Minocycline in the eradication of Helicobacter pylori infection: A systematic review and meta-analysis

Abstract

Background: Difficulty in obtaining tetracycline, increased adverse reactions, and relatively complicated medication methods have limited the clinical application of the classic bismuth quadruple therapy. Therefore, the search for new alternative drugs has become one of the research hotspots. In recent years, minocycline, as a semisynthetic tetracycline, has demonstrated good potential for eradicating Helicobacter pylori (H. pylori) infection, but the systematic evaluation of its role remains lacking.

Aim: To explore the efficacy, safety, and compliance of minocycline in eradicating H. pylori infection.

Methods: We comprehensively retrieved the electronic databases of PubMed, Embase, Web of Science, China National Knowledge Infrastructure, SinoMed, and Wanfang database as of October 30, 2023, and finally included 22 research reports on H. pylori eradication with minocycline-containing regimens as per the inclusion and exclusion criteria. The eradication rates of H. pylori were calculated using a fixed or a random effect model, and the heterogeneity and publication bias of the studies were measured.

Results: The single-arm meta-analysis revealed that the minocycline-containing regimens achieved good overall H. pylori eradication rates, reaching 82.3% [95% confidence interval (CI): 79.7%-85.1%] in the intention-to-treat analysis and 90.0% (95%CI: 87.7%-92.4%) in the per-protocol analysis. The overall safety and compliance of the minocycline-containing regimens were good, demonstrating an overall incidence of adverse reactions of 36.5% (95%CI: 31.5%-42.2%). Further by traditional meta-analysis, the results showed that the minocycline-containing regimens were not statistically different from other commonly used eradication regimens in eradication rate and incidence of adverse effects. Most of the adverse reactions were mild to moderate and well-tolerated, and dizziness was relatively prominent in the minocycline-containing regimens (16%).

Conclusion: The minocycline-containing regimens demonstrated good efficacy, safety, and compliance in H. pylori eradication. Minocycline has good potential to replace tetracycline for eradicating H. pylori infection.

Keywords: Eradication; Helicobacter pylori; Minocycline; Resistance; Safety.

Figure 1

Scheme of the minocyclines’ mechanism of action. Amino acids and tRNAs are linked together by aminoacyl-tRNA synthetase to produce specific Aminoacyl-tRNAs. ribosomes on the ribosomal complex then read the code along the 5’-3’ direction of the mRNAs while linking various aminoacyl-tRNA-transported amino acids according to the instructions of the mRNA coding sequences for the process of protein synthesis. When minocycline enters into bacteria, it specifically binds to the A site of bacterial ribosomal 30S subunit aminoacyl group, thus blocking the aminoacyl-tRNA binding at this site, preventing peptide chain elongation and bacterial protein synthesis, and exerting bactericidal effects. AA: Amino acids.

Figure 2

Literature identification process.

Figure 3

Forest plots comparing eradication rates for intention-to-treat and per-protocol analyses of quadruple regimens with and without minocycline. CI: Confidence interval.

Figure 4

Forest plots comparing eradication rates for intention-to-treat and per-protocol analyses of quadruple regimens with and without minocycline-metronidazole. CI: Confidence interval.

Figure 5

Comparison of the incidence of adverse reactions of quadruple therapy and dizziness in quadruple therapy with and without minocycline. A: Comparison of the incidence of adverse reactions of quadruple therapy with and without minocycline; B: Comparison of the incidence of dizziness in quadruple therapy with and without minocycline. CI: Confidence interval.

Figure 6

Funnel plots of all included studies through intention-to-treat and per-protocol analyses. A: Intention-to-treat analyses; B: Per-protocol analyses.

Figure 7

Sensitivity analysis of all included studies by sequentially removing each study with intention-to-treat and per-protocol analyses. A: Intention-to-treat analyses; B: Per-protocol analyses. CI: Confidence interval.