Could Increasing the Duration of Triple Therapy Be a Clinically Useful Strategy?
Authors: Lorenzo Fuccio, Rocco Maurizio Zagari, Franco Bazzoli
Journal: Annals of Internal Medicine (2008)

Letters15 April 2008Could Increasing the Duration of Triple Therapy Be a Clinically Useful Strategy?Lorenzo Fuccio, MD, Rocco Maurizio Zagari, MD, and Franco Bazzoli, MDLorenzo Fuccio, MDFrom University of Bologna, Bologna 40138, Italy.Search for more papers by this author, Rocco Maurizio Zagari, MDFrom University of Bologna, Bologna 40138, Italy.Search for more papers by this author, and Franco Bazzoli, MDFrom University of Bologna, Bologna 40138, Italy.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-148-8-200804150-00010 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate the comments of Dr. Calvet and colleagues, who disagree with our conclusion that prolonging triple therapy is unlikely to be a clinically useful strategy.One of the aims of our meta-analysis was to verify whether current European and U.S. recommendations (1, 2) that support 14 days as the duration of choice reflect the available data. Undoubtedly, increasing the duration of treatment from 7 to 14 days will statistically significantly increase the eradication rate by 5% (95% CI, 2% to 8%); however, this improvement is substantially lower than what was previously accepted (12%) (3).A statistically significant finding is not necessarily clinically significant in daily clinical practice. In the U.S. trial comparing different durations of triple therapy (4), 2 regimens were considered therapeutically equivalent if the CI was within the equivalence range of −15% to 15%. Of note, this cut-off was decided in consultation with the U.S. Food and Drug Administration (4). The result of our meta-analysis was largely within this range (CI, 2% to 8%).Dr. Calvet and colleagues suggested that the inclusion of the 2 large studies of patients with peptic ulcer could have provided an underestimation of the benefit of prolonging treatment. We performed a sensitivity analysis excluding these 2 large studies, and the result did not substantially change (7% [CI, 3% to 11%]). As expected, the difference slightly increases, but the range was, again, largely within the equivalence range.Finally, a cost-effectiveness analysis performed by Dr. Calvet and associates (5), and on the basis of a 9% increase in eradication with the longer therapy duration, concluded that “7-day therapy seems the most cost-effective strategy.”References1. Malfertheiner P, Megraud F, O'Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007;56:772-81. [PMID: 17170018] CrossrefMedlineGoogle Scholar2. Chey WD, Wong BC. Practice Parameters Committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007;102:1808-25. [PMID: 17608775] CrossrefMedlineGoogle Scholar3. Ford A, Moayyedi P. How can the current strategies for Helicobacter pylori eradication therapy be improved? Can J Gastroenterol. 2003;17 Suppl B 36B-40B. [PMID: 12845349] CrossrefMedlineGoogle Scholar4. Vakil N, Lanza F, Schwartz H, Barth J. Seven-day therapy for Helicobacter pylori in the United States. Aliment Pharmacol Ther. 2004;20:99-107. [PMID: 15225176] CrossrefMedlineGoogle Scholar5. Calvet X, Gené E, López T, Gisbert JP. What is the optimal length of proton pump inhibitor-based triple therapies for H. pylori? A cost-effectiveness analysis. Aliment Pharmacol Ther. 2001;15:1067-76. [PMID: 11421884] CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From University of Bologna, Bologna 40138, Italy.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoMeta-analysis: Duration of First-Line Proton-Pump Inhibitor–Based Triple Therapy for Helicobacter pylori Eradication Lorenzo Fuccio , Maria Eugenia Minardi , Rocco Maurizio Zagari , Diego Grilli , Nicola Magrini , and Franco Bazzoli Could Increasing the Duration of Triple Therapy Be a Clinically Useful Strategy? Xavier Calvet , Albert Villoria , and Mercedes Vergara Metrics 15 April 2008Volume 148, Issue 8Page: 624-625KeywordsConflicts of interestPeptic ulcers ePublished: 15 April 2008 Issue Published: 15 April 2008 CopyrightCopyright © 2008 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...