Vonoprazan<i>versus</i>conventional proton pump inhibitor‐based triple therapy as first‐line treatment against<i>Helicobacter pylori</i>: A multicenter retrospective study in clinical practice

Shichijo, Satoki; Hirata, Yoshihiro; Niikura, Ryota; Hayakawa, Yoku; Yamada, Atsuo; Mochizuki, Seibu; Matsuo, Keigo; Isomura, Yoshihiro; Seto, Motoko; Suzuki, Nobumi; Suzuki, Hirobumi; Yamamoto, Shin Ichiroh; Sugimoto, Takafumi; Omae, Tomoya; Okamoto, Makoto; Watabe, Hirotsugu; Togo, Goichi; Takano, Noriyuki; Fukui, Kiichi; Ito, Yuri; Koike, Kazuhiko

doi:10.1111/1751-2980.12398

Cited by 33 publications

(23 citation statements)

References 40 publications

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“…In recent years, several studies have compared eradication rates between VPZ-containing and PPI-containing triple therapies across centers in Japan. As shown in Table 2, up until September 2018, 23 reports had investigated the efficacy of first-line VPZ-containing therapy (21 reports for VPZ/AMX/CLR and 2 reports for VPZ/MNZ/CLR) (Matsumoto et al, 2016; Murakami et al, 2016; Noda et al, 2016; Shichijo et al, 2016; Shinozaki et al, 2016, 2018; Suzuki et al, 2016; Tsujimae et al, 2016; Yamada et al, 2016; Kajihara et al, 2017; Katayama et al, 2017; Maruyama et al, 2017; Nishizawa et al, 2017; Ono et al, 2017; Sakurai et al, 2017; Sue et al, 2017a,b, 2018a; Sugimoto et al, 2017; Tanabe et al, 2017, 2018; Mori et al, 2018; Ozaki et al, 2018), and 19 reports had compared the efficacy between VPZ-containing therapy and PPI-containing therapy, including 3 randomized control trials (Murakami et al, 2016; Maruyama et al, 2017; Sue et al, 2018a) and 16 non-randomized retrospective cohort trials (Matsumoto et al, 2016; Noda et al, 2016; Shichijo et al, 2016; Shinozaki et al, 2016; Suzuki et al, 2016; Tsujimae et al, 2016; Yamada et al, 2016; Kajihara et al, 2017; Nishizawa et al, 2017; Ono et al, 2017; Sakurai et al, 2017; Sue et al, 2017a,b; Mori et al, 2018; Ozaki et al, 2018; Tanabe et al, 2018).…”

Section: First-line Vonoprazan-containing Eradication Therapymentioning

confidence: 99%

Role of Vonoprazan in Helicobacter pylori Eradication Therapy in Japan

Sugimoto

Yamaoka

2019

Front. Pharmacol.

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Complete eradication of Helicobacter pylori is important for preventing the development of gastric cancer. The outcome of H. pylori eradication therapy is mainly dependent on bacterial susceptibility to antimicrobial agents and potent neutralization of intragastric pH across 24 h, especially when using acid-sensitive antimicrobial agents such as clarithromycin (CLR), amoxicillin and sitafloxacin. However, conventional regimens comprising twice-daily doses (bid) of proton pump inhibitors (PPIs) are generally insufficient for maintaining the required gastric acid secretion for 24 h for successful eradication in all H. pylori-positive patients. Further, the increasing prevalence of CLR-resistant strains with each year has led to a decrease in eradication rates of first-line PPI- and CLR-containing therapies in developed countries, including Japan. In 2015, the potassium-competitive acid blocker vonoprazan (VPZ) became clinically available in Japan. VPZ competitively inhibits H+/K+-ATPase activity more potently than PPIs (e.g., omeprazole, lansoprazole, rabeprazole, pantoprazole, and esomeprazole). Therefore, a VPZ-containing H. pylori eradication regimen is expected to increase the eradication rate compared with conventional regimens containing a standard dose of PPI. In fact, a recent meta-analysis that investigated the efficacy of first-line eradication therapy showed that a VPZ-containing regimen achieved a higher eradication rate than a PPI-containing regimen. While the Maastricht V/Florence Consensus Report recommends selecting a bismuth or non-bismuth quadruple therapy and concomitant therapy for patients living in areas with high prevalence of CLR resistance, a VPZ-containing regimen demonstrates effectiveness for patients infected with CLR-resistant strains and patients living in areas where the prevalence of CLR-resistant strains is >15%. As a next step, studies are needed to determine the factors affecting the clinical outcome of VPZ-containing therapy and optimal VPZ-containing alternative regimens for tailored treatments. In this review, we summarize the advantages and disadvantages of VPZ in H. pylori eradication therapy.

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Section: First-line Vonoprazan-containing Eradication Therapymentioning

confidence: 99%

Role of Vonoprazan in Helicobacter pylori Eradication Therapy in Japan

Sugimoto

Yamaoka

2019

Front. Pharmacol.

