AIM:To assess the efficacy and safety of standard triple therapy compared with other pre-existing and new therapies in China.METHODS:Literature searches were conducted in the following databases:PubMed,EMBASE,the Cochrane Central Register of Controlled Trials,the VIP database,the China National Knowledge Infrastructure database,and the Chinese Biomedical Database.A meta-analysis of all randomized controlled trials(RCTs)comparing standard triple therapy for the eradication of Helicobacter pylori with pre-existing and new therapies in China was performed using Comprehensive Meta-Analysis 2.0.There were 49 studies that met our criteria and the qualities of these studies were assessed using the Jadad scale.The Mantel-Haenszel method was used for pooling dichotomous data.We also conducted subgroupanalyses according to age,duration of treatment and drug type.Sensitivity analyses and a cumulative metaanalysis were also performed with CMA 2.0.Publication bias was evaluated using Egger’s test,Begg’s test or a funnel plot.RESULTS:A total of 49 RCTs including 8332 patients were assessed.This meta-analysis showed that standard triple therapy with proton pump inhibitors(PPIs),amoxicillin(AMO)and clarithromycin(CLA)was inferior to sequential therapy[relative risk(RR)=0.863;95%confidence interval(CI):0.824-0.904],but was not superior to quadruple therapy(RR=1.073;95%CI:0.849-1.357)or other triple therapies(RR=1.01;95%CI:0.936-1.089).The meta-analysis also suggested that standard triple therapy is slightly more effective than dual therapy(RR=1.14;95%CI:0.99-1.31).However,the differences were not statistically significant.We removed the only trial with a regimen lasting14 d by sensitivity analysis and found that 7-d standard triple therapy was superior to 7-d dual therapy(RR=1.222;95%CI:1.021-1.461).Moreover,a sub-analysis based on the duration of quadruple therapy indicated that the 7-d and 10-d standard triple therapies were inferior to sequential therapy(RR=0.790;95%CI:0.718-0.868;RR=0.917;95%CI:0.839-1.002,respectively).Additionally,there were no significant differences in cure rate or adverse events among standard triple therapy,quadruple therapy,and other triple therapies(RR=0.940;95%CI:0.825-1.072;RR=1.081;95%CI:0.848-1.378,respectively).Standard triple therapy had a higher occurrence of side effects than sequential therapy(RR=1.283;95%CI:1.066-1.544).CONCLUSION:The eradication rates with a standard triple therapy consisting of PPI,AMO,and CLA are suboptimal in China,and new treatment agents need to be developed.
