PMID- 37667805
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230906
IS  - 1756-283X (Print)
IS  - 1756-2848 (Electronic)
IS  - 1756-283X (Linking)
VI  - 16
DP  - 2023
TI  - Empirical versus tailored therapy based on genotypic resistance detection for 
      Helicobacter pylori eradication: a systematic review and meta-analysis.
PG  - 17562848231196357
LID - 10.1177/17562848231196357 [doi]
LID - 17562848231196357
AB  - BACKGROUND: The eradication rate of Helicobacter pylori infection with empirical 
      therapy has decreased due to increased drug resistance. The latest guidelines 
      recommend genotypic resistance-guided therapy, but its clinical efficacy remains 
      unclear. OBJECTIVES: The purpose of our study was to evaluate whether tailored 
      therapy based on genotypic resistance is superior to empirical therapy for H. 
      pylori infection. DESIGN: A systematic review and meta-analysis of randomized 
      controlled trials (RCTs) comparing tailored therapy based on genotypic resistance 
      with empirical therapy was performed. SOURCES AND METHODS: We retrieved relevant 
      studies from PubMed, Embase, and the Cochrane Library. The primary outcome was H. 
      pylori eradication rate and the adverse events (AEs) was the secondary outcome. A 
      random-effect model was applied to compare pooled risk ratios (RRs) with related 
      95% confidence intervals (CIs). RESULTS: A total of 12 qualified RCTs containing 
      3940 patients were identified in our systematic review and meta-analysis. The 
      pooled eradication rates of tailored therapy based on the detection of genotypic 
      resistance were consistently higher than those in the empirical treatment group, 
      with no statistical significance. In triple therapy, the eradication rate was 
      significantly higher in the tailored group than in the empirical group by 
      intention-to-treat analysis (ITT) and per-protocol analysis (PP) analysis 
      (p < 0.0001, RR: 1.20; 95% CI: 1.12-1.29; p < 0.0001, RR: 1.20; 95% CI: 
      1.15-1.25). In quadruple therapy, the eradication rate was higher in the 
      empirical group (p = 0.001, RR: 0.93; 95% CI: 0.89-0.97; p = 0.009, RR: 0.95; 95% 
      CI: 0.92-0.99). And this result was true for both bismuth quadruple therapy (BQT) 
      and non-BQT. Regarding total AEs, the pooled rate was 34% in the tailored group 
      and 37% in the empirical group, and no difference between the two groups was 
      found (p = 0.17, RR: 0.88; 95% CI: 0.74-1.06). CONCLUSION: In conclusion, 
      tailored therapy based on molecular methods may offer better efficacy than 
      empirical triple therapy, but it may not be superior to empirical quadruple 
      therapy in eradicating H. pylori infection. Larger and more individualized RCTs 
      are needed to aid clinical decision-making. REGISTRATION PROSPERO: 
      CRD42023408688.
CI  - (c) The Author(s), 2023.
FAU - Li, Meng
AU  - Li M
AUID- ORCID: 0009-0001-0280-0111
AD  - Department of Gastroenterology, Peking University First Hospital, Beijing, China.
FAU - Wang, Xiaolei
AU  - Wang X
AD  - Department of Gastroenterology, Peking University First Hospital, Beijing, China.
FAU - Meng, Wenting
AU  - Meng W
AD  - Department of Gastroenterology, Peking University First Hospital, Beijing, China.
FAU - Dai, Yun
AU  - Dai Y
AD  - Department of Gastroenterology, Peking University First Hospital, Beijing, China.
FAU - Wang, Weihong
AU  - Wang W
AD  - Department of Gastroenterology, Peking University First Hospital, No. 8 Xishiku 
      Street, Beijing 100034, China.
LA  - eng
PT  - Journal Article
DEP - 20230831
PL  - England
TA  - Therap Adv Gastroenterol
JT  - Therapeutic advances in gastroenterology
JID - 101478893
PMC - PMC10475236
OTO - NOTNLM
OT  - Helicobacter pylori
OT  - empirical
OT  - eradication
OT  - genotypic resistance
OT  - meta-analysis
OT  - tailored
COIS- The authors declare that there is no conflict of interest.
EDAT- 2023/09/05 06:42
MHDA- 2023/09/05 06:43
PMCR- 2023/08/31
CRDT- 2023/09/05 03:37
PHST- 2023/06/16 00:00 [received]
PHST- 2023/08/04 00:00 [accepted]
PHST- 2023/09/05 06:43 [medline]
PHST- 2023/09/05 06:42 [pubmed]
PHST- 2023/09/05 03:37 [entrez]
PHST- 2023/08/31 00:00 [pmc-release]
AID - 10.1177_17562848231196357 [pii]
AID - 10.1177/17562848231196357 [doi]
PST - epublish
SO  - Therap Adv Gastroenterol. 2023 Aug 31;16:17562848231196357. doi: 
      10.1177/17562848231196357. eCollection 2023.