Ethical Considerations of Comparing Sequential and Traditional Anti–<i>Helicobacter pylori</i> Therapy
Authors: David Y. Graham, Yoshio Yamaoka
Journal: Annals of Internal Medicine (2007)

Letters18 September 2007Ethical Considerations of Comparing Sequential and Traditional Anti–Helicobacter pylori TherapyDavid Y. Graham, MD and Yoshio Yamaoka, MD, PhDDavid Y. Graham, MDFrom Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030. and Yoshio Yamaoka, MD, PhDFrom Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-147-6-200709180-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Vaira and colleagues (1) recently reported that a sequential therapy regimen led to high cure rates and was better than legacy triple therapy (proton-pump inhibitor, amoxicillin, and clarithromycin) for eradicating Helicobacter pylori infection in Italian patients with dyspepsia or peptic ulcers. The sequential regimen was much more effective than triple therapy among patients with clarithromycin-resistant bacteria (1). These investigators and others have compared identical or very similar regimens and have reported similar high cure rates (Figure[2–6]).Figure 1.Results of the 5 previous comparisons of legacy triple and sequential therapy.Each bar shows mean and upper 95% CI values. ...References1. Vaira D, Zullo A, Vakil N, Gatta L, Ricci C, Perna F, et al. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: a randomized trial. Ann Intern Med. 2007;146:556-63. [PMID: 17438314] LinkGoogle Scholar2. De Francesco V, Zullo A, Hassan C, Della Valle N, Pietrini L, Minenna MF, et al. The prolongation of triple therapy for Helicobacter pylori does not allow reaching therapeutic outcome of sequential scheme: a prospective, randomised study. Dig Liver Dis. 2004;36:322-6. [PMID: 15191200] CrossrefMedlineGoogle Scholar3. Francavilla R, Lionetti E, Castellaneta SP, Magistà AM, Boscarelli G, Piscitelli D, et al. Improved efficacy of 10-Day sequential treatment for Helicobacter pylori eradication in children: a randomized trial. Gastroenterology. 2005;129:1414-9. [PMID: 16285942] CrossrefMedlineGoogle Scholar4. Scaccianoce G, Hassan C, Panarese A, Piglionica D, Morini S, Zullo A. Helicobacter pylori eradication with either 7-day or 10-day triple therapies, and with a 10-day sequential regimen. Can J Gastroenterol. 2006;20:113-7. [PMID: 16482238] CrossrefMedlineGoogle Scholar5. Zullo A, Vaira D, Vakil N, Hassan C, Gatta L, Ricci C, et al. High eradication rates of Helicobacter pylori with a new sequential treatment. Aliment Pharmacol Ther. 2003;17:719-26. [PMID: 12641522] CrossrefMedlineGoogle Scholar6. Zullo A, Gatta L, De Francesco V, Hassan C, Ricci C, Bernabucci V, et al. High rate of Helicobacter pylori eradication with sequential therapy in elderly patients with peptic ulcer: a prospective controlled study. Aliment Pharmacol Ther. 2005;21:1419-24. [PMID: 15948808] CrossrefMedlineGoogle Scholar7. Nagahara A, Miwa H, Ogawa K, Kurosawa A, Ohkura R, Iida N, et al. Addition of metronidazole to rabeprazole-amoxicillin-clarithromycin regimen for Helicobacter pylori infection provides an excellent cure rate with five-day therapy. Helicobacter. 2000;5:88-93. [PMID: 10849057] CrossrefMedlineGoogle Scholar8. Treiber G, Ammon S, Schneider E, Klotz U. Amoxicillin/metronidazole/omeprazole/clarithromycin: a new, short quadruple therapy for Helicobacter pylori eradication. Helicobacter. 1998;3:54-8. [PMID: 9546119] CrossrefMedlineGoogle Scholar9. Treiber G, Wittig J, Ammon S, Walker S, van Doorn LJ, Klotz U. Clinical outcome and influencing factors of a new short-term quadruple therapy for Helicobacter pylori eradication: a randomized, controlled trial (MACLOR study). Arch Intern Med. 2002;162:153-60. [PMID: 11802748] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030.Disclosures: Dr. Graham has received small amounts of grant support and/or free drugs or urea breath tests from Meretek Diagnostics, Janssen/Eisai, TAP Pharmaceuticals, and Biohit for investigator-initiated and investigator-controlled research in the area of H. pylori infection. He is a paid consultant for Otsuka Pharmaceuticals; a member of the Board of Directors of Meretek Diagnostics, the manufacturer of the 13C-urea breath test; and a consultant to Novartis with regard to H. pylori vaccine development. Finally, he receives royalties on the Baylor College of Medicine patent covering the serologic test HM-CAP (E-Z-EM, Lake Success, New York). PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSequential Therapy versus Standard Triple-Drug Therapy for Helicobacter pylori Eradication Dino Vaira , Angelo Zullo , Nimish Vakil , Luigi Gatta , Chiara Ricci , Federico Perna , Cesare Hassan , Veronica Bernabucci , Andrea Tampieri , and Sergio Morini Ethical Considerations of Comparing Sequential and Traditional Anti–Helicobacter pylori Therapy Dino Vaira , Angelo Zullo , and Nimish Vakil Metrics Cited bySequential versus standard triple first-line therapy for Helicobacter pylori eradicationEfficacy and safety of sequential therapy versus standard triple therapy in Helicobacter pylori eradication in Kashmir India: a randomized comparative trialSafety and efficacy of 1-week levofloxacin-based triple therapy in first-line treatment for Helicobacter pylori-related peptic ulcer disease in Kashmir, IndiaA Comparison between Sequential Therapy and a Modified Bismuth-based Quadruple Therapy for Helicobacter pylori Eradication in Iran: A Randomized Clinical TrialSequential versus standard triple therapy for Helicobacter pylori eradicationHelicobacter pylori Eradication Therapy Research: Ethical Issues and Description of ResultsTreatment of Helicobacter pylori infection: The past and the futureSequential Therapy for Helicobacter pylori Infection: Ethical Considerations RevisitedSequential Therapy for Helicobacter pylori EradicationTen and Eight-day Sequential Therapy in Comparison to Standard Triple Therapy for Eradicating Helicobacter pylori InfectionThe sequential therapy regimen for Helicobacter pylori eradicationEditorial: H. pylori Treatment: New Wine in Old Bottles?Meta-analysis: Sequential Therapy Appears Superior to Standard Therapy for Helicobacter pylori Infection in Patients Naive to TreatmentNadim S. Jafri, MD, MSc, Carlton A. Hornung, PhD, MPH, and Colin W. Howden, MDTherapy for Helicobacter pylori Infection Can be Improved 18 September 2007Volume 147, Issue 6Page: 434-435KeywordsAntimicrobial resistanceDiagnostic techniquesDrug therapyPeptic ulcersPopulation statisticsUreaVaccine development ePublished: 18 September 2007 Issue Published: 18 September 2007 Copyright & PermissionsCopyright © 2007 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...