Portal de Periódicos da CAPES

Bismuth quadruple regimen with tetracycline or doxycycline versus three‐in‐one single capsule as third‐line rescue therapy for Helicobacter pylori infection: Spanish data of the European Helicobacter pylori Registry (Hp‐EuReg)

2020; Wiley; Volume: 25; Issue: 5 Linguagem: Inglês

10.1111/hel.12722

1523-5378

Olga P. Nyssen, Ángeles Pérez‐Aísa, Luı́s Rodrigo, Manuel Castro de Moura, Pilar Mata Romero, Juan Ortuño, Jesús Barrio, José María Huguet, Ines Modollel, Noelia Alcaide, Alfredo J. Lucendo, Xavier Calvet, Mónica Perona, Bárbara Gómez, Blas José Gómez Rodríguez, Pilar Varela, Manuel Jiménez-Moreno, Manuel Domínguez‐Cajal, Liliana Pozzati, Diego Burgos‐Santamaría, Luís Bujanda, Jenifer Hinojosa, Javier Molina‐Infante, Tommaso Di Maira, Lluís Ferrer, Luís Fernández-Salazar, Ariadna Figuerola, Lluçia Titó, Cristóbal de la Coba Ortiz, Judith Gómez‐Camarero, Nuria Fernández, María Caldas, Ana Garre, Elena Resina, Ignasi Puig, Colm OʼMorain, Françis Mégraud, Javier P. Gisbert,

Gastric Cancer Management and Outcomes

Abstract Background Different bismuth quadruple therapies containing proton‐pump inhibitors, bismuth salts, metronidazole, and a tetracycline have been recommended as third‐line Helicobacter pylori eradication treatment after failure with clarithromycin and levofloxacin. Aim To evaluate the efficacy and safety of third‐line treatments with bismuth, metronidazole, and either tetracycline or doxycycline. Methods Sub‐study with Spanish data of the “European Registry on H pylori Management” (Hp‐EuReg), international multicenter prospective non‐interventional Registry of the routine clinical practice of gastroenterologists. After previous failure with clarithromycin‐ and levofloxacin‐containing therapies, patients receiving a third‐line regimen with 10/14‐day bismuth salts, metronidazole, and either tetracycline (BQT‐Tet) or doxycycline (BQT‐Dox), or single capsule (BQT‐three‐in‐one) were included. Data were registered at AEG‐REDCap database. Univariate and multivariate analyses were performed. Results Four‐hundred and fifty‐four patients have been treated so far: 85 with BQT‐Tet, 94 with BQT‐Dox, and 275 with BQT‐three‐in‐one. Average age was 53 years, 68% were women. Overall modified intention‐to‐treat and per‐protocol eradication rates were 81% (BQT‐Dox: 65%, BQT‐Tet: 76%, BQT‐three‐in‐one: 88%) and 82% (BQT‐Dox: 66%, BQT‐Tet: 77%, BQT‐three‐in‐one: 88%), respectively. By logistic regression, higher eradication rates were associated with compliance (OR = 2.96; 95% CI = 1.01‐8.84) and no prior metronidazole use (OR = 1.96; 95% CI = 1.15‐3.33); BQT‐three‐in‐one was superior to BQT‐Dox (OR = 4.46; 95% CI = 2.51‐8.27), and BQT‐Tet was marginally superior to BQT‐Dox (OR = 1.67; 95% CI = 0.85‐3.29). Conclusion Third‐line H pylori eradication with bismuth quadruple treatment (after failure with clarithromycin and levofloxacin) offers acceptable efficacy and safety. Highest efficacy was found in compliant patients and those taking 10‐day BQT‐three‐in‐one or 14‐day BQT‐Tet. Doxycycline seems to be less effective and therefore should not be recommended.