High Body Mass Index Is Correlated with the Success of Vonoprazan-Based Second-Line Therapy for <i>Helicobacter Pylori </i>Infection

Abstract

Eradication of Helicobacter pylori (Hp) is necessary for preventing peptic ulcers and stomach cancer. The potassium-competitive acid blocker vonoprazan is a gastric acid secretion inhibitor that improves the success rate of Hp eradication through its immediate and persistent inhibition of acid excretion. In Japan, first-line treatment involves a regimen in which vonoprazan is combined with amoxicillin and clarithromycin, while second-line treatment involves vonoprazan combined with amoxicillin and metronidazole. However, in contrast to the vonoprazan-based first-line therapy, no studies have investigated the factors influencing the success of vonoprazan-based second-line therapy. In this study, we therefore aimed to investigate factors related to the success of vonoprazan-based second-line therapy. We analyzed the association between the success of Hp eradication and patient factors including metronidazole/amoxicillin minimal inhibitory concentrations (MICs). MICs were measured using the Hp isolated from each patient. A receiver operating characteristic (ROC) analysis was conducted to examine continuous variables and eradication success. We reviewed the records of 33 patients (age: 34-79 years, male/female: 22/11, and body mass index (BMI): 16.1-28.8 kg/m 2 ) who underwent vonoprazan-based second-line therapy after failure of firstline therapy at seven Japanese facilities between October 2018 and June 2019. The eradication success rate was 81.8% (27/33). ROC analysis revealed an area under the curve and BMI cutoff value of 0.796 and 23.8 kg/m 2 , respectively. The eradication success rate was higher in patients with high BMI than in those with low BMI (p = 0.007). Our findings indicate that higher BMI is correlated with the success of vonoprazan-based second-line therapy.

Alcohol increases treatment failure for Helicobacter pylori eradication in Asian populations

“…Table 1 shows the characteristics of the 40 studies [ 1 – 3 , 7 , 8 , 11 – 17 , 19 – 46 ] selected. Among these studies, 24 studies [ 1 – 3 , 7 , 11 – 13 , 16 , 17 , 22 , 30 , 32 , 34 – 41 , 43 – 46 ] were conducted in Asia and 16 outside Asia. Seven studies [ 15 , 23 , 26 , 30 – 32 , 37 ] included all patients with peptic ulcers as subjects.…”

“…Among the studies conducted in Asia, only seven studies [ 16 , 32 , 36 , 37 , 43 – 45 ] had data on alcohol intake. Regarding the antibiotic agent(s) administered, clarithromycin was administered in 17 studies, and nitroimidazoles were administered in 3 studies [ 11 , 32 , 46 ]. A VPZ-based therapy regimen was followed in five studies [ 2 , 3 , 16 , 17 , 46 ].…”

“…Regarding the antibiotic agent(s) administered, clarithromycin was administered in 17 studies, and nitroimidazoles were administered in 3 studies [ 11 , 32 , 46 ]. A VPZ-based therapy regimen was followed in five studies [ 2 , 3 , 16 , 17 , 46 ]. The NOS results revealed that the average quality score was 6.2 (range, 5–8), indicating that the methodological quality of these studies was generally good.…”

Vonoprazan - a new drug for inhibiting gastric acid secretion

“…T. Kasai et al studied the impact of Body Mass Index (BMI) on the success of second-line therapy for H. pylori eradication. They found that patients with higher BMI were more successful in H. pylori eradication than patients with lower BMI [10].…”

Importance of Metronidazole in Vonoprazan-based <i>Helicobacter pylori</i> Treatment in Japan

“…Second, metronidazole sensitivity has relatively little effect on eradication outcomes in metronidazole-containing vonoprazan-based therapy. Kasai et al investigated factors related to H. pylori eradication success associated with vonoprazan, amoxicillin, and metronidazole triple therapy (7). They showed that H. pylori metronidazole susceptibility was not associated with the eradication success of the triple therapy investigated.…”