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Tailored treatment yielded higher H. pylori eradication rate
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CHICAGO — A tailored treatment regimen based on susceptibility to clarithromycin resulted in a higher eradication rate than standard treatment for Helicobacter pylori, according to data presented here at Digestive Disease Week.
“In Japan, there has been a decrease in the eradication rate because of clarithromycin resistance and insufficient acid inhibition during treatment,” Mitsushige Sugimoto, MD, of Hamamatsu University School of Medicine in Japan, said during his presentation. “Clarithromycin susceptibility-based tailored H. pylori eradication treatment with 10 mg rabeprazole four times a day is effective for all patients.”
The researchers compared the efficacy of the standard treatment strategies with treatment strategies tailored for clarithromycin susceptibility. For first-line therapy, the standard treatment was a proton pump inhibitor (PPI) twice daily, 750 mg amoxicillin twice daily and 200 mg clarithromycin twice daily. For second-line therapy, the standard treatment substituted 250 mg metronidazole twice daily for clarithromycin.
For the tailored treatment, patients with clarithromycin-sensitive H. pylori received 10 mg rabeprazole four times a day, 500 mg amoxicillin four times a day and 200 mg clarithromycin twice a day. Those with clarithromycin-resistant H. pylori received 250 mg metronidazole twice a day in place of the clarithromycin.
In the intention-to-treat analysis, the eradication rate among patients receiving tailored treatment was 96.7% vs. 79.6% for the standard treatment. Among those receiving tailored treatment, the eradication rates were similar for both the clarithromycin-based treatment and the metronidazole-based treatment.
Among patients in the tailored group, the eradication rates exceeded 90% across all CYP2C19 genotypes. In the standard treatment group, the eradication rates differed across genotypes, ranging from 75.7% for rapid metabolizers, 81.7% for intermediate metabolizers and 87% for poor metabolizers.
“Four times daily dosing of rabeprazole 10 mg achieved potent acid inhibition for 24 hours in CYP2C19 [rapid metabolizers], suggesting its potential efficacy in patients refractory to PPI therapeutic regimens and H. pylori eradication therapy,” Sugimoto said.
For more information:
Sugimoto M. #567. Presented at: Digestive Disease Week 2014; May 3-6, 2014; Chicago.
Disclosure: Sugimoto reports no relevant financial disclosures.