The efficacy of moxifloxacin-based triple therapy intreatment of Helicobacter pylori infection: a systematic reviewand meta-analysis of randomized clinical trials

摘要

Recent evidence shows that moxifloxacin could exert an antimicrobial effect against Helicobacter pylori in both in vitro and in vivo models. To systematically evaluate whether moxifloxacin-containing triple therapy could improve eradication rates and reduce side effects in first-line or second-line anti-H. pylori treatment, eligible articles were identified by searches of electronic databases. We included all randomized trials comparing moxifloxacin-based triple therapy with standard triple or quadruple therapy during H. pylori eradication treatment. Statistical analysis was performed with Review Manager 5.0.10. Subanalysis/sensitivity analysis was also performed. We identified seven randomized trials (n=1263). Pooled H. pylori eradication rates were 79.03% (95%CI: 75.73-82.07) and 68.33% (95%CI: 64.44-72.04) for patients with moxifloxacin-based triple therapy or with standard triple or quadruple therapy, respectively (intention-to-treat analysis). The odds ratio (OR) was 1.82 (95%CI: 1.17-2.81), the occurrence of total side effects was 15.23% (95%CI: 12.58-18.20) and 27.17% (95%CI: 23.64-30.92) for groups with or without moxifloxacin, and the summary OR was0.45 (95%CI: 0.26-0.77). In subgroup analyses, we noted that the second-lineeradication rate in the moxifloxacin group was significantly higher than that inthe quadruple therapy group (73.33 vs 60.17%, OR: 1.78, 95%CI:1.16-2.73, P<0.001). However, there was no difference in first-lineeradication treatment. Findings from this meta-analysis suggest thatmoxifloxacin-based triple therapy is more effective and better tolerated thanstandard triple or quadruple therapy. Therefore, a moxifloxacin-based tripleregimen should be used in the second-line treatment of H.pylori infection.