Efficacy of triple therapy with rabeprazole for Helicobacter pylori infection and CYP2C19 genetic polymorphism

• Published in: Alimentary pharmacology & therapeutics 2001-09, Vol.15 (9), p.1479-1484
• Main Authors: Hokari, K., Sugiyama, T., Kato, M., Saito, M., Miyagishima, T., Kudo, M., Nishikawa, K., Ishizuka, J., Komatsu, Y., Mizushima, T., Kagaya, H., Hige, S., Takeda, H., Asaka, M.
• Format: Article
• Language: English
• Subjects: 2-Pyridinylmethylsulfinylbenzimidazoles; Amoxicillin - administration & dosage; Amoxicillin - therapeutic use; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - therapeutic use; Anti-Ulcer Agents - administration & dosage; Anti-Ulcer Agents - metabolism; Anti-Ulcer Agents - therapeutic use; Aryl Hydrocarbon Hydroxylases; Benzimidazoles - administration & dosage; Benzimidazoles - metabolism; Benzimidazoles - therapeutic use; Biological and medical sciences; Clarithromycin - administration & dosage; Clarithromycin - therapeutic use; Cytochrome P-450 CYP2C19; Cytochrome P-450 Enzyme System - genetics; Digestive system; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Genotype; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Male; Medical sciences; Middle Aged; Mixed Function Oxygenases - genetics; Omeprazole - analogs & derivatives; Pharmacology. Drug treatments; Polymerase Chain Reaction; Polymorphism, Genetic; Polymorphism, Restriction Fragment Length; Proton Pump Inhibitors; Rabeprazole; Stomach Ulcer - drug therapy
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1046/j.1365-2036.2001.01063.x

Background: Rabeprazole is a new, potent, proton pump inhibitor. The metabolism of rabeprazole is less dependent on CYP2C19 genetic polymorphism. Methods: A total of 102 Helicobacter pylori‐positive patients with gastric ulcer were randomly allocated to three groups: rabeprazole 10 mg (RAC10), rabeprazole 20 mg (RAC20) or rabeprazole 40 mg (RAC40) plus amoxicillin 750 mg and clarithromycin 200 mg twice daily for 7 days. CYP2C19 genotype was determined by the polymerase chain reaction‐restriction fragment length polymorphism method. Results: All‐patients‐treated‐based eradication rates in patients treated with RAC10, RAC20 and RAC40 were 83%, 77% and 90%, respectively, and per protocol‐based eradication rates were 83%, 80% and 90%, respectively. The eradication rates in the three groups were not significantly different. There was also no significant difference between the all‐patients‐treated‐based eradication rate in CYP2C19 extensive metabolizers and that in poor metabolizers (86% vs. 77%). Adverse events were 12% in extensive metabolizers and 23% in poor metabolizers, and the difference in these incidence rates was also not statistically significant. Conclusions: Triple therapy with 10 mg of rabeprazole combined with amoxicillin/clarithromycin is effective for Japanese patients with H. pylori infection, and the H. pylori eradication rate is not affected by CYP2C19 genetic polymorphism.