Rabeprazole Can Overcome the Impact of CYP2C19 Polymorphism on Quadruple Therapy

Abstract

In quadruple therapy, rabeprazole-based regimens had better efficacy than esomeprazole-based regimens. CYP2C19 polymorphism also played an important role in quadruple therapy. It seems advisable to change PPI to rabeprazole in second-line quadruple therapy.

The Optimal First-Line Therapy ofHelicobacter pyloriInfection in Year 2012

“…Ethnic differences in the frequencies of CYP2C19 gene polymorphism are well known. Asian people have a higher proportion of poor metabolizers (20 versus 5%) compared to whites [50, 51]. The different phenotypes result in different degrees of PPI metabolism.…”

“…The mechanisms whereby PPIs influence the efficacy of eradicating H. pylori include (1) PPIs make acid-labile antibiotics more stable by increasing gastric pH value, especially clarithromycin, thereby increasing concentration and H. pylori sensitivity to antibiotics (2) PPIs may alter transport of antibiotics from plasma to gastric juice, increase luminal concentrations and elevating the success rate of eradication [52]. CYP2C19 genotype-dependent H. pylori eradication rates were noted in many kinds of PPIs [51, 53, 54]. However, rabeprazole and esomeprazole were less influenced by polymorphism of CYP2C19 [51, 52].…”

“…CYP2C19 genotype-dependent H. pylori eradication rates were noted in many kinds of PPIs [51, 53, 54]. However, rabeprazole and esomeprazole were less influenced by polymorphism of CYP2C19 [51, 52]. …”

New dual therapy for primary treatment of Helicobacter pylori infection: A prospective randomized study in Shanghai, China

“…Furthermore, they found that at pH 3.0, which is the likely pH value at the gastric surface, gene expressions were decreased including cell envelope biosynthesis, cell division and penicillin‐binding protein genes. Effective amoxicillin‐based dual therapy seems to be possible if gastric pH is kept nearly neutral in 24 h. In our study, rabeprazole is the preferred antibiotic not only because it is a second‐generation PPI, that is, it is mainly metabolized via nonenzymatic sulfoxide reduction to form a thioether metabolite, but it is also less affected by the CYP2C19 genotype in comparison to other PPIs . Therefore, rabeprazole has been reported to have a greater and faster acid suppression effect than other PPIs …”

“…Rabeprazole, a newly developed PPI, has been reported to be less susceptible to the influence of cytochrome P450 2C19 (CYP2C19) polymorphism. 15 Therefore, it has a greater and faster acid suppressive effect than other PPIs. Moreover, amoxicillin is one of the most effective antibiotics for H. pylori infection with few side effects.…”