Comparison Of The Effects Of Standard Triple Therapy And Bismuth Quadruple Therapy For The Eradication Of Helicobacter Pylori Based On Different Proton Pump Inhibitors:Network Meta-analysis

Objective To evaluate and compare the efficacy of standard triple therapy and bismuth quadruple therapy with different proton pump inhibitors in the eradication of Helicobacter pylori by Network Meta analysis.Methods The Chinese and English databases were searched,including the medical databases,such as the CNKI,Wan Fang,PUBMED,EMBASE,COCHRANE.The retrieval time was December 31 st 2016.The literature retrieval involved Standard triple therapy and quadruple therapy with bismuth for five proton pump inhibitors of omeprazole,lansoprazole,pantoprazole,repeprazoleand esomeprazole,a total of ten therapies,of which antibiotics are limited to a combination of clarithromycin and amoxicillin.The retrieved literature was screened according to the inclusion and exclusion criteria.Then make data extraction and quality evaluation for the final included documents,The evaluation tool uses the Cochrane collaboration group bias assessment tool.The result index was H.pylori eradication rate according to ITT analysis and adverse reaction rate.Review Manager5.3 software was used to carry out traditional meta analysis.Using Q test and I2 index to evaluate the heterogeneity of the study.Win BUGS1.4.3 and Stata13.0 software were used to analyze the network meta analysis.According to the results of network meta analysis,the eradication effects of various therapies were ranked according to the average rank order,and the sensitivity analysis was made according to the year of publication,sample size and course of treatment.Assessment publication bias by drawing the Funnel funnel map of correction comparison.Results 1 This study included 85 RCT studies with a total of 13929 patients.2 Results of traditional meta analysis: 18 direct comparisons were included in the literature.Among them,there are significant differences in effectiveness: Repeprazole triple therapy is better than omeprazole triple therapy(OR:0.50,95%CI: 0.39-0.63),esomeprazole triple therapy is superior to Omeprazole triple therapy(OR:0.60,95%CI:0.45-0.76),omeprazole quadruple therapy is better than omeprazole triple therapy(OR:0.27,95%CI:0.20-0.37),repeprazole quadruple therapy is superior to omeprazole triple therapy(OR:0.29,95%CI:0.10-0.85),lansoprazole quadruple therapy is superior to lansoprazole triple therapy(OR:0.50,95%CI:0.32-0.76),esomeprazole triple therapy is better than pantoprazole triple therapy(OR:0.29,95%CI:0.11-0.77),pantoprazole quadruple therapy is better than pantoprazole triple therapy(OR:0.34,95%CI:0.18-0.61),repeprazole quadruple therapy is better than Repeprazole triple therapy(OR:0.39,95%CI:0.23-0.66),repeprazole quadruple therapy is superior to esomeprazole triple therapy(OR:0.27,95%CI:0.12-0.60),esomeprazole quadruple therapy is superior to esomeprazole triple therapy(OR:0.20,95%CI:0.10-0.40),pantoprazole quadruple therapy is better than omeprazole quadruple therapy(OR:0.31,95%CI:0.12-0.83),repeprazole quadruple therapy is better than omeprazole quadruple therapy(OR:0.34,95%CI:0.18-0.65).There is no statistical difference between the other six kinds of direct comparison.Including the comparison of omeprazole triple therapy with pantoprazole triple therapy and lansoprazole triple therapy,lansoprazole triple therapy with pantoprazole triple therapy,rabeprazole triple therapy and esomeprazole triple therapy,rabeprazole triple therapy and esomeprazole triple therapy.Only omeprazole triple therapy and esomeprazole triple therapy have statistically significant differences in the incidence of adverse reactions.The incidence of the former was higher than that of the latter.There was no significant difference in the incidence of the remaining 16 adverse reactions.3 Results of network meta analysis: according to the results of network meta analysis,the relative order of the ten therapies is from high to low according to the average rank.The order of the ten therapies is as follows: Esomeprazole quadruple therapy(average rank:0.96,95CI%: 0.78-1.00),rabeprazole quadruple therapy(average rank:0.88,95%CI:0.67-1.00),pantoprazole quadruple therapy(average rank:0.75,95%CI: 0.44-1.00),lansoprazole quadruple therapy(average rank:0.66,95%CI:0.33-0.89),omeprazole quadruple therapy(average rank:0.59,95%CI:0.33-0.78),esomeprazole standard triple therapy(average rank:0.42,95%CI:0.22-0.56),rabeprazole standard triple therapy(average rank:0.38,95%CI:0.22-0.56),lansoprazole standard triple therapy(average rank:0.22,95%CI:0.11-.0.44),pantoprazole standard triple therapy(average rank: 0.11,95%CI:0.00-0.33),omeprazole standard triple therapy(average rank:0.03,95%CI:0.00-0.11).The results of adverse reactions show that esomeprazole triple therapy is lower than omeprazole triple therapy(OR:1.44,95%CI:1.11-1.85),omeprazole quadruple therapy is higher than esomeprazole triple therapy(OR:0.53,95%CI:0.33-0.80)and lansoprazole triple therapy(OR:0.62,95%CI:0.37-0.99).The consistency of the direct comparison and indirect comparison are good by inconsistency test.The results of sensitivity analysis suggest that,The year of publication,course of treatment and sample size had no significant effect on the results.Conclusion 1 The eradication rate of bismuth quadruple therapy was generally better than that of standard triple therapy,but there was no significant difference in the eradication rate between the triple therapy of later rabeprazole and esomeprazole and the quadruple therapy of earlier omeprazole and lansoprazole.2 Eradication rate of esomeprazole and rabeprazole quadruple therapy are higher.3 The eradication rate of omeprazole triple therapy was the lowest.4 this study only showed that the incidence of adverse effects of esomeprazole triple therapy was lower.The vast majority of the differences are not statistically significant,and the conclusion about the incidence of adverse reactions across therapies needs to be confirmed by more studies.