Vonoprazan-Based Regimen Is More Useful than PPI-Based One as a First-Line<i>Helicobacter pylori</i>Eradication: A Randomized Controlled Trial

Maruyama, Masafumi; Tanaka, Naoki; Kubota, Daisuke; Miyajima, Masayuki; Kimura, Takefumi; Tokutake, Koujiro; Imai, Ryujiro; Fujisawa, Toru; Mori, Hiromitsu; Matsuda, Yoshiaki; Wada, Shinpei; Horiuchi, Akira; Kiyosawa, Kendo

doi:10.1155/2017/4385161

Cited by 57 publications

(68 citation statements)

References 24 publications

(28 reference statements)

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“…A large Japanese trial comparing vonoprazan vs PPI in firstline triple therapy reported a significantly higher eradication rate with vonoprazan (90.8%) compared to esomeprazole (77.5%) or rabeprazole (68.4%). 53 The eradication rates of vonoprazan with amoxicillin and clarithromycin in clarithromycin-resistant patients were 82.9%. 6,54 A meta-analysis of 14 studies with over 14 636 patients found that the pooled eradication rates of vonoprazan-containing regimens were higher than that of PPI-containing regimens when used as first-line therapies.…”

Section: Vonopr a Z Anmentioning

confidence: 97%

“…The utility of vonoprazan, a novel potassium‐competitive acid blocker that provides reversible acid suppression by preventing K+ from binding to gastric H+/K+‐ATPase, has been further explored in the past year. A large Japanese trial comparing vonoprazan vs PPI in first‐line triple therapy reported a significantly higher eradication rate with vonoprazan (90.8%) compared to esomeprazole (77.5%) or rabeprazole (68.4%) . The eradication rates of vonoprazan with amoxicillin and clarithromycin in clarithromycin‐resistant patients were 82.9% …”

Section: Vonoprazanmentioning

confidence: 99%

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Treatment of Helicobacter pylori infection in 2018

et al. 2018

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Treatment options for the eradication of Helicobacter pylori continue to evolve. There have been many guidelines for H. pylori treatment published, which may lead to some confusion. However, most are in agreement with the most recent iteration of the Maastricht treatment guidelines. Triple therapy is still the most frequently used treatment, especially in areas of low clarithromycin resistance. Its best results are achieved when taken for a minimum of 10 days and with high-dose acid suppression. Quadruple therapy is gaining in popularity particularly in areas with increasing resistance to standard triple therapy. Whether three antibiotics, or bismuth and two antibiotics are used, excellent eradication rates are achieved, albeit with increased side effects. Levofloxacin second-line therapy is widely used; however bismuth, when available, is an increasingly successful option. Sequential therapy is challenging in terms of compliance and is no longer recommended. This past year witnessed a notable increase in the number of studies based on antimicrobial susceptibility testing and tailored eradication therapy, reflecting the role of culture-guided treatment, which may well represent the future of H. pylori treatment and prevent the inappropriate use of antibiotics.

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Section: Vonopr a Z Anmentioning

confidence: 97%

Section: Vonoprazanmentioning

confidence: 99%

Treatment of Helicobacter pylori infection in 2018

et al. 2018

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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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“…A double-blind phase 3 study of triple therapy with VPZ (VAC) for first-line H. pylori eradication showed a high success rate of 92.6% [13]. Recently, a retrospective study with a large sample size [14], a meta-analysis [15] and prospective studies [16] [17] showed that the eradication rate of first-line VPZ (VAC) therapy was higher than that with PPI (PAC) therapy. In Japan, MNZ triple therapy is decided as second-line therapy under the National Health Insurance System.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Tolerability of Second-Line Metronidazole Triple Therapy Using Vonoprazan for Helicobacter pylori Eradication in Japan—Comparative Study: Vonoprazan vs. Proton Pump Inhibitors

Ohtaka¹,

Miura²,

Hanawa³

et al. 2018

OJGas

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Aim: To investigate the efficacy and tolerability of second-line metronidazole triple therapy with vonoprazan (VPZ) for Helicobacter pylori (H. pylori).Methods: We retrospectively reviewed medical records of patients who experienced clarithromycin triple therapy failure and were treated with secondline (20 mg VPZ (n = 274)/30 mg lansoprazole (n = 323) or 10 mg rabeprazole (n = 141) twice daily, 750 mg amoxicillin twice daily, 250 mg metronidazole twice daily for 7 days) eradication therapies. Successful eradication rates were compared between two groups: those receiving VPZ and those receiving a proton pump inhibitor (PPI). Adverse events were also investigated. Results: Successful second-line eradication rates according to ITT analysis and PP analysis, respectively, were 79.9% and 92.4% for VPZ therapy and 83.6% and 93.3% for PPI therapy. There were no significant differences between treatment groups. The eradication rates in those who had received first-line VPZ therapy previously according to ITT and PP analysis were 75.2% and 88.1%, respectively; in contrast, values were 82.5% and 95.4%, respectively, for those who had received first-line PPI therapy previously. In second-line therapy, the overall adverse event rate for VPZ therapy was the same as for PPI therapy. Conclusions: The efficacy and tolerability of metronidazole-containing second-line triple therapy with VPZ or a PPI were equivalent.How to cite this paper: Ohtaka, M., Miura, M., Hanawa, M.,

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Vonoprazan-Based Regimen Is More Useful than PPI-Based One as a First-LineHelicobacter pyloriEradication: A Randomized Controlled Trial

Cited by 57 publications

References 24 publications

Treatment of Helicobacter pylori infection in 2018

Treatment of Helicobacter pylori infection in 2018

Treatment of Helicobacter pylori infection 2017

Efficacy and Tolerability of Second-Line Metronidazole Triple Therapy Using Vonoprazan for Helicobacter pylori Eradication in Japan—Comparative Study: Vonoprazan vs. Proton Pump Inhibitors

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