Group conferences were also performed. Boolean operators (NOT, AND, OR) were used in succession to narrow and widen the search. Sixteen articles and four abstracts met the inclusion criteria, and were included in the meta-analysis by using Review Manager 4.2.8. RESULTS: The eradication rates demonstrated that clarithromycin-based triple therapy is inferior to bismuth-based quadruple therapy (OR = 0.53, 95% CI: 0.35–0.80, P = 0.002). Thirteen RCTs compared levofloxacin-based triple therapy vs. bismuth-based quadruple therapy, the eradication rates of the two regimens were shown to have no significant difference (OR = 1.43, 95% CI: 0.82–2.51, P = 0.21). But the eradication rates demonstrated superiority of the 10-day levofloxacin-based triple therapy over 7-day bismuth-based quadruple therapy (OR = 4.79, 95% CI: 2.95–7.79, P < 0.00001). Levofloxacin-based triple therapy was better tolerated than bismuth-based quadruple therapy with lower rates of side effects (OR = 0.41, 95% CI: 0.27–0.61, P < 0.0001), and lower rates of discontinuation of therapy due to adverse events (OR = 0.13, 95% CI: 0.06–0.33, P < 0.0001). Furthermore, our meta-analysis suggested that the eradication rates of the moxifloxacin-based triple therapy has a slight superiority to bismuth-based quadruple therapy, but there was no significant difference between them. CONCLUSION: Second-generation fluoroquinolone-based triple therapy can be suggested as the regimen of choice for rescue therapy in the eradication of persistent H. pylori infection especially 10-day levofloxacin-based triple therapy.

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  1. Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

    Yuqin Li, Xiayue Huang, Linhua Yao, Ruihua Shi & Guoxin Zhang

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Li, Y., Huang, X., Yao, L. et al. Advantages of Moxifloxacin and Levofloxacin-based triple therapy for second-line treatments of persistent Helicobacter pylori infection: a meta analysis. Wien Klin Wochenschr 122, 413–422 (2010). https://doi.org/10.1007/s00508-010-1404-3

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