Open AccessRandomized controlled study on the effects of triple therapy including vonoprazan or rabeprazole for the second-line treatment of Helicobacter pylori infection
Author(s) -
Mariko Hojo,
Daisuke Asaoka,
Tsutomu Takeda,
Yuji Shimada,
Kenshi Matsumoto,
Keīichi Matsumoto,
Noboru Yatagai,
Yoichi Akazawa,
Kazuki Ueda,
Hiroya Ueyama,
Akihito Nagahara
Publication year - 2020
Publication title -
therapeutic advances in gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.278
H-Index - 51
eISSN - 1756-2848
pISSN - 1756-283X
DOI - 10.1177/1756284820966247
Subject(s) - rabeprazole , medicine , helicobacter pylori , gastroenterology , breath test , proton pump inhibitor , amoxicillin , metronidazole , urea breath test , omeprazole , randomized controlled trial , confidence interval , intention to treat analysis , helicobacter pylori infection , antibiotics , microbiology and biotechnology , biology
Background and Aim: Inhibition of gastric acid secretion is important for eradicating Helicobacter pylori. Vonoprazan (VPZ) is a strong, long-lasting inhibitor of gastric acid secretion. Studies that examined the effectiveness of VPZ-based triple therapy in second-line treatment have been performed. However, there have been no randomized controlled studies to compare the effect between VPZ-based triple therapy and proton pump inhibitor (PPI)-based triple therapy in second-line treatment, and it is not known which is more effective between VPZ-based and PPI-based therapies. This study aimed to compare the effectiveness of second-line triple therapies including VPZ or rabeprazole (RPZ) as the PPI.Methods: Eligible patients with H. pylori infection who failed first-line triple therapy were assigned randomly to the VPZ [VPZ40 mg/day, amoxicillin (AMPC) 1500 mg/day, metronidazole (MNZ) 500 mg/day] or RPZ (RPZ20 mg/day, AMPC1500 mg/day, MNZ500 mg/day) group. A 13 C-urea breath test result of less than 2.5% was considered as successful eradication.Results: In total, 46 and 41 patients were analyzed as intention to treat (ITT) and per protocol (PP), respectively. Eradication rates in the VPZ and RPZ groups were 73.9% [95% confidence interval (CI) 51.6–89.8%] and 82.6% (95% CI 61.2–95.0%) based on ITT analysis, respectively ( p = 0.72). Based on PP analysis, the eradication rates in the VPZ and RPZ groups were 89.5% (95% CI 66.9–98.7%) and 86.4% (95% CI 65.1–97.1%), respectively ( p = 1.00). Two patients in the VPZ group and one in the RPZ group discontinued treatment due to side effects ( p = 1.00).Conclusion: There were no significant differences in efficacy and safety between second-line therapies including VPZ or RPZ.