Triple vs. quadruple therapy for treating <b><i>Helicobacter pylori</i></b> infection: an updated meta‐analysis

Sirs, Since we submitted our paper, ‘Triple vs. quadruple therapy for treating Helicobacter pylori infection: a meta-analysis’, for publication in Alimentary Pharmacology and Therapeutics,1 a new study comparing triple with quadruple therapy has been published.2 Full-text reports of two of the studies included in the meta-analysis in abstract form have also been published.3, 4 The objective of this letter is to update the meta-analysis using these new results. The report of Mantzaris et al. compares triple with quadruple therapy for H. pylori infection in patients with duodenal ulcer.2 The authors obtained better eradication rates with triple than with quadruple therapy. However, the differences did not reach statistical significance. The results of the report by Katelaris et al. are identical to those published in abstract form,3 whereas there are small differences between the abstract and full-text form of the paper by Laine et al.4 The results of our meta-analysis did not change after introducing these modifications (Figure 1). In the intention-to-treat analysis, eradication was achieved in 449 of 559 patients with quadruple therapy [80%; 95% confidence interval (CI), 77–84%] and in 451 of 569 patients with triple therapy (79%; 95% CI, 74–81%). The odds ratio (Figure 1) was 1.00 (95% CI, 0.64–1.57; P = 1). In the per protocol analysis, eradication was achieved in 421 of 486 patients with quadruple therapy (87%; 95% CI, 84.1–90.5%) and in 435 of 509 patients with triple therapy (85%; 95% CI, 81.4–88.3%). The odds ratio was 0.95 (95% CI, 0.58–1.57; P = 0.9). Triple vs. quadruple therapy. Intention-to-treat (ITT) analysis. CI, confidence interval; OR, odds ratio. In conclusion, the update of our meta-analysis suggests that the conclusions of the previous report can be maintained, and that the effectiveness of quadruple and triple therapy is very similar for the initial treatment of H. pylori infection.