A Randomized Controlled Study Comparing Reverse Hybrid Therapy and Standard Triple Therapy for Helicobacter pylori Infection

作者：Hsu, Ping-I; Kao, Sung-Shuo; Wu, Deng-Chyang^*; Chen, Wen-Chi; Peng, Nan-Jing; Yu, Hsien-Chung; Wang, Huay-Min; Lai, Kwok-Hung; Cheng, Jin-Shiung; Chen, Angela; Chuah, Seng-Kee; Tsay, Feng-Woei

来源：Medicine, 2015, 94(48): e2104.

DOI：10.1097/MD.0000000000002104

• SEQUENTIAL THERAPY
• ERADICATION RATE
• CLARITHROMYCIN
• MANAGEMENT
• RESISTANCE
• EFFICACY
• AMOXICILLIN
• CONCOMITANT
• PREVALENCE
• GUIDELINES

Reverse hybrid therapy is an 1-step 2-phase treatment for Helicobacter pylori (H. pylori) infection with less cost than standard triple therapy. We conducted a randomized, controlled study to compare the efficacies of standard triple therapy and reverse hybrid therapy in the treatment of H. pylori infection.From October 2012 to March 2015, consecutive H. pylori-infected subjects were randomly allocated to receive either a reverse hybrid therapy (pantoprazole plus amoxicillin for 12 days and clarithromycin plus metronidazole for the initial 7 days) or a standard triple therapy (pantoprazole plus amoxicillin and clarithromycin for 12 days). H. pylori status was assessed 6 weeks after treatment. Additionally, antibiotic resistances and host CYP2C19 genotypes were examined and analyzed.A total of 440 H. pylori-infected patients were randomly assigned to receive either a reverse hybrid (n=220) or a standard triple therapy (n=220). The reverse hybrid group had a higher eradication rate than standard triple group either by intention-to-treat (93.6% vs. 86.8%; P=0.016) or per-protocol analysis (95.7% vs. 88.3%; P=0.005). The 2 patient groups exhibited similar frequencies of overall adverse events (14.1% vs. 9.5%) and drug compliance (96.8% vs. 98.6%). Clarithromycin resistance was an independent risk factor predicting eradication failure in standard triple group (P<0.001), but not in reverse hybrid group. CYP2C19 genotypes did not affect the eradication rates in both groups.Reverse hybrid therapy can be considered for first-line treatment of H. pylori infection since the new therapy achieves a higher eradication rate than standard triple therapy with similar tolerability and less pharmaceutical cost.

• 出版日期2015-12
• 单位中山大学; 长春大学