Efficacy and Tolerability of Second-Line Metronidazole Triple Therapy Using Vonoprazan for Helicobacter pylori Eradication in Japan—Comparative Study: Vonoprazan vs. Proton Pump Inhibitors

Abstract

Aim: To investigate the efficacy and tolerability of second-line metronidazole triple therapy with vonoprazan (VPZ) for Helicobacter pylori (H. pylori).Methods: We retrospectively reviewed medical records of patients who experienced clarithromycin triple therapy failure and were treated with secondline (20 mg VPZ (n = 274)/30 mg lansoprazole (n = 323) or 10 mg rabeprazole (n = 141) twice daily, 750 mg amoxicillin twice daily, 250 mg metronidazole twice daily for 7 days) eradication therapies. Successful eradication rates were compared between two groups: those receiving VPZ and those receiving a proton pump inhibitor (PPI). Adverse events were also investigated. Results: Successful second-line eradication rates according to ITT analysis and PP analysis, respectively, were 79.9% and 92.4% for VPZ therapy and 83.6% and 93.3% for PPI therapy. There were no significant differences between treatment groups. The eradication rates in those who had received first-line VPZ therapy previously according to ITT and PP analysis were 75.2% and 88.1%, respectively; in contrast, values were 82.5% and 95.4%, respectively, for those who had received first-line PPI therapy previously. In second-line therapy, the overall adverse event rate for VPZ therapy was the same as for PPI therapy. Conclusions: The efficacy and tolerability of metronidazole-containing second-line triple therapy with VPZ or a PPI were equivalent.How to cite this paper: Ohtaka, M., Miura, M., Hanawa, M.,

Galectin-2 Has Bactericidal Effects against Helicobacter pylori in a β-galactoside-Dependent Manner

“…Although the widespread use of this therapy reduced the morbidity of H. pylori-mediated peptic ulcers and gastric cancer [5,6], the bacterium eradication efficacy remained approximately 70% due to the appearance of clarithromycin resistant bacterium [7]. The bactericidal efficacy of secondary therapy substituting metronidazole for clarithromycin is approximately 80% [8] and the value is suspected to decrease in the future due to the speculated appearance of the antibiotic-resistant bacterium [9]. In addition, amoxicillin cannot be prescribed to patients with penicillin allergy.…”

Preparation and biological evaluation of metronidazole derivatives with monoterpenes and eugenol

“…Metronidazole was and still is a reliable antibacterial with no evidence of serious bacterial resistance issues . However, bacterial resistance for some pathogens such as H. pylori may occur . Other unwanted side‐effects and safety issues may also occur, even though it is known to be highly tolerable …”