UEGJournal Abstracts 2021 - 55

Contact E-Mail Address: opnyssen@gmail.com
Introduction: Even with the currently most effective treatment regimens,
approximately 10-20% of patients will fail to achieve H. pylori eradication.
Aims & Methods: To evaluate the effectiveness and safety of second-line
empirical treatments in Europe. A systematic prospective registry of the
clinical practice of European gastroenterologists regarding H. pylori infection
and treatment was established. All infected adult patients were
systematically registered at AEG-REDCap e-CRF from 2013 to February
2021. Variables included: Patient's demographics, previous eradication
attempts, prescribed treatment, adverse events, and outcomes. Modified
intention-to-treat (mITT) and per-protocol (PP) analyses were performed
and data were subject to quality review.
Results: Overall, 5,932 patients from 31 countries received a secondline
therapy; from those, 5,228 (88%) were treated empirically and were
therefore included for analysis. Mean age was of 51 (±15) years, 64% were
women and 6% had penicillin allergy. Most frequent treatment indications
were dyspepsia (55%) and gastroduodenal ulcer (17%). Endoscopy was
performed in 47% of the cases and 13
C-urea breath test was used in 45%
to diagnose the infection.
Overall effectiveness was 84% (both by mITT and PP). Over 97% of patients
were compliant. Adverse events were reported in 28% of the cases
and tolerance was quite similar among therapies. Most frequent secondline
prescriptions and effectiveness per antibiotic combination is shown
in table 1.
After failure of first-line clarithromycin-containing treatment, optimal
eradication (>90%) was obtained with moxifloxacin-containing triple
therapy, or quadruple therapy with levofloxacin and bismuth. In patients
receiving triple regimens containing levofloxacin or moxifloxacin and levofloxacin-bismuth
quadruple regimens, cure rates were optimized with
14-day regimens using high doses of proton pump inhibitors (PPIs). However,
single capsule or quadruple therapy with levofloxacin and bismuth
achieved consistent eradication rates regardless of the PPI dose, duration
of therapy, or previous first-line treatment regimen.
Treatment
Triple-A+L
Single capsule*
Quadruple-A+L+B
Triple-C+A
Quadruple-M+Tc+B
Quadruple C+A+B
Quadruple-C+A+M
Triple-A+Mx
Triple-A+M
Other
Total
1,624
889
647
264
257
221
143
103
562
346
N % Use mITT, N (%) (95% CI) PP, N (%) (95% CI)
1,434 (81)
810 (89)
559 (88)
246 (78)
32.1
17.6
12.8
6.8
5.2
5.1
4.4
2.8
2.0
11.1
232 (84)
154 (87)
207 (82)
135 (91)
48 (58)
NA
5,056 100% 4,326 (84)
(79-83) 1,413 (81) (79-83)
(87-92)
(86-91)
(73-84)
(79-89)
(81-93)
(76-87)
(86-96)
(47-69)
NA
223 (85)
148 (87)
202 (82)
135 (91)
86 (58)
NA
(80-90)
(81-93)
(77-88)
(86-96)
(47-79)
NA
(82-85) 4,236 (84) (80-83)
7-13 days
95%CI - 95% confidence interval, C - clarithromycin, M - metronidazole,
T - tinidazole, A - amoxicillin, L - levofloxacin, B - bismuth salts, Tc - tetracycline,
Mx - moxifloxacin, N - Total number of patients receiving an empirical treatment,
Other - Other second-line empirical treatments with less than 100 patients
treated in each category;*three-in-one single capsule containing metronidazole
tetracycline and bismuth
Table 1. Frequency of second-line empirical treatment prescriptions and
effectiveness by modified intention-to-treat (mITT) and per-protocol (PP)
analyses
Conclusion: Empirical second-line regimens including either 14-day triple
therapies with levofloxacin or moxifloxacin, or 14-day levofloxacin-bismuth
quadruple or 10-day three-in-one single capsule bismuth quadruple
therapies provided optimal effectiveness. However, many other secondline
treatments evaluated reported low eradication rates.
