Current status of first- and second-line <i>Helicobacter pylori</i> eradication therapy in the metropolitan area: a multicenter study with a large number of patients

Mori, Hideki; Suzuki, Hidekazu; Omata, Fumio; Masaoka, Tatsuhiro; Asaoka, Daisuke; Kawakami, Kohei; Mizuno, Shigeaki; Kurihara, Naoto; Nagahara, Akihito; Sakaki, Nobuhiro; Ito, Masayoshi; Kawamura, Yo; Suzuki, Masayuki; Shimada, Yuji; Sasaki, Hirokazu; Matsuhisa, Takeshi; Torii, Akihiro; Nishizawa, Toshihiro; Mine, Tetsuya; Ohkusa, Toshifumi; Kawai, Takashi; Tokunaga, Kazutoshi; Takahashi, Shinichi

doi:10.1177/1756284819858511

Cited by 31 publications

(41 citation statements)

References 41 publications

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“…In this study, a significant trend of decreasing eradication rates was observed with increasing age, which is consistent with previous reports[ 27 , 28 ]. Possible reasons include lower tolerance to and compliance with therapy, more potential complications, increased risks of drug side effects, and increased antibiotic resistance because of higher accumulated antibiotic consumption[ 29 ].…”

Section: Discussionsupporting

confidence: 93%

“…Selecting a PPI with a stable effect and high efficacy that is weakly influenced by CYP2C19 genotypes can improve the eradication rate[ 12 ]. In addition to the modification of dual therapy by high-dose PPI mentioned above, vonoprazan, a first-in-class potassium-competitive acid blocker, was recently reported to be an independent factor for successful H. pylori eradication in both primary and rescue therapy[ 27 ].…”

Section: Discussionmentioning

confidence: 99%

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Current status of Helicobacter pylori eradication and risk factors for eradication failure

Yan¹,

Wang²,

Chen³

et al. 2020

WJG

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BACKGROUND The Helicobacter pylori ( H. pylori ) eradication rate is decreasing in the general population of China. AIM To evaluate the H. pylori eradication status in real-world clinical practice and to explore factors related to eradication failure. METHODS Patients with H. pylori infection who were treated with standard 14-d quadruple therapy and received a test of cure at a provincial medical institution between June 2018 and May 2019 were enrolled. Demographic and clinical data were recorded. Eradication rates were calculated and compared between regimens and subgroups. Multivariate analysis was performed to identify predictors of eradication failure. RESULTS Of 2610 patients enrolled, eradication was successful in 1999 (76.6%) patients. Amoxicillin-containing quadruple regimens showed a higher eradication rate than other quadruple therapy regimens (83.0% vs 69.0%, P < 0.001). The quadruple therapy containing amoxicillin plus clarithromycin achieved the highest eradication rate (83.5%). Primary therapy had a higher eradication rate than rescue therapy (78.3% vs 66.5%, P < 0.001). In rescue therapy, the amoxicillin- and furazolidone-containing regimens achieved the highest eradication rate (80.8%). Esomeprazole-containing regimens showed a higher eradication rate than those containing other proton pump inhibitors (81.8% vs 74.9%, P = 0.001). Multivariate regression analysis found that older age, prior therapy, and use of omeprazole or pantoprazole were associated with an increased risk of eradication failure. CONCLUSION The total eradication rate is 76.6%. Amoxicillin-containing regimens are superior to other regimens. Age, prior therapy, and use of omeprazole or pantoprazole are independent risk factors for eradication failure.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Current status of Helicobacter pylori eradication and risk factors for eradication failure

Yan¹,

Wang²,

Chen³

et al. 2020

WJG

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“…On the other hand, in Argentina 75% of patients were cured with clarithromycin TT but 93% achieved eradication with levofloxacin TT 6 . Interestingly, a Japanese study, where eradication rates with clarithromycin TT were evaluated over time during the period 2013‐2018, showed that treatment success improved markedly over that time period, coinciding with the use of the potassium competitive acid blocker (P‐CAB), vonoprazan, becoming the preferred means of acid inhibition over PPI 7 . This will be explored in more detail later in this review.…”

