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. 2022 Jan-Feb;35(1):42-47.
doi: 10.20524/aog.2021.0670. Epub 2021 Oct 12.

Assessment of first-line eradication treatment in Greece: data from the European Registry on Helicobacter pylori management (Hp-EuReg)

Theodore Rokkas  1 , Sotirios Georgopoulos  2 , Spyros Michopoulos  3 , Vasiliki Ntouli  4 , Christos Liatsos  5 , Ignasi Puig  6 , Olga P Nyssen  7 , Francis Mégraud  8 , Colm O'Morain  9 , Javier P Gisbert  7 ; Hp-EuReg Investigators
Affiliations

Assessment of first-line eradication treatment in Greece: data from the European Registry on Helicobacter pylori management (Hp-EuReg)

Theodore Rokkas et al. Ann Gastroenterol. 2022 Jan-Feb.

Abstract

Background: Helicobacter pylori (H. pylori) is the most common chronic bacterial infection. Its management has to rely on local effectiveness, given the geographical variability of bacterial antibiotic resistance. We evaluated treatment effectiveness in naïve patients in Greece, as part of the European Registry on the management of H. pylori (Hp-EuReg).

Methods: Patients were registered in the AEG-REDCap Electronic Case Report Form from 2013-2020. All cases with a first-line treatment were included. Modified intention-to-treat (mITT) analysis was used.

Results: A total of 547 patients from 5 medical institutions were treated with the following regimens: concomitant with proton pump inhibitors (PPIs), clarithromycin, amoxicillin and metronidazole (concomitant-C+A+M) (38%); hybrid with PPI, clarithromycin, amoxicillin and metronidazole (hybrid-C+A+M) (20%); sequential with PPI, clarithromycin, amoxicillin and tinidazole (sequential-C+A+T) (12%); sequential with PPI, clarithromycin, amoxicillin and metronidazole (sequential-C+A+M) (12%); concomitant with PPI, clarithromycin, amoxicillin and tinidazole (concomitant-C+A+T) (8%); triple with PPI, clarithromycin and amoxicillin (triple-C+A) (7%); and other (3%). Overall compliance was 99%. Triple-C+A, sequential-C+A+T, sequential-C+A+M and concomitant-C+A+T were used from 2013-2015. The respective mITT cure rates (95% confidence interval) were 92% (78-98), 87% (76-94), 67% (54-78) and 91% (79-98). Since 2015, patients were also treated with concomitant-C+A+M and hybrid-C+A+M regimens, with respective mITT cure rates of 90% (85-94) and 88% (80.5-94). Adverse events were reported by 31% of the patients, dysgeusia being the most frequent (15%).

Conclusions: "Optimized" H. pylori therapies should achieve cure rates over 90%. In Greece, at present, only non-bismuth quadruple concomitant regimens achieve this target and can be recommended as first-line treatment.

Keywords: Greece; Helicobacter pylori; Hp-EuReg; treatment.

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Conflict of interest statement

Conflicts of interest: Dr. Megraud received research support from Aptalis Pharma, bioMerieux and Mobidiag and is a consultant for Phathom Pharmaceuticals. Dr. Gisbert has served as speaker, consultant, and advisory member for, or has received research funding from Mayoly, Allergan, Diasorin, Phathom and Gebro Pharma. Dr Nyssen has received research funding from Mayoly and Allergan

Figures

Figure 1
Figure 1
Percentages of regimens used as empirical first-line treatment in Greece C, clarithromycin; A, amoxicillin; M, metronidazole; T, tinidazole
Figure 2
Figure 2
Effectiveness of the regimens used in the Greek cohort. Modified intention to treat results are expressed as percentages with 95% confidence intervals (CI) C, clarithromycin; A, amoxicillin; M, metronidazole; T, tinidazole
Figure 3
Figure 3
Treatment prescription trends (2013-2020) in Greece C, clarithromycin; A, amoxicillin; M, metronidazole; T, tinidazole
See this image and copyright information in PMC

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