Sequential therapy – more studies are still required
Bibliographic record
Abstract
We read the randomised controlled trial (RCT) by Kim et al. with great interest.1 This demonstrated that 10-day sequential therapy was as safe as, and more efficacious than, 14-day standard triple therapy as first line eradication regimen for H. pylori in Korea. These results are consistent with those of systematic reviews and meta-analyses of previous RCTs.2, 3 However, the majority of these had been performed in Italy,4 hence the importance of the current data. Moreover, the authors should be commended on choosing a ‘worthy’ comparator, namely 14-day triple therapy. To our knowledge, apart from two other RCTs,5, 6 all previous trials have compared the 10-day sequential therapy to either a 7- or 10-day triple regimen, both of which would be expected to perform suboptimally. Nevertheless, in our opinion, the results should be interpreted with caution. The study was described as ‘single-blind’, but it is unclear who was blinded, and for which outcome. The assessment of H. pylori status at entry (single rapid urease test for the majority) and post-treatment (single urea breath test) was not as rigorous as experts have recommended.7 There was no mention of prospective trial registration, and no justification was provided for enrolling a further 199 patients in addition to the a priori calculated sample size of 210 (suggestive of continued enrolment until the desired level of statistical significance was reached). Furthermore, the absence of pre-treatment antimicrobial resistance data in this study limits generalisability of the results to other populations. Overall, despite existing limitations, the study by Kim et al. provides much needed data on sequential therapy from Asia. However, a recent study from Latin America did not concur with these results.5 Thus, there is still an unmet need for high-quality RCTs assessing sequential therapy, especially in North America and Northern Europe. Declaration of personal interests: GL has served as a consultant for AstraZeneca. Declaration of funding interests: GL has received research funding from AstraZeneca.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.165 | 0.266 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.017 | 0.020 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.008 | 0.028 |
| Open science | 0.008 | 0.003 |
| Research integrity | 0.019 | 0.019 |
| Insufficient payload (model declined to judge) | 0.060 | 0.013 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".