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“…In 2016, a phase III randomized, double-blind study reported an eradication rate of 92.6% (95% CI: 89.2–95.2%) using a first-line vonoprazan-containing regimen and 75.9% (70.9–80.5%) using a lansoprazole-containing regimen [ 12 ]. Other studies have reported that the efficacy of first-line vonoprazan-containing regimens ranges from 82.9% to 94.6% [ 13 , 14 , 15 , 16 , 29 , 30 , 31 ]. Based on 21 studies that investigated a total of 12,010 patients receiving PPI-containing first-line therapy, no studies reported an eradication rate higher than 85% [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent study reported that vonoprazan 20 mg inhibits H + /K + -ATPase activity at a 400-fold lower dose than lansoprazole 30 mg at pH 6.6 [ 11 ]. Therefore, vonoprazan-containing eradication therapy appears to have a higher eradication rate than PPI-containing regimen [ 12 , 13 , 14 , 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of Antibiotic Susceptibility and CYP3A4/5 and CYP2C19 Genotype on the Outcome of Vonoprazan-Containing Helicobacter pylori Eradication Therapy

et al. 2020

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Background: Helicobacter pylori eradication containing the potassium-competitive acid blocker, vonoprazan, achieves a higher eradication rate than therapy with proton pump inhibitors (PPIs). Because vonoprazan is mainly metabolized by CYP3A4/5, CYP genotype may affect the eradication rate. We investigated the influence of antibiotic susceptibility and CYP3A4/5 and CYP2C19 genotypes on the eradication rates. Methods: A total of 307 Japanese who were genotyped for CYP3A4 *1/*22, CYP3A5 *1/*3 and CYP2C19 *1/*2/*3/*17, and investigated for susceptibility to antimicrobial agents, received vonoprazan-containing regimens: (1) With amoxicillin and clarithromycin as the first-line treatment; (2) with amoxicillin and metronidazole as the second-line treatment; or (3) with amoxicillin and sitafloxacin as the third-line treatment. Results: The eradication rate was 84.5% (95% confidence interval [CI]: 78.9–89.1%) using first-line, 92.6% (95% CI: 82.1–97.9%) using second-line and 87.5% (95% CI: 73.1–95.8%) using third-line treatment. Infection with clarithromycin-resistant strains was a predictive factor for failed eradication (odds ratio: 5.788, 95% CI: 1.916–17.485, p = 0.002) in multivariate analysis. No significant differences were observed in the eradication rate of regimens among CYP3A4, CYP3A5 and CYP2C19 genotypes. Conclusions: Genotyping for CYP3A4 *1/*22, CYP3A5 *1/*3 and CYP2C19 *1/*2/*3/*17 before vonoprazan-containing eradication treatment may not be useful for predicting clinical outcomes.

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“…Vonoprazan 20 mg demonstrated a more rapid and sustained acid-inhibitory effect than esomeprazole 20 mg or rabeprazole 10 mg [69]. Recent studies revealed that P-CAB based triple therapy was more effective than PPI-based triple therapy as a first-line H. pylori eradication method [70–73]. Furthermore, even in the presence of clarithromycin-resistant strains, P-CAB-based triple therapy showed good eradication rates that were superior to those for PPI-based triple therapy (76.1% versus 40.2%) [74].…”

Section: First-line Treatment Options For Cases With High Antibiotmentioning

confidence: 99%

Optimal First-Line Treatment forHelicobacter pyloriInfection: Recent Strategies

Lee

Park

2016

Gastroenterology Research and Practice

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A new treatment strategy is needed, as the efficacy of triple therapy containing clarithromycin—the current standard treatment for Helicobacter pylori infection—is declining. Increasing antibiotic resistance of H. pylori is the most significant factor contributing to eradication failure. Thus, selecting the most appropriate regimen depending on resistance is optimal, but identifying resistance to specific antibiotics is clinically challenging. In a region suspected to have high clarithromycin resistance, bismuth quadruple therapy and so-called nonbismuth quadruple therapies (sequential, concomitant, and sequential-concomitant hybrid) are some first-line regimen options. However, more research is needed regarding appropriate second-line treatments after first-line treatment failure. Tailored therapy, which is based on antibiotic sensitivity testing, would be optimal but has several limitations for clinical use, and an alternative technique is required. A novel potassium-competitive acid blocker-based eradication regimen could be a valuable eradication option in the near future.

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Vonoprazanversusconventional proton pump inhibitor‐based triple therapy as first‐line treatment againstHelicobacter pylori: A multicenter retrospective study in clinical practice

Abstract: Vonoprazan-based triple therapy is feasible, and has a higher rate for H. pylori eradication than conventional PPI as a first-line regimen.

Cited by 33 publications

References 40 publications

Role of Vonoprazan in Helicobacter pylori Eradication Therapy in Japan

Role of Vonoprazan in Helicobacter pylori Eradication Therapy in Japan

Effect of Antibiotic Susceptibility and CYP3A4/5 and CYP2C19 Genotype on the Outcome of Vonoprazan-Containing Helicobacter pylori Eradication Therapy

Optimal First-Line Treatment forHelicobacter pyloriInfection: Recent Strategies

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