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Evaluation of the efficacy and safety of the hybrid scheme for eradication therapy of Helicobacter pylori infection.
Ter Arkh. 2018 Aug 27; 90(8):33-39.TA

Abstract

AIM

The aim is to conduct a comprehensive comparative study of the efficacy and safety of the hybrid scheme of eradication therapy (ET) in patients with peptic ulcer of the stomach or duodenum associated with Helicobacter pylori.

MATERIALS AND METHODS

Materials and methods. In a prospective, randomized comparative study, 180 patients were divided into three equal groups of 60 people, depending on the prescribed 10-day ET regimen. Group 1 - the standard triple scheme (omeprazole, amoxicillin and clarithromycin); group 2 - four-component therapy with preparations of bismuth (omeprazole, tetracycline, metronidazole, bismuth tricalium dicitrate); group 3 - hybrid scheme (first 5 days: omeprazole and amoxicillin, the next 5 days: omeprazole, amoxicillin, clarithromycin, metronidazole). The effectiveness of ET was determined with the help of a breath test a month after the end of therapy. Adverse events were recorded by patients in specially developed diaries. Pharmacoeconomic analysis was carried out using the "cost-effectiveness" method with calculation of the CER coefficient.

RESULTS

Results and discussion. The effectiveness of standard triple therapy was 73.3% (ITT), 75.9% (PP); four-component therapy with bismuth preparations - 78.3% (ITT), 82.4% (PP); hybrid scheme - 85% (ITT), 91% (PP). Hybrid therapy proved to be significantly more effective than standard triple therapy with a odds ratio (OR) of 3.25; 95% confidence interval (CI) 1.08-9.73 (p=0.043, χ2=4.75, p-level=0.029298). The incidence of adverse events with the use of triple, four-component and hybrid ET regimens was 15; 18.3 and 28.3% respectively. The OR of at least one adverse event in patients receiving a hybrid ET regimen compared with triple therapy was 2.24 (95% CI 0.91-5.53, p=0.0823, χ2=3.14, p-level=0.076394), and compared with the four-component therapy - 1.76 (95% CI 0.74-4.17, p=0.2804, χ2=1.68, p-level=0.194924). According to the results of the pharmacoeconomic analysis, the most profitable from an economic point of view was a hybrid ET scheme with a CER of 20.1.

CONCLUSION

The conclusion. Hybrid therapy showed the greatest effectiveness in comparison with the triple and four-component ET regimens, however, the incidence of side effects in patients receiving the hybrid ET scheme was higher, although it remained within the acceptable level for use in clinical practice. Pharmacoeconomic analysis also showed the advisability of designating a hybrid ET scheme. The obtained data allow to draw a conclusion about the necessity of further study of the efficiency and safety of the hybrid ET scheme.

Authors+Show Affiliations

A.I. Evdokimov Moscow State Medicine and Dentistry, University of the Ministry of Health of Russia, Moscow, Russia.A.I. Evdokimov Moscow State Medicine and Dentistry, University of the Ministry of Health of Russia, Moscow, Russia.A.I. Evdokimov Moscow State Medicine and Dentistry, University of the Ministry of Health of Russia, Moscow, Russia.A.I. Evdokimov Moscow State Medicine and Dentistry, University of the Ministry of Health of Russia, Moscow, Russia.A.I. Evdokimov Moscow State Medicine and Dentistry, University of the Ministry of Health of Russia, Moscow, Russia.

