Usefulness of vonoprazan, a potassium ion-competitive acid blocker, for primary eradication of<i>Helicobacter pylori</i>

Yamada, Shinya; Kawakami, Takumi; Nakatsugawa, Yoshikazu; Suzuki, Takahiro; Fujii, Hideki; Tomatsuri, Naoya; Nakamura, Hideki; Sato, Hideki; Okuyama, Yûsuke; Kimura, Hiroyuki; Yoshida, Norimasa

doi:10.4292/wjgpt.v7.i4.550

Cited by 35 publications

(40 citation statements)

References 19 publications

(20 reference statements)

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“…Unlike the present study, recent Japanese retrospective studies of second-line H. pylori eradication therapy did not show a significant difference between PCAB and PPIbased regimens [21][22][23][24][25]. However, 4 studies showed a trend of superiority of PCAB over PPI-based regimens by 4-6% for second-line eradication success [21,22,24,25]. We can suggest 2 possible explanations why the past studies did not show statistically significant differences.…”

Section: Discussioncontrasting

confidence: 78%

A Potassium-Competitive Acid Blocker-Based Regimen as Second-Line Therapy Improves Helicobacter pylori Eradication

et al. 2019

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Background/Aims: Although a potassium-competitive acid blocker (PCAB)-based regimen improves the rate of successful Helicobacter pylori first-line eradication, the efficacy of a PCAB-based regimen as second-line therapy is unclear. The aim of this study is to compare the success of second-line eradication of H. pylori using PCAB and proton pump inhibitor (PPI)-based regimens. Methods: From 2014 to 2017, 624 patients who underwent second-line H. pylori eradication were enrolled. A standard triple regimen for second-line H. pylori eradication includes metronidazole 250 mg, amoxicillin 750 mg, and PPI or PCAB twice daily for 7 days. The success of eradication was compared using intention-to-treat, per-protocol, and propensity-score matching analysis. Results: All patients completed the 7-day course of therapy. Patients using a PCAB-based regimen had a higher rate of eradication than those using a PPI-based regimen in both intention-to-treat (90% [298/330] vs. 85% [250/294], p = 0.045) and per-protocol analyses (96% [298/309] vs. 91% [250/274], p = 0.008). Adverse events occurred in 4 patients. Propensity score matching analysis acquired 274 matched pairs. Patients using a PCAB-based regimen had a higher rate of eradication than those using a PPI-based regimen (96% [264/274] vs. 91% [250/274], p = 0.013). Conclusions: PCABbased second-line H. pylori eradication is significantly better than PPI-based therapy.

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Section: Discussioncontrasting

confidence: 78%

A Potassium-Competitive Acid Blocker-Based Regimen as Second-Line Therapy Improves Helicobacter pylori Eradication

et al. 2019

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“…A total of 133 studies were identified in the PubMed, EMBASE, and Cochrane Library databases. After reviewing the titles, abstracts, and full texts, we ultimately included 14 studies in the meta‐analysis. The detailed selection process is shown in Figure .…”

Section: Resultsmentioning

confidence: 99%

“…The detailed selection process is shown in Figure . In the 12 included studies, there are 2 well‐designed RCTs and 12 retrospective studies . The basic characteristics of all of the included studies are presented in Table .…”

Section: Resultsmentioning

confidence: 99%

Review: A Japanese population‐based meta‐analysis of vonoprazan versus PPI for Helicobacter pylori eradication therapy: Is superiority an illusion?

et al. 2017

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“…year where this agent is approved for use, all of which have found superiority for vonoprazan over PPI in triple therapy formats. [100][101][102][103][104][105][106][107][108][109][110][111] This is summarized in Table 2. It is noteworthy, however, that vonoprazan has been tested in triple therapies only and not in other regimens such as quadruple therapy, sequential therapy, or with bismuth.…”

Section: Vonoprazanmentioning

confidence: 99%

Treatment of Helicobacter pylori infection 2017

et al. 2017

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Over the last decade, it has been widely reported that the success of Helicobacter pylori eradication treatment is falling. A steady decline was observed in the number of patients achieving eradication with standard first-line triple therapy of two antibiotics and a proton pump inhibitor [1][2][3]. It now appears that the first-line eradication therapies most commonly used in everyday clinical practice fall considerably short of the 80% intention-to-treat (ITT) eradication rates that are considered the minimal acceptable levels as recommended in the Maastricht guidelines [4]. Interestingly, two studies emerged from Asian centers in the last 12 months, which show that, in this part of the world at least, eradication levels using standard therapies remain close to 80%. A Malaysian study showed a standard 1-week pantoprazole, amoxycillin, and clarithromycin regimen to be well tolerated and highly efficacious with a per-protocol eradication rate of 84% [5]. A Japanese study showed remarkably consistent per-protocol eradication rates from 2001 to 2009 fluctuating between 75 and 78% for standard 7-day triple-therapy regimens [6]. A limit of many studies especially those including clarithromycin or levofloxacin is that H. pylori susceptibility to the drugs, which is the main prediction of failure, was not tested. LevofloxacinThe use of levofloxacin as a first-line therapy has been examined in great depth in the last year. Levofloxacin may be used as a substitute for clarithromycin in either a standard triple or sequential regimen. A large study comparing the antibiotics in either regimen shows a clear advantage to levofloxacin in both combinations. Per-protocol cure rates for triple therapy were 66% for omeprazole-clarithromycin-amoxycillin compared with 83% for omeprazole-levofloxacin-amoxycillin and 81% for omeprazole-amoxycillin-clarithromycin-metronidazole vs 85% for omeprazole-amoxycillin-levofloxacinmetronidazole, with no difference in compliance rates or adverse events [7]. It has been proposed that sequential levofloxacin-based regimens are of most benefit in areas where clarithromycin resistance is in excess of 15%, and another study in such an area showed eradication rates of 81% with clarithromycin sequential therapy compared with 96% with levofloxacin sequential therapy. A third arm in this study looked at the dose of levofloxacin required and illustrated no benefit in increasing the dose from 250 to 500 mg [8]. Indeed, another study went so far as to suggest that once-daily dosing of a levofloxacin-based triple regimen may be as efficacious as twice daily [9]. The literature from Asia also seems to support levofloxacin as a good alternative first-line therapy. A study on a triple regimen showed per-protocol eradication rates of 78% for standard clarithromycin-containing therapies compared with 83% for a levofloxacin-based regimen [10]. Another study from the Middle East looked at whether combining clarithromycin and levofloxacin in the same regimen could be Keywords Peptic ulcer disease, resistance, compli...

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Usefulness of vonoprazan, a potassium ion-competitive acid blocker, for primary eradication ofHelicobacter pylori

Cited by 35 publications

References 19 publications

A Potassium-Competitive Acid Blocker-Based Regimen as Second-Line Therapy Improves Helicobacter pylori Eradication

A Potassium-Competitive Acid Blocker-Based Regimen as Second-Line Therapy Improves Helicobacter pylori Eradication

Review: A Japanese population‐based meta‐analysis of vonoprazan versus PPI for Helicobacter pylori eradication therapy: Is superiority an illusion?

Treatment of Helicobacter pylori infection 2017

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