Vol. 9 | October 2021
14-29 days
≥ 30 days
Recent 30-day
use and/or
distant use
(vs no use)
Recent only
Distant only
Both use
0.87
(0.77-0.99)
1.31
(1.23-1.40)
1.30
(1.12-1.51)
794 (90) (88-92)
542 (89) (86-91)
241 (78) (73-84)
Disclosure: Dr. Nyssen has received research funding from Mayoly, Allergan.
Dr.
Gisbert has served as a speaker, a consultant and advisory member
for or has received research funding from Mayoly, Allergan, Diasorin, Phathom
and Gebro Pharma.
OP070
TIMING OF PREVIOUS EXPOSURE TO ANTIBIOTICS AND FAILURE OF
CLARITHROMYCIN-CONTAINING TRIPLE THERAPY FOR HELICOBACTER
PYLORI: A POPULATION-BASED STUDY
C.-G. Guo1, F. Jiang1, K.S. Cheung1
, B. Li2
, P.H. Ooi1
, W.K Leung1
1The University of Hong Kong, Department of Medicine, Hong
Kong, China, 2The University of Hong Kong, Department of Surgery,
Hong Kong, China
Contact E-Mail Address: waikleung@hku.hk
Introduction: Due to increasing antibiotic resistance, the success rate of
conventional Helicobacter pylori (HP) eradication therapy is declining.
Studies showed that previous exposure to specific antibiotics, like macrolide
and metronidazole, adversely affected treatment success rates.
Aims & Methods: This is a population-based retrospective cohort study including
all HP patients who received the first course of clarithromycin-containing
triple therapy in 2003-2018. Failure of eradication was identified by
the need of retreatment for HP. Prior antibiotic uses before the start of the
primary triple therapy (up to 180 days, 1 or 3 years) were retrieved. Logistic
regression model was used to evaluate the relationship between previous
antibiotic exposure and need of retreatment conditioned by the year of
primary therapy and adjusted for age, sex, duration of therapy (7, 10 or 14
days), triple therapy type (amoxicillin or metronidazole), and use of proton
pump inhibitors in the past 180 days. Analyses for antibiotic use in recent
(within 30 days) or distant (from 30 to 180 days, 1 or 3 years) period and with
different definition of recent use (60 days) were also performed.
Results: 120,396 HP infected patients were included with an overall retreatment
rate of 7.56%. Overall, any antibiotic use before triple therapy
was associated with increased risk of retreatment (OR for 0-180 days: 1.21,
95% CI 1.14-1.28) and the risk increased progressively with longer duration
of use. The results were also consistent for prior exposure up 1 or 3
years; and for distant antibiotic use using both 30 and 60 days as cut-off
(Table).
Antibiotic use
in 180 days
Duration of any
use (vs no use)
1-6 days
1.13
(1.05-1.21)
1.31
(1.18-1.44)
1.37
(1.16-1.61)
1.63
(1.25-2.13)
OR
(95% CI)
Antibiotic use
in 1 year
Duration of
any use
(vs no use)
1-6 days
7-13 days
14-29 days
≥ 30 days
Recent 30-day
use and/or
distant use
(vs no use)
Recent only
Distant only
Both use
0.83
(0.72-0.95)
1.36
(1.29-1.43)
1.35
(1.18-1.55)
1.17
(1.10-1.25)
1.32
(1.22-1.44)
1.58
(1.41-1.77)
1.80
(1.51-2.15)
OR
(95% CI)
Antibiotic use
in 3 years
Duration of
any use (vs no
use)
1-6 days
7-13 days
14-29 days
≥ 30 days
Recent 30day
use and/
or distant use
(vs no use)
Recent only
Distant only
Both use
Table. Timing of previous antibiotic use and risk of retreatment
55
0.85
(0.72-0.99)
1.36
(1.30-1.42)
1.31
(1.16-1.48)
1.18
(1.11-1.24)
1.24
(1.16-1.33)
1.55
(1.44-1.68)
2.10
(1.91-2.31)
OR
(95% CI)
Tuesday, October 5, 2021
Monday, October 4, 2021
Sunday, October 3, 2021
UEGJournal Abstracts 2021

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