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

30701937

Citation

Yurenev, G L., et al. "Evaluation of the Efficacy and Safety of the Hybrid Scheme for Eradication Therapy of Helicobacter Pylori Infection." Terapevticheskii Arkhiv, vol. 90, no. 8, 2018, pp. 33-39.
Yurenev GL, Partzvania-Vinogradova EV, Andreev DN, et al. Evaluation of the efficacy and safety of the hybrid scheme for eradication therapy of Helicobacter pylori infection. Ter Arkh. 2018;90(8):33-39.
Yurenev, G. L., Partzvania-Vinogradova, E. V., Andreev, D. N., Dicheva, D. T., & Maiev, I. V. (2018). Evaluation of the efficacy and safety of the hybrid scheme for eradication therapy of Helicobacter pylori infection. Terapevticheskii Arkhiv, 90(8), 33-39. https://doi.org/10.26442/terarkh201890833-39
Yurenev GL, et al. Evaluation of the Efficacy and Safety of the Hybrid Scheme for Eradication Therapy of Helicobacter Pylori Infection. Ter Arkh. 2018 Aug 27;90(8):33-39. PubMed PMID: 30701937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of the efficacy and safety of the hybrid scheme for eradication therapy of Helicobacter pylori infection. AU - Yurenev,G L, AU - Partzvania-Vinogradova,E V, AU - Andreev,D N, AU - Dicheva,D T, AU - Maiev,I V, PY - 2019/2/1/entrez PY - 2019/2/1/pubmed PY - 2019/4/4/medline KW - Helicobacter pylori KW - eradication therapy KW - four-component therapy KW - hybrid therapy KW - peptic ulcer KW - pharmacoeconomics. KW - safety KW - triple therapy SP - 33 EP - 39 JF - Terapevticheskii arkhiv JO - Ter Arkh VL - 90 IS - 8 N2 - AIM: The aim is to conduct a comprehensive comparative study of the efficacy and safety of the hybrid scheme of eradication therapy (ET) in patients with peptic ulcer of the stomach or duodenum associated with Helicobacter pylori. MATERIALS AND METHODS: Materials and methods. In a prospective, randomized comparative study, 180 patients were divided into three equal groups of 60 people, depending on the prescribed 10-day ET regimen. Group 1 - the standard triple scheme (omeprazole, amoxicillin and clarithromycin); group 2 - four-component therapy with preparations of bismuth (omeprazole, tetracycline, metronidazole, bismuth tricalium dicitrate); group 3 - hybrid scheme (first 5 days: omeprazole and amoxicillin, the next 5 days: omeprazole, amoxicillin, clarithromycin, metronidazole). The effectiveness of ET was determined with the help of a breath test a month after the end of therapy. Adverse events were recorded by patients in specially developed diaries. Pharmacoeconomic analysis was carried out using the "cost-effectiveness" method with calculation of the CER coefficient. RESULTS: Results and discussion. The effectiveness of standard triple therapy was 73.3% (ITT), 75.9% (PP); four-component therapy with bismuth preparations - 78.3% (ITT), 82.4% (PP); hybrid scheme - 85% (ITT), 91% (PP). Hybrid therapy proved to be significantly more effective than standard triple therapy with a odds ratio (OR) of 3.25; 95% confidence interval (CI) 1.08-9.73 (p=0.043, χ2=4.75, p-level=0.029298). The incidence of adverse events with the use of triple, four-component and hybrid ET regimens was 15; 18.3 and 28.3% respectively. The OR of at least one adverse event in patients receiving a hybrid ET regimen compared with triple therapy was 2.24 (95% CI 0.91-5.53, p=0.0823, χ2=3.14, p-level=0.076394), and compared with the four-component therapy - 1.76 (95% CI 0.74-4.17, p=0.2804, χ2=1.68, p-level=0.194924). According to the results of the pharmacoeconomic analysis, the most profitable from an economic point of view was a hybrid ET scheme with a CER of 20.1. CONCLUSION: The conclusion. Hybrid therapy showed the greatest effectiveness in comparison with the triple and four-component ET regimens, however, the incidence of side effects in patients receiving the hybrid ET scheme was higher, although it remained within the acceptable level for use in clinical practice. Pharmacoeconomic analysis also showed the advisability of designating a hybrid ET scheme. The obtained data allow to draw a conclusion about the necessity of further study of the efficiency and safety of the hybrid ET scheme. SN - 0040-3660 UR - https://www.unboundmedicine.com/medline/citation/30701937/Evaluation_of_the_efficacy_and_safety_of_the_hybrid_scheme_for_eradication_therapy_of_Helicobacter_pylori_infection_ L2 - https://medlineplus.gov/pepticulcer.html DB - PRIME DP - Unbound Medicine ER -