Summary of findings for the main comparison. Is 10‐day SEQ efficacy superior to STT?
| Is 10‐day SEQ efficacy superior to STT? | ||||||
| Patient or population: participants with Helicobacter pylori infection Settings: participants naïve to eradication treatment Intervention: 10‐day sequential regimen Comparison: standard triple therapy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Standard triple therapy | 10‐day sequential regimen | |||||
| Eradication proportion | Study population | RD 0.09, 95% CI 0.06 to 0.11 | 12,701 (44 studies) | ⊕⊕⊕⊝ moderate1,2,4 | Results were highly heterogeneous (I² = 75%), and 20 studies did not demonstrate differences between therapies | |
| 751 per 1000 | 833 per 1000 (811 to 863) | |||||
| Moderate | ||||||
| 750 per 1000 | 832 per 1000 (810 to 862) | |||||
| Geographic region | Study population | RD 0.09, 95% CI 0.06 to 0.12 | 12284 (44 studies) | ⊕⊕⊝⊝ low3 | The Latin American subgroup showed no consistent results with the remaining subgroups and there was a tendency to better efficacy with STT than with SEQ in all three included studies although two did not demonstrate differences between therapies | |
| 749 per 1000 | 839 per 1000 (809 to 869) | |||||
| Moderate | ||||||
| 749 per 1000 | 839 per 1000 (809 to 869) | |||||
| Publication date | Study population | RD 0.08, 95% CI 0.06 to 0.11 | 12751 (44 studies) | ⊕⊕⊕⊝ moderate1,2,4,5 | Results were more heterogeneous (69%) in the "after 2008" subgroup | |
| 750 per 1000 | 833 per 1000 (811 to 863) | |||||
| Moderate | ||||||
| 750 per 1000 | 832 per 1000 (810 to 862) | |||||
| STT length | 7 days | RD 0.14, 95% CI 0.12 to 0.17 | 5439 (22 studies) | ⊕⊕⊕⊕ high1 | Six out of 22 studies did not demonstrate differences when 7 days STT was compared to 10 days SEQ. Results for this comparison were consistent (I² = 38%) | |
| Study population | ||||||
| 725 per 1000 | 870 per 1000 (848 to 892) | |||||
| Moderate | ||||||
| 720 per 1000 | 864 per 1000 (842 to 886) | |||||
| 10 days | RD 0.06, 95% CI 0.02 to 0.10 | 3967 (19 studies) | ⊕⊕⊕⊕ high1,2 | In this subgroup 10 days SEQ was better than 10 days STT however heterogeneity between studies was greater (I² = 62%) than in the 7 days STT subgroup analysis. One study out of 19 demonstrated 10 days STT was superior to 10 days SEQ. Eleven studies could not demonstrate differences between therapies | ||
| Study population | ||||||
| 732 per 1000 |
791 per 1000 (754 to 835) |
|||||
| Moderate | ||||||
| 722 per 1000 |
780 per 1000 (744 to 823) |
|||||
| 14 days | RD 0.02, 95% CI ‐0.02 to 0.06 | 3831 (8 studies) | ⊕⊕⊕⊕ high1,2 | 14 days STT did not demonstrate differences with 10 days SEQ | ||
| Study population | ||||||
| 803 per 1000 | 811 per 1000 (795 to 827) | |||||
| Moderate | ||||||
| 811 per 1000 | 819 per 1000 (803 to 835) | |||||
| Bacterial antibiotic resistance | Study population | RD 0.13, 95% CI 0.03 to 0.24 | 832 (8 studies) | ⊕⊝⊝⊝ very low2,4,5,6,7,8 | SEQ was superior to STT in those patients with primary clarithromycin resistant strains only | |
| 672 per 1000 | 807 per 1000 (699 to 914) | |||||
| Moderate | ||||||
| 550 per 1000 | 660 per 1000 (572 to 748) | |||||
| Adverse events rate | Study population | RD 0.00, 95% CI ‐0.02 to 0.02 | 8103 (27 studies) | ⊕⊕⊕⊕ high5,9 | No differences were reported between treatment arms | |
| 195 per 1000 | 199 per 1000 (176 to 215) | |||||
| Moderate | ||||||
| 187 per 1000 | 191 per 1000 (168 to 206) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RD: Risk difference | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1Different STT lengths (different total doses) modify RDs. 2There is moderate to substantial unexplained heterogeneity. 3Small number of studies and wider confidence intervals in the South American subgroup. 4Confidence intervals overlap. 5Wide confidence intervals in some subgroups. 6Lack of reporting in most of the studies. 7Small number of studies in some subgroups. 8Metronidazole resistance is dose‐dependent. 9Longer treatments (higher total dose) led to higher rates of AEs.