{
  "abstract": "Objective To assess the efficacy, safety and compliance with dual, triple and quadruple therapy first-line regimens for Helicobacter pylori eradication.Design A systematic review and network meta-analysis (NMA) reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses NMA guidance.Data sources PubMed, Cochrane Library, ProQuest and Scopus were searched until 12 October 2025.Eligibility criteria Randomised controlled trials (RCTs) published in English that measured the eradication rate, adverse events and compliance rates of dual therapy compared with triple or quadruple therapy for H. pylori first-line treatment.Data extraction and synthesis Data extraction and risk-of-bias assessment were performed by two independent reviewers. The data were analysed and represented as pooled ORs. Heterogeneity was assessed using meta-regression and trim-and-fill analyses.Results Pairwise meta-analysis of 56 RCTs showed that dual therapy had no different eradication rates than triple therapy (intention-to-treat (ITT): OR 0.88, 95% CI 0.60 to 1.29; per-protocol (PP): OR 0.76, 95% CI 0.46 to 1.25). Dual therapy outperformed quadruple therapy (OR 1.20, 95% CI 1.04 to 1.39) with fewer adverse events (OR 0.32, 95% CI 0.28 to 0.38) and higher compliance rates (OR: 1.49, 95% CI 1.26 to 1.76). Based on the NMA, RAC-7 has the highest probability of effective treatment for both ITT (P-score=0.9436) and PP (P-score=0.9545).Conclusion Dual therapy represents a promising first-line option, demonstrating comparable efficacy and adverse event rates with higher compliance, although triple therapy showed the highest probability of being the most effective first-line regimen in the NMA, followed by quadruple therapy. Further studies in non-Asian populations, along with resistance-guided treatment approaches, are needed to refine global eradication strategies.",
  "authors": [
    {
      "affiliations": [
        "Department of Environmental and Preventive Medicine, Oita University Faculty Of Medicine Graduate School of Medicine, Yufu, Japan",
        "Faculty of Medicine, University of Indonesia, Jakarta, Central Jakarta, Indonesia"
      ],
      "name": "Iqbal Taufiqqurrachman"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Department of Internal Medicine, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia"
      ],
      "name": "Ari Fahrial Syam"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Department of Internal Medicine, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia"
      ],
      "name": "Hasan Maulahela"
    },
    {
      "affiliations": [
        "Division of Gastroenterology, Department of Internal Medicine, Rumah Sakit Umum Pusat Nasional Dr Cipto Mangunkusumo, Central Jakarta, Indonesia",
        "Human Cancer Research Center, Indonesian Medical and Research Education Institute, Universitas Indonesia Fakultas Kedokteran, Jakarta, Indonesia"
      ],
      "name": "Murdani Abdullah"
    },
    {
      "affiliations": [
        "Department of Environmental and Preventive Medicine, Oita University Faculty Of Medicine Graduate School of Medicine, Yufu, Japan",
        "Division of Genome-Wide Microbiology, Research Center for Global and Local Infectious Diseases (RCGLID), Oita University, Yufu, Oita, Japan"
      ],
      "name": "Takashi Matsumoto"
    },
    {
      "affiliations": [
        "Gastroentero-Hepatology Division, Department of Internal Medicine, Airlangga University Faculty of Medicine, Surabaya, Indonesia",
        "Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia"
      ],
      "name": "Muhammad Miftahussurur"
    },
    {
      "affiliations": [
        "Department of Environmental and Preventive Medicine, Oita University Faculty Of Medicine Graduate School of Medicine, Yufu, Japan",
        "Division of Genome-Wide Microbiology, Research Center for Global and Local Infectious Diseases (RCGLID), Oita University, Yufu, Oita, Japan",
        "Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia",
        "Medicine-Gastroenterology, Baylor College of Medicine, Houston, Texas, USA"
      ],
      "name": "Yoshio Yamaoka"
    }
  ],
  "title": "Comparative efficacy, safety and compliance with dual, triple and quadruple therapy as the first-line treatment regimens for Helicobacter pylori eradication: a systematic review and network meta-analysis",
  "uid": "b426784d-4204-5d86-9086-4da6c943f5fb"
}