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Vonoprazan-based triple therapy is effective for Helicobacter pylori eradication irrespective of clarithromycin susceptibility
Background Helicobacter pylori causes peptic ulcers and accounts for over 90% of gastric cancers; however, eradication rates have been declining due to antimicrobial resistance. Vonoprazan (VPZ), a potassium-competitive acid blocker, produces rapid and profound gastric acid suppression and has shown...
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Published in: | Journal of gastroenterology 2020-11, Vol.55 (11), p.1054-1061 |
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Main Authors: | , , , , , , , , , , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
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Summary: | Background
Helicobacter pylori
causes peptic ulcers and accounts for over 90% of gastric cancers; however, eradication rates have been declining due to antimicrobial resistance. Vonoprazan (VPZ), a potassium-competitive acid blocker, produces rapid and profound gastric acid suppression and has shown promising effects in the improvement of
H. pylori
eradication rates. The efficacy and safety of VPZ-based triple therapy as a first-line regimen for
H. pylori
eradication and its relationship with clarithromycin (CAM) susceptibility were evaluated.
Methods
From May 2015 to September 2017,
H. pylori
-infected patients who underwent esophagogastroduodenoscopy with CAM susceptibility testing were prospectively enrolled. Patients received a 7-day triple therapy regimen (VAC) of VPZ (20 mg), amoxicillin (750 mg), and CAM (200 mg) twice daily. Eradication rates, demographics, CAM susceptibility, and safety profiles were assessed.
Results
VAC was administered to 146 patients (median age: 63, range: 22–85 years) (60% of whom were females) who underwent CAM susceptibility testing, and 131 patients underwent
13
C-urea breath testing to evaluate eradication success. The prevalence of CAM resistance was 34.2%. The overall eradication rates of VAC in per protocol (PP) and “intention to treat” (ITT) analyses were 90.8% (
n
= 131) and 81.5% (
n
= 146), respectively. In PP analysis for CAM susceptibility, the eradication rates of VAC were comparable between CAM-sensitive (91.6%,
n
= 83) and CAM-resistant (89.4%,
n
= 47) strains. The corresponding rates from the ITT analysis were 80.0% (
n
= 95) and 84.0% (
n
= 50), respectively. No adverse events requiring discontinuation of VAC were observed.
Conclusions
CAM-resistant
H. pylori
was prevalent in one-third of patients in the Tokyo metropolitan area. VPZ-based triple therapy was highly effective and well-tolerated irrespective of CAM susceptibility. Therefore, it could be a valuable first-line treatment regimen for
H. pylori
infection. |
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ISSN: | 0944-1174 1435-5922 |
DOI: | 10.1007/s00535-020-01723-6 |