S3119 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

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 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 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. 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. Conclusion: 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.