Yu Huang, Shuhan Qiu, Yixian Guo, Jinnan Chen, Meixuan Li, Zhaohui Ding, Wei Zhang, Xiao Liang, Hong Lu
{"title":"优化米诺环素含铋四联疗法对幽门螺旋杆菌的拯救治疗：真实世界证据研究。","authors":"Yu Huang, Shuhan Qiu, Yixian Guo, Jinnan Chen, Meixuan Li, Zhaohui Ding, Wei Zhang, Xiao Liang, Hong Lu","doi":"10.1111/hel.13138","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>The optimal dosage of minocycline remains unclear for <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication. We aimed to evaluate the efficacy and safety of four different regimens with minocycline and metronidazole compared to classical bismuth quadruple therapy for <i>H. pylori</i> rescue treatment.</p>\n </section>\n \n <section>\n \n <h3> Materials and Methods</h3>\n \n <p>From March 2021 to March 2024, refractory <i>H. pylori</i>-infected patients with at least two previous treatment failures who received 14-day therapy with b.i.d. proton pump inhibitor 20 mg and bismuth 220 mg, plus tetracycline 400 mg q.i.d and metronidazole 400 mg q.i.d (BQT), or minocycline 50 mg q.i.d and metronidazole 400 mg q.i.d (PBMn<sub>4</sub>M<sub>4</sub>), or minocycline 50 mg t.i.d and metronidazole 400 mg t.i.d (PBMn<sub>3</sub>M<sub>3</sub>), or minocycline 50 mg b.i.d and metronidazole 400 mg q.i.d (PBMn<sub>2</sub>M<sub>4</sub>), or minocycline 50 mg b.i.d and metronidazole 400 mg t.i.d (PBMn<sub>2</sub>M<sub>3</sub>) were included in this retrospective study. <i>H. pylori</i> eradication was assessed by <sup>13</sup>C-urea breath test at least 6 weeks after treatment. All adverse effects during treatment were recorded.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Totally, 823 patients were enrolled: 251 with BQT, 97 with PBMn<sub>4</sub>M<sub>4</sub>, 191 with PBMn<sub>3</sub>M<sub>3</sub>, 108 with PBMn<sub>2</sub>M<sub>4</sub>, and 176 with PBMn<sub>2</sub>M<sub>3</sub>. The eradication rates of BQT, PBMn4M4, PBMn3M3, PBMn2M4, and PBMn2M3 were 89.2%, 87.6%, 91.6%, 88.0%, and 91.5%, respectively, by intention-to-treat analysis; 96.1%, 97.7%, 97.8%, 96.9%, and 97.6%, respectively, by modified intention-to-treat analysis; 97.1%, 97.5%, 97.7%, 96.8%, and 97.6%, respectively, by per-protocol analysis. Metronidazole resistance did not affect the efficacy of all groups. PBMn<sub>2</sub>M<sub>3</sub> group achieved the greatest compliance and the fewest moderate and severe adverse events.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The novel bismuth-containing quadruple therapy with a low dose of minocycline and metronidazole is an alternative to classical bismuth quadruple therapy for <i>H. pylori</i> rescue treatment with superior safety and compliance.</p>\n </section>\n \n <section>\n \n <h3> Trial Registration</h3>\n \n <p>ClinicalTrials.gov identifier: NCT06332599</p>\n </section>\n </div>","PeriodicalId":13223,"journal":{"name":"Helicobacter","volume":"29 5","pages":""},"PeriodicalIF":4.3000,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Optimization of Minocycline-Containing Bismuth Quadruple Therapy for Helicobacter pylori Rescue Treatment: A Real-World Evidence Study\",\"authors\":\"Yu Huang, Shuhan Qiu, Yixian Guo, Jinnan Chen, Meixuan Li, Zhaohui Ding, Wei Zhang, Xiao Liang, Hong Lu\",\"doi\":\"10.1111/hel.13138\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>The optimal dosage of minocycline remains unclear for <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication. We aimed to evaluate the efficacy and safety of four different regimens with minocycline and metronidazole compared to classical bismuth quadruple therapy for <i>H. pylori</i> rescue treatment.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Materials and Methods</h3>\\n \\n <p>From March 2021 to March 2024, refractory <i>H. pylori</i>-infected patients with at least two previous treatment failures who received 14-day therapy with b.i.d. proton pump inhibitor 20 mg and bismuth 220 mg, plus tetracycline 400 mg q.i.d and metronidazole 400 mg q.i.d (BQT), or minocycline 50 mg q.i.d and metronidazole 400 mg q.i.d (PBMn<sub>4</sub>M<sub>4</sub>), or minocycline 50 mg t.i.d and metronidazole 400 mg t.i.d (PBMn<sub>3</sub>M<sub>3</sub>), or minocycline 50 mg b.i.d and metronidazole 400 mg q.i.d (PBMn<sub>2</sub>M<sub>4</sub>), or minocycline 50 mg b.i.d and metronidazole 400 mg t.i.d (PBMn<sub>2</sub>M<sub>3</sub>) were included in this retrospective study. <i>H. pylori</i> eradication was assessed by <sup>13</sup>C-urea breath test at least 6 weeks after treatment. All adverse effects during treatment were recorded.