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• W1992261738 abstract "Sirs, We appreciate the attention that Dr Huang and Professor Hunt have given to our review. However, we take exception to the suggestion that our review will be recognized by most readers as a meta-analysis. To avoid any possible confusion we stated quite clearly in both the Summary and Discussion of our paper, as others have done,1234 that the pooled analysis approach 1234567 is at variance with the principles associated with meta-analysis. Our review was specifically focussed on clarithromycin-based therapies, and we deliberately did not pool results from studies using different proton pump inhibitors (PPIs). In their letter, Dr Huang and Professor Hunt raise four technical issues, first, suggesting that we did not include three studies (their references 3–5). The abstract from Kadayifci et al. (their reference 3) was indeed missed, but in a review of such large proportions, omitting just one study out of 152 has no material effect. Adding these data raises the pooled result for OCA from 82.7% (n = 2886/3489) to 82.8% (n = 2919/3527). The data reported by Buda et al. (their reference 4) have been presented in at least three abstracts, and we cited the most recent (reference 31 of our review). The pilot study by Stack et al. (their reference 5) with the new proton pump inhibitor rabeprazole was excluded because it was the sole example. Dr Huang and Professor Hunt state in their letter, and concluded in abstracts,6, 7 that clarithromycin 500 mg b.d. in the 7-day PPI + clarithromycin + amoxycillin combination is significantly more effective than 250 mg b.d. for Helicobacter pylori eradication. We do concur that suitably sized, double-blind, comparative studies are the only way to truly measure the relative efficacies of different regimens. However, only one of their five citations (their references 3, 6–9) to comparative studies supports their conclusion. The study by Lind et al. (their reference 7) showed that OAC 500 mg b.d. was more effective than OAC 250 mg b.d. with ITT eradication rates of 90.6% and 79.5%, respectively. In contrast, Kadayifci et al. (their reference 3) detected no difference in ITT eradication rates between OAC 250 mg b.d. (86%) and OAC 500 mg b.d. (88%). We rejected the data from Aydin et al. (their reference 8) from our review (citation 66) because there was insufficient information in their abstract to determine an ITT eradication rate [the authors actually reported eradication rates of ≈ 93% with 1-week regimens of OAC 250 mg b.d. and OAC 500 mg b.d.]. Subjects in the study from Costa et al. (their reference 9) were given AC 250 mg b.d. and AC 500 mg b.d. with lansoprazole o.d. Reviews have indicated that different PPIs within an eradication regimen cannot be considered equivalent,1, 8 and therefore Dr Huang and Professor Hunt cannot justifiably pool these data with lansoprazole and those from regimens that included omeprazole for the very reasons they have stated in their correspondence. Nevertheless, this appears to have been precisely the case in their reference 6, the title of which describes a meta-analysis. Furthermore, lansoprazole 30 mg o.d. was used by Costa et al., which our analysis suggests is a daily dose associated with a lower eradication rate. Moreover, the consensus conferences have unanimously recommended twice-daily dosing of PPIs in 1-week eradication regimens.91011 Our inclusion of the study by Gisbert et al. (their reference 10) of patients who had failed previous H.␣pylori eradication treatment is of no consequence to the pooled eradication rate. Only 12 patients were involved, of whom 10 were cured with OCA. Dr Huang and Professor Hunt's comment that all patients in RBC-based triple therapy studies were receiving eradication therapy for the first time is incorrect. Our international RBC protocols specifically do not exclude such patients.121314 We appreciate now that references 181 and 182 concern the same study. The unfortunate practice of repeated reporting of data is endemic to this field of study. Finally, in our review we made no recommendations regarding dosage in the 1-week regimens based on clarithromycin with either a nitroimidazole or amoxycillin. It is, however, difficult to conclude from comparative studies that the eradication rates of PPIs with AC 500 mg are higher than with AC 250 mg. Whereas Lind et al. (their reference 7) showed that OAC 500 mg b.d. was indeed statistically more effective than OAC 250 mg b.d., Bigard et al.15 more recently reported a numerical inferiority. The only pertinent study with lansoprazole (their reference 9) showed no statistically significant benefit of the higher dose of clarithromycin, and no relevant studies with pantoprazole have been published." @default.
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• W1992261738 title "Reply-clarithromycin-based triple therapies" @default.
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• W1992261738 doi "https://doi.org/10.1046/j.1365-2036.1999.0467b.x" @default.
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