The sequential therapy regimen for Helicobacter pylori eradication: a pooled-data analysis

Background: Standard triple therapies are the most used treatment in clinical practice. However, a critical fall in the H pylori eradication rate following these therapies has been observed in the last few years. The sequential regimen is a novel, promising therapeutic approach. Objectives: To evaluate the available data on the sequential therapy regimen. Methods: A pooled-data analysis of all studies on the sequential regimen was performed. The eradication rate was calculated according to gastroduodenal pathology, proton pump inhibitor used, antibiotic resistance, as well as setting (paediatric or geriatric patients). Compliance, side effects, and cost implications were also evaluated. Results: Overall, more than 1800 patients have been treated with the sequential regimen. Such a therapy was superior to 7-10 days triple therapies in paediatric, adult and elderly patients, achieving an eradication rate constantly higher than 90% at ITT analysis. Although primary clarithromycin resistance reduced the efficacy of such a therapy, a success rate significantly higher than that observed with the standard 7-10 days triple therapies was found. Conclusion: The 10-day sequential treatment regimen achieves higher eradication rates than standard triple therapies.