Different Dose Of Esomeprazole In Triple Therapy For Helicobacter Pylori Eradication:A Meta-analysis

Objective:To evaluate the efficacy and safety of high-dose(80mg/d) versus standard-dose(40mg/d) esomeprazole in 7-day triple therapy for Helicobacter pylori infection by Meta-analysis.Methods: A systematic search was performed in Pub Med, The Cochrane Library, OVID, Wanfang database, CNKI and VIP(from their inception to January 2016). Randomized controlled trials comparing high dose of esomeprazole with standard dose in 7-day triple therapy for H.pylori infection were selected. The quality of included RCTs were evaluated by the Cochrane Collaboration's tool for assessing risk of bias.Statistical analysis was performed by Review Manager 5.3, Odds ratio(OR) and 95% confidence intervals(95% CI)for all outcomes were calculated.Results: Six studies, including 1319 patients(640 patients with high-dose esomeprazole and 679 with standard-dose), were enrolled in the analysis. The test for heterogeneity was negative and hence a fixed effects model was used. A mean intention-to-treat(ITT) eradication rates of 80.8% was achieved with high-dose esomeprazole and one of 76.4% with standard-dose, with a difference of statistical significance(OR=1.33, 95%CI: 1.01-1.76, P=0.04). In the per protocol analysis(PP), eradication rates were 91% in the high-dose group and 86.4% in standard-dosegroup, with a difference of statistical significance(OR=1.57,95%CI:1.08-2.28,P=0.02).Significant difference of side effects was found between 2groups(12.8% vs. 9.4%, OR=1.46,95%CI:1.02-2.07,P=0.04).Sub-analysis showed that the eradication rates were significantly higher in esomeprazole 40 mg twice a day group than 40 mg once a day group both by ITT analyses and PP analyses(ITT analysis: OR=2.24,95%CI:1.26-4.00,P=0.006;PP analysis:OR=2.81,95%CI:1.45-5.48,P=0.002).However, the eradication rates were nosignificantly different in esomeprazole 40 mg twice a day group than 20 mgtwice a day group both by ITT analyses and PP analyses(ITT analysis:OR=1.18,95%CI:0.86-1.60,P=0.30;PP analysis:OR=1.22,95%CI:0.79-1.89,P=0.37).Conclusion: In esomeprazole-based triple therapy for curing Helicobacter pylori infection, high-dose(80mg/d) esomeprazole seems more effective but less safe than standard-dose(40mg/d).In addition, esomeprazole 40 mg twice a day is superior to 40 mg once a day, and similar to 20 mg twice a day.