Fourteen RCTs were included of which five were abstract publications. Nine RCTs were included of mono- versus dual-therapy interventions with 601 participants.
Seven studies, involving a total of 531 participants, compared lansoprazole with lansoprazole plus amoxycillin 1-3 g/day. Two studies, involving a total of 68 patients, compared the efficacy of lansoprazole alone with the combination of lansoprazole and clarithromycin 400-600 mg/day.
Two studies, involving a total of 105 participants, compared combination therapy with lansoprazole plus one, two, or three antibacterial agents.
Five RCTs were included reviewing triple therapy with lansaprazole versus omeprazole with over 650 participants (exact number not stated).
Lansoprazole has a high degree of efficacy in eradicating H. pylori, above all when used within treatment schemes including amoxicillin or clarithromycin, and metronidazole or tinidazole. This efficacy is comparable to that of other PPIs.
Results for monotherapy versus dual therapy (7 studies of lansoprazole alone versus lansoprazole plus amoxicillin) found gastric and duodenal ulcer healing rates were similar and not statistically significant; gastric ulcer healing with monotherapy 90.8% versus dual therapy 88.5% (OR = 0.8; 95% CI: 0.3, 1.9) and duodenal ulcer healing with monotherapy 95.7% versus dual therapy 97.0% (OR = 1.5, 95% CI: 0.4, 5.7). An additional two studies of lansoprazole alone versus lansoprazole plus clarithromycin found gastric ulcer healing using monotherapy 89.3% versus 92.5% for dual therapy (OR = 1.6; 95% CI: 0.3, 9.3). Total eradication of H. pylori using monotherapy for gastric ulcers was 13.3% versus 45.9% for dual therapy (OR = 6.2; 95% CI:2.9, 13.7) and duodenal ulcer eradication with monotherapy was 8.3% versus 58.3% for dual therapy (OR = 13.6, 95% CI: 6.9, 26.7). An additional two studies of lansoprazole alone versus lansoprazole plus clarithromycin found gastric ulcer eradication using monotherapy 0% versus 27.5% for dual therapy (OR not calculated).
Results for dual therapy versus triple- or quadruple-therapy (2 studies) found peptic ulcer healing rates were 96.4% for dual therapy versus 99% for triple- or quadruple-therapy (OR = 1.8, 95% CI: 0.1, 23.0), chi-square = 0.51. Total eradication of H. pylori using dual therapy versus triple- or quadruple-therapy (2 studies) found combined gastric and duodenal eradication rates were 57.1% for dual therapy versus 91.8% (OR = 8.5; 95% CI:2.9, 24.5), chi-square 0.90, for triple-or quadruple therapy.