Impact of clarithromycin resistance and CYP2C19 genetic polymorphism on treatment efficacy of Helicobacter pylori infection with lansoprazole- or rabeprazole-based triple therapy in Japan

Abstract

The key to successful eradication of H. pylori, using lansoprazole or rabeprazole with clarithromycin and amoxicillin, is clarithromycin susceptibility, not CPY2C19 polymorphism.

The Influence of CYP2C19 Polymorphism on Eradication of Helicobacter pylori: A Prospective Randomized Study of Lansoprazole and Rabeprazole

“…[24][25][26][27][28] In Japan, standard rabeprazole dose is 10 mg 14 and most Japanese articles uses 10 mg b.i.d. for H. pylori eradication.…”

“…29,30 No differences among CYP2C19 genetic polymorphism in our RAC are compatible with other previous study results. [24][25][26][27][28] In the direct comparison of LAC and RAC according to genotypic difference, the eradication rate of LAC in each genotypic polymorphism is statistically similar to that of RAC. The studies about pharmacokinetics and pharmacodynamics of both PPIs are like below; Mean 24-hour pH and percentage time for pH＞4 were not significantly different between lansoprazole 30 mg and rabeprazole 20 mg in 72 healthy volunteers.…”

“…31 The median values of the 24-hour percent time for pH＞4 of HomEM were 59% in 20 mg rabeprazole and 56% in 30 mg lansoprazole. 32 There were 3 clinical studies 25,26,28 that directly compared H. pylori eradication rates of lansoprazole and rabeprazole according to CYP2C19 polymorphism. Although these studies had relatively small sample size and insufficient randomization, they all reported no significant differences of eradication rate between lansoprazole and rabeprazole group according to each CYP2C19 polymorphism.…”

Cytochrome P450 2C19 loss-of-function polymorphism is associated with an increased treatment-related mortality in patients undergoing allogeneic transplantation

“…Interestingly, the poorest eradication rate was found not in PMs, but in EMs. [5][6][7] All of our study-patients received omeprazole.…”

“…Among the drugs which are metabolized by CYP2C19 enzymes are cytostatics, proton pump inhibitors, antidepressants, sedative, beta blockers, antiviral and anti-fungal agents. [2][3][4][5][6][7][8][9] Recently, it was demonstrated that PMs of CYP2C19 showed a decrease in platelet responsiveness to clopidogrel. 10 In another study, it was reported that patients treated with antidepressants and genotyped as PMs for CYP2D6 and CYP2C19, remained in hospital for longer (median 57.5 versus 40.0 days) compared to IMs.…”