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Totally, 823 patients were enrolled: 251 with BQT, 97 with PBMn<sub>4</sub>M<sub>4</sub>, 191 with PBMn<sub>3</sub>M<sub>3</sub>, 108 with PBMn<sub>2</sub>M<sub>4</sub>, and 176 with PBMn<sub>2</sub>M<sub>3</sub>. The eradication rates of BQT, PBMn4M4, PBMn3M3, PBMn2M4, and PBMn2M3 were 89.2%, 87.6%, 91.6%, 88.0%, and 91.5%, respectively, by intention-to-treat analysis; 96.1%, 97.7%, 97.8%, 96.9%, and 97.6%, respectively, by modified intention-to-treat analysis; 97.1%, 97.5%, 97.7%, 96.8%, and 97.6%, respectively, by per-protocol analysis. Metronidazole resistance did not affect the efficacy of all groups. PBMn<sub>2</sub>M<sub>3</sub> group achieved the greatest compliance and the fewest moderate and severe adverse events.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>The novel bismuth-containing quadruple therapy with a low dose of minocycline and metronidazole is an alternative to classical bismuth quadruple therapy for <i>H. pylori</i> rescue treatment with superior safety and compliance.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Trial Registration</h3>\\n \\n <p>ClinicalTrials.gov identifier: NCT06332599</p>\\n </section>\\n </div>\",\"PeriodicalId\":13223,\"journal\":{\"name\":\"Helicobacter\",\"volume\":\"29 5\",\"pages\":\"\"},\"PeriodicalIF\":4.3000,\"publicationDate\":\"2024-09-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Helicobacter\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/hel.13138\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Helicobacter","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/hel.13138","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Optimization of Minocycline-Containing Bismuth Quadruple Therapy for Helicobacter pylori Rescue Treatment: A Real-World Evidence Study
Background
The optimal dosage of minocycline remains unclear for Helicobacter pylori (H. pylori) eradication. We aimed to evaluate the efficacy and safety of four different regimens with minocycline and metronidazole compared to classical bismuth quadruple therapy for H. pylori rescue treatment.
Materials and Methods
From March 2021 to March 2024, refractory H. pylori-infected patients with at least two previous treatment failures who received 14-day therapy with b.i.d. proton pump inhibitor 20 mg and bismuth 220 mg, plus tetracycline 400 mg q.i.d and metronidazole 400 mg q.i.d (BQT), or minocycline 50 mg q.i.d and metronidazole 400 mg q.i.d (PBMn4M4), or minocycline 50 mg t.i.d and metronidazole 400 mg t.i.d (PBMn3M3), or minocycline 50 mg b.i.d and metronidazole 400 mg q.i.d (PBMn2M4), or minocycline 50 mg b.i.d and metronidazole 400 mg t.i.d (PBMn2M3) were included in this retrospective study. H. pylori eradication was assessed by 13C-urea breath test at least 6 weeks after treatment. All adverse effects during treatment were recorded.
Results
Totally, 823 patients were enrolled: 251 with BQT, 97 with PBMn4M4, 191 with PBMn3M3, 108 with PBMn2M4, and 176 with PBMn2M3. The eradication rates of BQT, PBMn4M4, PBMn3M3, PBMn2M4, and PBMn2M3 were 89.2%, 87.6%, 91.6%, 88.0%, and 91.5%, respectively, by intention-to-treat analysis; 96.1%, 97.7%, 97.8%, 96.9%, and 97.6%, respectively, by modified intention-to-treat analysis; 97.1%, 97.5%, 97.7%, 96.8%, and 97.6%, respectively, by per-protocol analysis. Metronidazole resistance did not affect the efficacy of all groups. PBMn2M3 group achieved the greatest compliance and the fewest moderate and severe adverse events.
Conclusions
The novel bismuth-containing quadruple therapy with a low dose of minocycline and metronidazole is an alternative to classical bismuth quadruple therapy for H. pylori rescue treatment with superior safety and compliance.
期刊介绍：
Helicobacter is edited by Professor David Y Graham. The editorial and peer review process is an independent process. Whenever there is a conflict of interest, the editor and editorial board will declare their interests and affiliations. Helicobacter recognises the critical role that has been established for Helicobacter pylori in peptic ulcer, gastric adenocarcinoma, and primary gastric lymphoma. As new helicobacter species are now regularly being discovered, Helicobacter covers the entire range of helicobacter research, increasing communication among the fields of gastroenterology; microbiology; vaccine development; laboratory animal science.
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