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<p>Helicobacter pylori (H. pylori) has been implicated in immune thrombocytopenia (ITP), but the magnitude and reliability of benefit from eradication therapy in randomized trials remain uncertain. We performed a PRISMA-guided, PROSPERO-registered (CRD420251149478) systematic review and meta-analysis restricted to randomized controlled trials (RCTs) comparing H. pylori eradication versus control in ITP. Random-effects models generated risk ratios (RRs) for categorical outcomes: complete response (CR), partial response (PR), overall response (CR + PR), no/minimal response (NR), and 1-year relapse, and mean differences (MDs) for platelet-count change at approximately 6 months. Heterogeneity was assessed using I² and τ². Robustness was evaluated using leave-one-out analyses and additional post hoc sensitivity analyses for clinically or statistically influential trials. Small-study effects were explored using funnel plots and Egger/Begg tests when sufficient studies were available. Eight RCTs (<i>n</i> = 297) across Asia and Latin America met inclusion. Eradication increased CR without statistical significance (RR 1.45, 95% CI 0.87–2.41; I²=40.9%) and did not change PR (RR 0.88, 0.57–1.36; I²=0%) or overall response (RR 1.04, 0.90–1.20; I²=35.9%). NR was significantly lower with eradication (RR 0.65, 0.49–0.85; I²=14.8%). Relapse at 1 year trended lower but was not significant (RR 0.49, 0.24–1.01; I²=0%). Platelet counts rose more after eradication at ~ 6 months (MD + 61.9 × 10⁹/L, 36.1–87.7; I²=74.9%). Leave-one-out analyses did not materially change the overall conclusions. In a post hoc sensitivity analysis excluding Tang 2013 from the platelet-change outcome because of unusually small reported SDs, the platelet-count benefit remained significant and heterogeneity decreased to I²=0%. Funnel plots and formal tests suggested small-study effects for CR and overall response, indicating that these estimates may be inflated; no/minimal response showed no evidence of asymmetry. In randomized trials, H. pylori eradication in ITP was associated with a lower risk of no/minimal response and a greater platelet-count increase, while effects on CR, PR, overall response, and relapse remained uncertain. Because CR and overall response showed evidence of small-study effects, the most robust categorical finding was the reduction in no/minimal response. Larger, adequately powered trials are needed to define which patients are most likely to benefit and to confirm the durability of platelet response.</p>

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Helicobacter pylori eradication for immune thrombocytopenia reduces non-response and raises platelet counts: Meta-analysis of randomized trials

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月28日

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  • Moath Hattab,
  • Fathi Milhem,
  • Hammam Jallad,
  • Mahmoud Suleiman,
  • Halla Albada,
  • Ayman Khaled,
  • Sakeena Saife,
  • Mira Hallak,
  • Sarah Saife,
  • Fadi Abualhommos,
  • Mohammad Bdair

摘要

Helicobacter pylori (H. pylori) has been implicated in immune thrombocytopenia (ITP), but the magnitude and reliability of benefit from eradication therapy in randomized trials remain uncertain. We performed a PRISMA-guided, PROSPERO-registered (CRD420251149478) systematic review and meta-analysis restricted to randomized controlled trials (RCTs) comparing H. pylori eradication versus control in ITP. Random-effects models generated risk ratios (RRs) for categorical outcomes: complete response (CR), partial response (PR), overall response (CR + PR), no/minimal response (NR), and 1-year relapse, and mean differences (MDs) for platelet-count change at approximately 6 months. Heterogeneity was assessed using I² and τ². Robustness was evaluated using leave-one-out analyses and additional post hoc sensitivity analyses for clinically or statistically influential trials. Small-study effects were explored using funnel plots and Egger/Begg tests when sufficient studies were available. Eight RCTs (n = 297) across Asia and Latin America met inclusion. Eradication increased CR without statistical significance (RR 1.45, 95% CI 0.87–2.41; I²=40.9%) and did not change PR (RR 0.88, 0.57–1.36; I²=0%) or overall response (RR 1.04, 0.90–1.20; I²=35.9%). NR was significantly lower with eradication (RR 0.65, 0.49–0.85; I²=14.8%). Relapse at 1 year trended lower but was not significant (RR 0.49, 0.24–1.01; I²=0%). Platelet counts rose more after eradication at ~ 6 months (MD + 61.9 × 10⁹/L, 36.1–87.7; I²=74.9%). Leave-one-out analyses did not materially change the overall conclusions. In a post hoc sensitivity analysis excluding Tang 2013 from the platelet-change outcome because of unusually small reported SDs, the platelet-count benefit remained significant and heterogeneity decreased to I²=0%. Funnel plots and formal tests suggested small-study effects for CR and overall response, indicating that these estimates may be inflated; no/minimal response showed no evidence of asymmetry. In randomized trials, H. pylori eradication in ITP was associated with a lower risk of no/minimal response and a greater platelet-count increase, while effects on CR, PR, overall response, and relapse remained uncertain. Because CR and overall response showed evidence of small-study effects, the most robust categorical finding was the reduction in no/minimal response. Larger, adequately powered trials are needed to define which patients are most likely to benefit and to confirm the durability of platelet response.