Rifabutin-Based Triple Therapy (RHB-105) for <i>Helicobacter pylori</i> Eradication

Graham, David Y.; Canaan, Yamil; Maher, James W.; Wiener, Gregory; Hultén, Kristina G.; Kalfus, Ira

doi:10.7326/m19-3734

Cited by 70 publications

(83 citation statements)

References 29 publications

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“…Mori et al reported a low prevalence of rifabutin‐resistant H pylori (1 of 29 cases) at third‐ and fourth‐line therapy 27 . A recent study utilizing rifabutin in all‐in‐one capsule with omeprazole and AMX showed a high eradication rate in an environment of clinically significant antibiotic resistance 39 . According to the report, rifabutin resistant strain was not observed at baseline (0/345), and even in 27 eradication failed cases after the rifabutin‐containing treatment.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of a new rifabutin‐based triple therapy with vonoprazan for refractoryHelicobacter pyloriinfection: A prospective single‐arm study

et al. 2020

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Background A small proportion of Helicobacter pylori‐infected individuals in Japan suffer failure of eradication therapy with third‐line regimens containing the potent acid suppressor, vonoprazan, and a quinolone. Objectives This prospective study evaluated the efficacy and safety of rifabutin‐based triple therapy with vonoprazan for refractory H pylori infection. Methods Patients who failed H pylori eradication by clarithromycin‐based first‐line, metronidazole‐based second‐line, and sitafloxacin‐based third‐line therapies were recruited. After obtaining informed consent, patients received eradication therapy with vonoprazan (20 mg), amoxicillin (750 mg), and rifabutin (150 mg) twice daily for 10 days. Eradication was confirmed by a negative H pylori stool antigen or urea breath test at least 8 weeks after the end of therapy. Results Nineteen patients were included in the study. All of the patients completed the course of medication. Eradication of H pylori was confirmed in all of the patients (19/19; 100%, 95% confidence interval; 83‐100%). The most common adverse event was soft stool/diarrhea (4/19, 21%). No severe adverse event was observed. Conclusions Ten‐day rifabutin with amoxicillin and vonoprazan triple therapy appears to be effective and safe for refractory H pylori infections. However, considering the recent publications showing high eradication rates with vonoprazan amoxicillin dual therapy, confirmation will require future studies comparing our new therapy with vonoprazan‐amoxicillin dual with similar doses and duration and with vonoprazan‐rifabutin dual therapy.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of a new rifabutin‐based triple therapy with vonoprazan for refractoryHelicobacter pyloriinfection: A prospective single‐arm study

et al. 2020

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“…Finally, for the present review, to the best of our knowledge the most updated in the literature, all the studies that have evaluated the efficacy of rifabutin-containing regimens for the treatment of H. pylori infection are summarized in Table 2 [19,20,36,39,41,47,48,51,52,57,[67][68][69]77,78,. Overall, from the 3052 patients treated with rifabutin-containing regimens included in Table 2, a mean H. pylori eradication rate (by intention-to-treat analysis) of 73% (95% confidence interval (CI), 69-78%) was calculated (Figure 3).…”

Section: Efficacy Of Rifabutin For H Pylori Eradicationmentioning

confidence: 99%

Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

Gisbert¹

2020

Pathogens

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Nowadays, apart from having to know first-line Helicobacter pylori eradication regimens well, we must also be prepared to face treatment failures. The aim of this review is to summarize the role of rifabutin in the management of H. pylori infection. Bibliographical searches were performed in PubMed. Data on resistance and efficacy of rifabutin-containing regimens on H. pylori eradication were meta-analyzed. Mean H. pylori rifabutin resistance rate (39 studies, including 9721 patients) was 0.13%; when studies only including patients naïve to H. pylori eradication treatment were considered, this figure was even lower (0.07%). Mean H. pylori eradication rate (by intention-to-treat) with rifabutin-containing regimens (3052 patients) was 73%. Respective cure rates for second-, third-, fourth- and fifth-line therapies, were 79%, 69%, 69% and 72%. Most studies administered rifabutin 300 mg/day, which seemed to be more effective than 150 mg/day. The ideal length of treatment remains unclear, but 10–12-day regimens are generally recommended. Adverse events to rifabutin treatment in H. pylori studies were relatively infrequent (15%), and severe adverse events were exceptional (myelotoxicity was the most significant, although always reversible). In summary, rifabutin-containing therapy represents an encouraging strategy generally restricted, at present, to patients where previous (usually multiple) eradication regimens have failed.

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“…The recent approval of the combination regimen of omeprazole, rifabutin, and amoxicillin is likely to have a major impact on management. Although rifabutin-based regimens were not recommended for first-line use in the 2017 ACG guideline, that document was prepared before the availability of the results of the US-based clinical trial [59]. Antibiotic resistance testing-where available-should still be considered after failure of eradication with two different regimens.…”

Section: Discussionmentioning

confidence: 99%

Update on the Management of Helicobacter pylori Infection

Saleem

Howden

2020

Curr Treat Options Gastro

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Purpose of review Our purpose was to provide an update on methods and indications for testing and treatment selection focusing on novel modalities. Recent findings Increasing antibiotic resistance has reduced treatment effectiveness. Antibiotic resistance testing is not widely available in North America where there are insufficient resistance and susceptibility data. Quadruple regimens (bismuth-based or concomitant/non-bismuth-based) have been recommended first-line. A rifabutin-based combination product recently approved by the US Food and Drug Administration is highly effective and should simplify treatment. The potassium-competitive acid blocker vonoprazan is being evaluated as part of dual or triple combination regimens. Molecular-based genotypic testing for antibiotic resistance and an effective H. pylori vaccine remain under development. Summary Inability to test for antibiotic resistance renders treatment selection empiric. However, resistance to rifabutin and amoxicillin remains rare. Effective management continues to comprise appropriate diagnostic testing for active infection, utilization of an effective regimen, and post-treatment testing.

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Rifabutin-Based Triple Therapy (RHB-105) for Helicobacter pylori Eradication

Cited by 70 publications

References 29 publications

Efficacy and safety of a new rifabutin‐based triple therapy with vonoprazan for refractoryHelicobacter pyloriinfection: A prospective single‐arm study

Efficacy and safety of a new rifabutin‐based triple therapy with vonoprazan for refractoryHelicobacter pyloriinfection: A prospective single‐arm study

Rifabutin for the Treatment of Helicobacter pylori Infection: A Review

Update on the Management of Helicobacter pylori Infection

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