H. pylori eradication provides short-term prevention of aspirin-induced peptic ulcer bleeding in older adults (HEAT)

Reference

Hawkey C, Avery A, Coupland CAC, et al, for the HEAT Trialists. Helicobacter pylori eradication for primary prevention of peptic ulcer bleeding in older patients prescribed aspirin in primary care (HEAT): a randomised, double-blind, placebo-controlled trial. Lancet 2022;400(10363):1597-1606.

Synopsis

These investigators conducted this pragmatic trial in primary care settings in the United Kingdom. The participants were 60 years older, were taking no more than 325 mg aspirin daily, and had H. pylori based on urea breath testing. They were randomized to receive a 1-week H. pylori eradication regimen (lansoprazole 30 mg, clarithromycin 500 mg, and metronidazole 400 mg twice daily; n = 2677) or 1 week of matching placebo (n = 2675). After a median of 5 years of follow-up, 12.7% of the intervention patients and 14.5% of the control patients either died or withdrew from the study. After conducting some fancy statistical tests, the authors determined that during the first 2.5 years of follow-up, the eradication group had fewer definite or probable peptic ulcer bleeds than the control group (6 vs 17; 0.92 events per 1000 person-years vs 2.61 events per 1000 person-years). The authors report the number needed to treat as 238 patients (95% CI 184 - 1661). These differences largely evaporated beyond 2.5 years. Some messiness of the study comes from the declining use of aspirin over time and the 10% increased use of proton pump inhibitor medication in both groups (< 3% at baseline).