Rosario Anton

Su1172 Non-Bismuth Quadruple (Concomitant) Therapy for Eradication of H. pylori: Standard vs. Optimized (14-Day, High-Dose PPI) Regimen

BACKGROUND:Helicobacter pylori infection is usually treated with a proton pump inhibitor (PPI), amoxicillin and clarithromycin, but it fails in ≥ 20% of patients. AIM: To estimate, by a systematic review and meta-analyses, the most effective rescue treatments after the failure of a first-line therapy with PPI, amoxicillin and clarithromycin in H. pylori eradication. METHODS: Selection of studies: Meta-analyses were performed with randomized clinical trials (RCT) that assessed the efficacy of second-line regimens; the generic inverse variance was applied on prospective and retrospective studies. Inclusion criteria: studies treating H. pylori-positive patients after clarithromycin-amoxicillin-PPI failure. Exclusion criteria: Secondline treatment based on the antibiotic sensitivity, or if the confirmation of eradication were made only by serology, PCR or polyclonal stool antigen test. Search strategy: Bibliographical searches were performed in PubMed, CINAHL, Cochrane Library, ClinicalTrials.gov, DDW y EHSG, up to April 2013. Data synthesis: Intention to treat eradication rate. RESULTS: The efficacies of the second-line treatments are shown on the table attached. A metaanalysis comparing the triple therapy with levofloxacin-amoxicillin-PPI against the quadruple bismuth-metronidazole-tetracycline-PPI regimen showed a non-statistically significant tendency towards better results levofloxacin (OR = 1.74; 95% C.I. = 0.83-3.67; p = 0.14; I2 = 79%; 6 studies; 1,057 patients). CONCLUSION: The most effective second-line treatments, after a clarithromycin-amoxicillin-PPI failure, are the metronidazole-amoxicillin-PPI or a 10 days levofloxacin-amoxicillin-PPI therapy. More high quality trials, performed outside Japan, are needed to verify the efficacy of the 14 days dual therapy with amoxicillin-PPI.

Effectiveness of anti-TNFα drugs in patients with Crohn's disease who do not achieve remission with their first anti-TNFα agent.

BACKGROUND Anti-TNF treatment is effective for Crohns disease (CD); however, some patients did not achieve remission with these drugs. AIMS To evaluate the short-term effectiveness of a second anti-TNF in CD patients who did not achieve remission with the first one and to assess its durability. METHODS Patients who did not achieve remission with their first anti-TNF were included. The short-term response of the second anti-TNF was assessed, the long-term response was evaluated in patients who achieved remission (Kaplan-Meier). Cox-regression was performed to identify predictors of loss of efficacy. RESULTS In all, 118 CD patients received a second anti-TNF after primary failure of the first. The first anti-TNF was discontinued because of non-response in 54% of patients and partial response in 46%. Fifty-one percent of patients achieved remission in the short-term. The probability of remission was lower in patients for whom the drug indication was perianal disease (OR=0.3, 95% CI=0.1-0.7, P=0.005). The dose was increased in 33% of patients, and 37% achieved/regained remission. The probability of maintaining remission was 76%, 68% and 64% at 12, 18 and 24 months, respectively. CONCLUSIONS Approximately half of the patients achieved remission with a second anti-TNF after primary failure of the first, this strategy was less effective in patients with perianal disease.