P2041 - Efficacy and Safety of Minocycline-Containing Bismuth Quadruple Therapies versus Standard First-Line Bismuth Quadruple Therapies for Helicobacter pylori Eradication: A Systematic Review and Meta-Analysis

Hakim Wazir, MBBS¹, Aagamjit Singh, MBBS², I M Khalid Reza, MBBS³, Hafsa Ajmal, MBBS⁴, Zeeshan Ahmed, MBBS⁴, Yousra Iftequar, MBBS⁵, Nandipi Vibha Sri, MBBS⁶, Noora Inam, MBBS⁷, Nayanika Tummala, MD⁸, Hareem Tahir, MBBS⁹, Muhammad Zahid Anwar, MBBS¹⁰, Anum Z. Khan, ¹¹, Ayesha Sharif, MD¹²
1Gajju Khan Medical College,Swabi Pakistan Medicine department, Shahmansor, Swabi, North-West Frontier, Pakistan; 2William Beaumont Hospital, Troy, MI; 3Enam Medical College, Dhaka, Dhaka, Bangladesh; 4King Edward Medical University, Lahore, Punjab, Pakistan; 5Dr. VRK Women’s Medical College, Hyderabad, Telangana, India; 6Navodaya Medical College, Raichur, India, Raichur, Karnataka, India; 7Gajju khan medical college, Swabi, Punjab, Pakistan; 8St. Mary's General Hospital, New York Medical College, Poughkeepsie, NY; 9Internal Medicine, University of South Dakota, Sioux Falls, SD; 10Lady Reading Hospital, Nowshera, North-West Frontier, Pakistan; 11Jinnah Medical Dental College, Karachi, Sindh, Pakistan; 12William Beaumont hospital, Royal Oak, MI

Introduction: Growing antibiotic resistance and limited availability of key components in standard Helicobacter pylori treatments have driven the search for effective alternatives. Minocycline, with its broad-spectrum activity and favorable pharmacokinetics, has emerged as a promising substitute. This meta-analysis compares the safety and efficacy of minocycline-containing bismuth quadruple therapy (MBQT) to conventional first-line BQT regimens, incorporating data from the recent study by Lin et al.

Methods: A comprehensive literature search was conducted on PubMed, EMBASE, Cochrane Library, and Science Direct from inception to May 20, 2025. After screening via Rayyan, data were extracted on an Excel spreadsheet. Quality was assessed using the Cochrane RoB 2.0 tool. Eligible randomized controlled trials (RCTs) were included and analyzed using RevMan 5.4. Outcomes assessed were intention-to-treat and per-protocol eradication rates. Adverse effects were compared among therapies. A random-effects model was used; an I² < 50% and p-value < 0.05 indicated homogeneity.

Results: Five RCTs with 7 interventions involving 2,812 patients were included. The pooled odds ratio (OR) for MBQT in intention-to-treat (ITT) analysis was 1.25 (95% CI: 0.96–1.61), showing a non-significant trend. No heterogeneity was detected (I² = 0.0%). In the modified ITT (mITT) analysis (2 studies), MBQT showed higher eradication (OR: 1.70, 95% CI: 0.00–1042.90), but wide CI and high heterogeneity (I² = 70.7%) limited interpretation. All studies were included in the per-protocol (PP) analysis, which showed a statistically significant improvement with MBQT (OR: 1.67, 95% CI: 1.14–2.45) and low heterogeneity (I² = 5.2%), suggesting consistent results (Figure 1). Although not statistically significant, MBQT was associated with a slightly lower rate of adverse events compared to standard therapy (OR: 0.81, 95% CI: 0.59–1.12). I² = 50.6% showed moderate heterogeneity in safety outcomes (Figure 2).

Discussion: Patients who completed the treatment benefited more from MBQT, which also has a comparable safety profile to conventional BQT regimens. For the treatment of H. pylori infection, MBQT may be considered a safe first-line alternative.


Figure: Figure 1. Forest plot of the included studies showing Intention-to-treat (ITT) eradication rates (as Odds Ratio with 95% Confidence Intervals), Modified intention-to-treat (mITT), and per-protocol (PP) eradication rates.


Figure: Figure 2. Forest plot of the included studies showing adverse effects of Minocycline-Containing Bismuth Quadruple
Therapies Versus Standard First-Line Bismuth Quadruple Therapies

Disclosures:
Hakim Wazir indicated no relevant financial relationships.
Aagamjit Singh indicated no relevant financial relationships.
I M Khalid Reza indicated no relevant financial relationships.
Hafsa Ajmal indicated no relevant financial relationships.
Zeeshan Ahmed indicated no relevant financial relationships.
Yousra Iftequar indicated no relevant financial relationships.
Nandipi Vibha Sri indicated no relevant financial relationships.
Noora Inam indicated no relevant financial relationships.
Nayanika Tummala indicated no relevant financial relationships.
Hareem Tahir indicated no relevant financial relationships.
Muhammad Zahid Anwar indicated no relevant financial relationships.
Anum Khan indicated no relevant financial relationships.
Ayesha Sharif indicated no relevant financial relationships.

Hakim Wazir, MBBS¹, Aagamjit Singh, MBBS², I M Khalid Reza, MBBS³, Hafsa Ajmal, MBBS⁴, Zeeshan Ahmed, MBBS⁴, Yousra Iftequar, MBBS⁵, Nandipi Vibha Sri, MBBS⁶, Noora Inam, MBBS⁷, Nayanika Tummala, MD⁸, Hareem Tahir, MBBS⁹, Muhammad Zahid Anwar, MBBS¹⁰, Anum Z. Khan, ¹¹, Ayesha Sharif, MD¹². P2041 - Efficacy and Safety of Minocycline-Containing Bismuth Quadruple Therapies versus Standard First-Line Bismuth Quadruple Therapies for <i>Helicobacter pylori</i> Eradication: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.