European Registry on H. pylori Management (Hp-EuReg): Empirical first-line treatment use and effectiveness trends in Europe in the period 2013-2020

Abstract

Background: The impact of consensus, prescription choices and efficacy trends on clinical practice over time has not been studied in depth. Methods: International multicenter prospective non-interventional registry aimed to evaluate the decisions and outcomes of H. pylori management by European gastroenterologists. All infected adult patients were registered at AEG-REDCap e-CRF up to April 2020. Modified intention-to- treat (mITT) and time trend analyses were performed. Results: So far 24,882 first-line empirical prescriptions from 29 European countries have been included. Overall, the most common prescribed treatments in 2013-20 were triple therapies; however, a shift in antibiotic regimens was identified. Triple therapies decreased from >50% of prescription in 2013/15 to less than 20% in 2018/20; concomitant therapy decreased from 21% in 2013/14 to 13% in 2019/20, while Pylera® increased from 0-1% in 2014/2015 to 18% in 2018/20. An increase in the average duration of treatments from 10.9 days in 2013 to 12.0 in 2020, and of the daily dose of PPI was identified. No trend was identified regarding the effectiveness of each specific treatment (data now shown); however, an overall 5% improvement in first-line mITT effectiveness was observed (Table 1). Conclusions: European gastroenterological practice is constantly adapting to the newest published evidence and recommendations (reducing the use of triple therapies and increasing the duration of treatment and the dose of PPIs), with a subsequent improvement in overall effectiveness.