Eradication Efficacy of Modified Dual Therapy Compared with Bismuth-Containing Quadruple Therapy as a First-Line Treatment of Helicobacter pylori

• Published in: The American journal of gastroenterology Vol. 114; no. 3; pp. 437 - 445
• Main Authors: Yang, Jing, Zhang, Yi, Fan, Ling, Zhu, Yang-Jie, Wang, Ting-Yi, Wang, Xing-Wei, Chen, Dong-Feng, Lan, Chun-Hui
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.03.2019
• Subjects: Adult; Amoxicillin - therapeutic use; Anti-Bacterial Agents - therapeutic use; Anti-Ulcer Agents - therapeutic use; Antibiotics; Breath Tests; Carbon Isotopes; Clarithromycin - therapeutic use; Clinical trials; Compliance; Disease; Drug Costs; Drug Resistance, Bacterial; Drug Therapy, Combination; Esomeprazole - therapeutic use; Female; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Infections; Laboratories; Male; Medication Adherence; Middle Aged; Organometallic Compounds - therapeutic use; Patients; Polymorphism; Potassium; Side effects; Treatment Outcome; Urea; Hong Kong China; United States > US; China; Shanghai China
• ISSN: 0002-9270; 1572-0241; 1572-0241
• DOI: 10.14309/ajg.0000000000000132

This study assessed the effectiveness, adverse events, patient adherence, and costs of modified dual therapy compared with bismuth-containing quadruple therapy for treating Helicobacter pylori infection in Chinese patients. We also sought to determine whether modified dual therapy could be used as an alternative first-line treatment for H. pylori infection. A total of 232 H. pylori-infected, treatment-naive patients were enrolled in this open-label, randomized controlled clinical trial. Patients were randomly allocated into 2 groups: the 14-day modified dual therapy group and the bismuth-containing quadruple therapy group. Eradication rates, drug-related adverse events, patient compliance, and drug costs were compared between the 2 groups. The modified dual therapy group achieved eradication rates of 87.9%, 91.1%, and 91.1% as determined by the intention-to-treat, per-protocol, and modified intention-to-treat analyses, respectively. The eradication rates were similar compared with the bismuth-containing quadruple therapy group: 89.7%, 91.2%, and 90.4%. In addition, modified dual therapy ameliorated variations in the CYP2C19, IL-1B-511, and H. pylori VacA genotypes. There were no significant differences in the compliance rates between the 2 groups. The modified dual therapy group exhibited significantly less overall side effects compared with the bismuth-containing quadruple therapy group (P < 0.001). Furthermore, the cost of medications in the modified dual therapy was lower compared with that in the bismuth-containing quadruple therapy. Modified dual therapy at high dose and administration frequency is equally effective and safer and less costly compared with bismuth-containing quadruple therapy.