Section: Triple Therapymentioning

confidence: 99%

Review – Treatment of Helicobacter pylori infection 2020

et al. 2020

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This review summarizes important studies regarding Helicobacter pylori therapy published from April 2019 to April 2020. The main themes that emerge involve studies assessing antibiotic resistance, and there is also growing momentum behind the utility of vonoprazan as an alternative to proton pump inhibitor (PPI) therapy and also bismuth‐based regimens as a first‐line regimen. Antibiotic resistance is rising wherever it is being assessed, and clarithromycin resistance in particular has reached a point where it may no longer be a viable therapy without previous testing in many regions of the world. The evidence for the efficacy of a bismuth‐based quadruple therapy as a first‐line therapy is now very clearly established, and there is substantial evidence that it is the best performing first‐line therapy. The utility of vonoprazan as an alternative to PPI therapy, especially in resistant and difficult‐to‐treat groups, has also been considered in great detail this year, and it may offer an opportunity in the near future to reduce the problem of antibiotic resistance.

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“… 25 The eradication rate increased as the proportion of VPZ-containing regimens in the first-line eradication regimen increased. 26 However, it is not known whether P-CAB-based therapy or PPI-based therapy as the second-line treatment is more effective. In the phase III trial, some subjects who failed their allocated VPZ- or PPI-based first-line triple therapy received VPZ-based second-line triple therapy that consisted of VPZ, AMPC, and metronidazole (MTZ).…”

Section: Introductionmentioning

confidence: 99%

“…To date, prospective single-arm studies and retrospective studies that examined the effect of P-CAB-based triple therapy in second-line treatment have been performed. 26 – 28 However, there have been no randomized controlled studies to compare the treatment effect between P-CAB-based triple therapy and PPI-based triple therapy in second-line treatment. This study aimed to examine the differences in efficacy and safety between the second-line triple therapies that included VPZ or rabeprazole (RPZ) as the PPI.…”

Section: Introductionmentioning

confidence: 99%

Randomized controlled study on the effects of triple therapy including vonoprazan or rabeprazole for the second-line treatment of Helicobacter pylori infection

Hojo

Asaoka

Takeda

et al. 2020

Therap Adv Gastroenterol

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Background and Aim: Inhibition of gastric acid secretion is important for eradicating Helicobacter pylori. Vonoprazan (VPZ) is a strong, long-lasting inhibitor of gastric acid secretion. Studies that examined the effectiveness of VPZ-based triple therapy in second-line treatment have been performed. However, there have been no randomized controlled studies to compare the effect between VPZ-based triple therapy and proton pump inhibitor (PPI)-based triple therapy in second-line treatment, and it is not known which is more effective between VPZ-based and PPI-based therapies. This study aimed to compare the effectiveness of second-line triple therapies including VPZ or rabeprazole (RPZ) as the PPI. Methods: Eligible patients with H. pylori infection who failed first-line triple therapy were assigned randomly to the VPZ [VPZ40 mg/day, amoxicillin (AMPC) 1500 mg/day, metronidazole (MNZ) 500 mg/day] or RPZ (RPZ20 mg/day, AMPC1500 mg/day, MNZ500 mg/day) group. A 13C-urea breath test result of less than 2.5% was considered as successful eradication. Results: In total, 46 and 41 patients were analyzed as intention to treat (ITT) and per protocol (PP), respectively. Eradication rates in the VPZ and RPZ groups were 73.9% [95% confidence interval (CI) 51.6–89.8%] and 82.6% (95% CI 61.2–95.0%) based on ITT analysis, respectively ( p = 0.72). Based on PP analysis, the eradication rates in the VPZ and RPZ groups were 89.5% (95% CI 66.9–98.7%) and 86.4% (95% CI 65.1–97.1%), respectively ( p = 1.00). Two patients in the VPZ group and one in the RPZ group discontinued treatment due to side effects ( p = 1.00). Conclusion: There were no significant differences in efficacy and safety between second-line therapies including VPZ or RPZ.

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Current status of first- and second-line Helicobacter pylori eradication therapy in the metropolitan area: a multicenter study with a large number of patients

Cited by 31 publications

References 41 publications

Current status of Helicobacter pylori eradication and risk factors for eradication failure

Current status of Helicobacter pylori eradication and risk factors for eradication failure

Review – Treatment of Helicobacter pylori infection 2020

Randomized controlled study on the effects of triple therapy including vonoprazan or rabeprazole for the second-line treatment of Helicobacter pylori infection

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