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Fig 1.

Flowchart of study search and screening.

This diagram outlines the steps involved in identifying, selecting, and excluding studies for inclusion in the analysis, including the number of studies at each stage of the process.

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Table1.

The characteristics of included RCTs.

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Fig 2.

The risk of bias graph.

This figure presents the proportion of included RCTs that were assessed as having low, unclear, or high risk of bias across six domains. The graph provides an overall visualization of the methodological quality of the included studies.

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Fig 3.

The network comparison of interventions for primary and safety Outcomes.

The network diagram illustrates the comparative relationships among different intervention groups. The size of each circle represents the sample size of the corresponding intervention group, while the connecting lines indicate direct comparisons between groups. The thickness of the lines reflects the number of studies conducted for each comparison. Fig 3.A displays the network comparison for the primary outcome, and Fig 3.B represents the network comparison for the safety outcome.

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Fig 4.

The ranking probabilities of quadruple therapies for efficacy and safety.

The figure illustrates the ranking probabilities of different quadruple therapies. Each colored curve represents a specific therapy, with the area under the curve indicating its likelihood of being the most effective or safest. A larger area suggests better efficacy or safety. Fig 4.A presents the results for the primary outcome, while Fig 4.B shows the results for the safety outcome.

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Fig 5.

The league table of network meta-analysis in primary outcome.

Each cell displays the results of comparisons between the “column intervention” and the “row intervention,” expressed as [OR, 95% CI]. **** indicates statistical significance (P < 0.05). An OR > 1 suggests that the column intervention is more effective than the row intervention.

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Fig 6.

The league table of network meta-analysis in safety outcome.

Each cell displays the results of comparisons between the “column intervention” and the “row intervention,” expressed as [OR, 95% CI]. **** indicates statistical significance (P < 0.05). An OR < 1 suggests that the column intervention is more safe than the row intervention.

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